SECTION 19 1 190D. South Carolina Unanticipated Medical Outcome Reconciliation Act In any claim or civil action brought by or on behalf of a patient allegedly experiencing an unanticipated outcome of medical care, any and all statements, affirmations, gestures, activities, or conduct expressing benevolence, regret, apology, sympathy, commiseration, condolence, compassion, mistake, error, or a general sense of benevolence which are made by a health care provider, an employee or agent of a health care provider, or by a health care institution to the patient, a relative of the patient, or a representative of the patient and which are made during a designated meeting to discuss the unanticipated outcome shall be inadmissible as evidence and shall not constitute an admission of liability or an admission against interest.
Ethics Ethics is the discipline that considers how human beings ought to behave to achieve certain goals. what is the goal? what behavior will reach it? Ethical problem occurs when: several plausible actions available unclear: which most likely to achieve goal.
Solution to a Problem Science single goal single standard of truth goal a standard a Ethics goal b standard b goal c standard c goal d standard d
Solution to a Problem Science single goal The single good standard of the patient of truth goal a The good of the hospital standard a Ethics goal b goal c goal d The good standard of b science standard c The good of society standard d
Solution to a Problem Science What s right is the greatest good single for goal the greatest number single standard of truth goal a What s right is intuitively self-evident Ethics goal b What s right is what serves social justice goal c What s right is what Jesus, or Mohammed, or Buddha, or says goal d standard a standard b standard c standard d
Solutions to Ethical Problems Not simple Ethics not like science Is ethics arbitrary? Or Can we discover an ethic for medicine?
Where Does Ethics Come From? Tradition That s the way it s always been. Authority That s the way I was taught to do it. Reason That s the way reality determines we ought to behave.
Solutions to Ethical Problems Ethics not like science Not simple Is ethics arbitrary? Or can we discover an ethic for medicine?
Ethics Virtues Values Flourishing life Basic template for professions: identify distinguishing characteristic rank virtues for particular profession define professional excellence
Medical Ethics Virtues Good of the patient Excellent physician biological-medical good self-understood good
Distinguishing Characteristic The overarching need for TRUST Successful treatment of patients requires physicians have access to: intimate details of personal history intimate access to the body itself Intimacy greater than anyone else, including minister, lawyer, spouse. The fundamental need for intimacy requires that physicians be trustworthy, serving pts interests before their own.
Virtues Serving the Good of Patients Biological-medical good scientific objectivity competence (medical/technical) integrity in using knowledge/skills Patient s perception of own good respect for patients self-determination (autonomy) honesty in disclosure compassion for patients humanity beneficence in supporting patients goals
Lawsuit Reality Injury Error
2006 Annual Report Queries: 42,649,602 Med Mal Payment Reports: 15,843 Adverse Action Reports (State licensure, clinical privileges, professional society, membership, exclusions, and DEA actions): 7,044 South Carolina: Med Mal Payment Reports: 2,398/242,818 Adverse Action Reports: 802/65,991
CEJA Why should anyone care about AMA s Code of Medical Ethics? largest, most diverse medical society ethics policy 160 yrs old, continually updated most comprehensive code The Code used by state licensing boards (behavioral standards) courts (guidance in making decisions) In effect, the Code sets ethical standards for medical profession.
2006-2007 Ed: 399 pp 10 Sections 190 Opinions Annotations (articles, court cases); 0-20 pp Un-annotated June 08 (free for medical students!)
CEJA Function What CEJA does: develops ethics policy for AMA (guidelines for physicians) meets 5-6x per year (3 d), 2-3 teleconf writes reports with recommendations many published, peer-rvw j: 21 (my tenure) recommendations Opinions in Code Code published q 2 y judicial function (C&B, membership)
Discipline for Ethical Misconduct CEJA empowered to sanction AMA members for Code violations admonishment, censure, probation, suspension, expulsion (NPDB) 200-250 cases reviewed each year 30-35 actions against membership
Society of Thoracic Surgeons Standards and Ethics Committee Code of Ethics Policy for ethics violations Since 2005: 12 complaints, 8 sanctions
Patient Safety Policy Goal: ensure pt safety Process: provide safe, protected reporting mechanism; investigate, analyze, proced to prevent errors convey conclusions to all relevant participants to optimize learning experience for all caregivers report errors to pts/families identify/report colleagues who endanger pts to facilitate their retraining, rehab, discipline
AMA Code Med Ethics, Opinion 9.031 Reporting Impaired, Incompetent, or Unethical Colleagues
Physicians with Disruptive Behavior Verbal/phys conduct, neg affects pt care, should be reported to: in-house impaired MD program chief clinical service, chief hosp staff Medical staff should have policies that: clearly state stdrds of care, professnl envir describe behaviors that warrant intervention provide reporting channels (protect reporters) estab review and verific proc, due process specify corrective actions, monitoring, cnfdntiality Aim retrain, rehab, restrict practice AMA Code Med Ethics, Opinion 9.045 Physicians with. Disruptive Behavior
HC Error Bottom Line First obligation: ensure pt safety Cooperate w safety/error reporting policies safe/secure reporting, study, prevention of errors optimize learning experience for all caregivers Report errors to pts/families w honesty,compassion Advise/report colleagues who endanger pts