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Ethical Decision-Making
What is Ethics?
Ethics is the formal process of intentionally and
critically analyzing, with respect to clarity and
consistency, the basis for one’s moral
judgments.
 Ethical reasoning is necessary to resolve the
potential conflicts between personal values
and professional values.
 Ethical decision making requires everyone to
consider the perspectives of others, even
when they have different values.
Addressing Ethical Issues
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Many people may want to answer questions of professional
ethics according to their own personal morality.
However, resolving conflict depends on the more formal
mechanism of ethics.
Most of the time people do not make a distinction between
morality and ethics, however, there is a difference.
 Morality refers to your own personal moral choices.
 Ethics refers to the formal process of intentionally and
critically analyzing the basis for your moral judgments for
clarity and consistency and considering other’s views.
 HIA professionals must go beyond the right or wrong moral
perspective and evaluate the many values and perspectives
of others who are engaged in the decision to be made.
Addressing Ethical Issues (cont.)
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People need ethics to help resolve conflict
 Ethics provides a formal way to step back from the conflict.
 Important because you are held accountable for your
actions as a professional
 Patients do not know your personal moral values, but
they have expectations of your professional conduct
(e.g.- the ethical dilemma of the pharmacist who will not
dispense “morning after” pill).
 They expect you to be able to act professionally.
 Ethics helps search for reasons to support once choice over
the other.
 Ethics helps apply this reasoning in future situations.
Addressing Ethical Issues (cont.)
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Consider the opinion of others
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Individuals as professionals
Three components of an Ethics
Curriculum
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Knowledge: The HIM professional needs to
be aware of the standards set forth in the
professional Code of Ethics.
Development: The moral maturity of the
HIM professional needs to be nurtured and
reinforced so that it can be applied in
professional settings.
Skills: HIM professionals need practice in
identifying ethical issues and applying a
process of ethical decision making to ethical
issues that arise in the practice of HIM (e.g.
ROI, Coding, QM,etc.).
Seven Steps in Ethical
Decision Making
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Step 1: Identify the ethical
question (i.e.- what is the ethical
question?).
 Look for the “shoulds”- normative
questions about what ought to happen
according to norms and standards.
The Process of Ethical
Decision Making
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Step 2: What are the facts? (good
ethics begins with good facts)
 Known facts
 Facts to be Gathered
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It is always tempting to avoid ethical
discussion by claiming that there are not
enough facts to make the decision.
The Process of Ethical
Decision Making
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Step 3: What is the perspective of
all stakeholders (i.e.- values at stake)?
A stakeholder is someone who will be affected by the
decision to be made
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The patient: values accurate medical record that will be
the basis of quality care.
The HIM Professional: integrity is at stake if the
professional is willing to violate core values for the sake of
reimbursement
Other health care professionals: obligations to promote
welfare of patients (accurate medical records)
Hospital Administrators: Should optimize reimbursement
without compromising truth-telling.
Society: People pay for health care and want costs
The Process of Ethical
Decision Making
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Step 4: What are the options in
the case?
 Determine possible actions or
strategies, alternatives, choices…
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Seek more information
The Process of Ethical
Decision Making
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Step 5: What should I do?
- Consider the best option based on
core values
- Seek more information: base your
choice on the best available data
The Process of Ethical
Decision Making
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Step 6: What justifies your choice?
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Provide reasons to support choice based
on the values at stake
The Process of Ethical
Decision Making
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Step 7: How could this ethical
problem have been prevented?
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Are there any systematic changes that
could have been made to prevent the
problem from happening again?
Recap of Seven Steps in Ethical
Decision Making
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1. Identify the ethical question
2. Determine the facts in the case
3. Determine what values are at stake from
the perspectives of all stakeholders
4. Identify the available options in the case
5. Determine what you should do
6. Justify your choice
7. Explore how this ethical problem might
have been prevented
Justification in Ethical Reasoning:
How do you know what is best?
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Most difficult aspect of ethics is deciding
what you think is the best course of
action and providing good reasons to
support your choice.
What choices are better or worse? How
do you justify your actions?
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Ethical reasoning: apply ethical theories,
and approaches.
Two (2) Classical Theories
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1. Utilitarian Theories
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Jeremy Bentham and John Stuart Mill
Considers the consequences of an action (or failure to
take action) in terms of how the action promotes happiness
Actions are right to the extent that they tend to
promote happiness and wrong to the extent that they
tend to promote the reverse of happiness
Judges the rightness and wrongness of an action by its
consequences
Advantages
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Simplicity: only one thing needs to be considered - happiness
Two (2) Classical Theories
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2. Deontological Theories
Theories are based on the calculation of duties
rather than the consequences
Considers whether it is one’s duty to perform
or not perform an action
Immanuel Kant (famous deontological moral
theorist)- If you want to know a proposed action
is morally acceptable, the right question is not
“What are the consequences?” but “Can I, as a
rational person, consistently will that everyone in
a similar situation should act in the same way?”
Deontological Theories
(cont.)
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Advantages
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in that it supports common moral intuitions
Disadvantages
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Inability to decide among duties when they
conflict
Inability to take some considerations of the
consequences
Seems important to break a promise if it will
save them from severe harm
Applications of More Than One
Theory
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Many philosophers have come to doubt
that there can only be one correct theory
Many philosophers believe we should use
them as a guide
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Partial contributions to a comprehensive,
although necessarily fragmented, moral vision
Utilitarianism examines consequences
Deontological analyzes the duties involved, the
duty to tell the truth, and the accuracy and
integrity of the medical record
Four (4) Current Ethical
Approaches
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# 1. Principle-based Analysis
Four core ethical principles
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Beauchamp and Childress’s Principles of
Biomedical Ethics (1994)
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Respect for autonomy (means self-determination)
Nonmaleficence (not harming others)
Beneficence (promoting good)
Justice (treating others fairly)
# 1. Principle-based Analysis
(cont.)
-- Principles are helpful in understanding
ethical issues in professional practice and
drafting policies regarding ethical issues.
-- Strong reliance on rules and duties and
dealing with patients and other strangers
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More important to avoid harm than it is
to promote good
# 2. Analysis of Rights
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Based on the consideration of whether an
action affirms or violates human rights
Moral Discussion, especially in the U.S., occurs
using the language of rights
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A right is an especially powerful moral claim that
others are obligated to respect
In health care scholars debate a right to
die, a right to life, and a right to health
care
Analysis of Rights (cont.)
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Advantage
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Rights-based approaches are simple to apply
Disadvantage
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People disagree about which claims are
determined “basic human rights”
Causes much debate: some people believe
there is a certain right to choice and another
party believes that there is a certain right to life
# 3. Ethics of Care
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Based on what action best supports the
relationships of the parties involved
Emphasize the importance of focusing on the
patient and the professional in context of his or
her relationships
Considers the emotional commitment and
willingness of individuals in relationships to act
unselfishly for the benefit of others
Values sympathy, compassion, fidelity,
discernment, and love
Has lack of a well developed basis for
providing justification for courses
# 4. Virtue Based Ethics
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Emphasizes how the action expresses and
shapes the character of the person who
performs it
Closely associated with ethics of care
A virtue is a habit of behavior in a good way
Emphasizes the agents who perform actions and
make choices
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What would the good HIM professional do?
It looks at feelings, motivations, duties, and not
only actions but at character as well
When confronted with an ethical
dilemma ……
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1. Talk with trusted colleagues and get advice.
2. Approach the problem through the proper
channels and document your efforts.
3. Frame issues for the institution in terms of shared
values and the AHIMA Code of Ethics.
4. Appeal to professional sources as necessary.
5. Address the issue in some way rather than letting
it go on unaddressed.
Apply 7 steps of ethical decision making.
Justify ethical reasoning through theories and
approaches.