discussion board replies – masters level responses
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. Compare and contrast the legal and ethical issues of your area of practice with those explored by other students. Each reply must be supported by 4 scholarly sources, including the textbook chapter and the Bible, cited in current APA format
Replies must be more than 450 words each
not including references in word count
Due to the fact that I am currently pursuing a degree in Healthcare Administration, all chapters included in this module relate in some way or another to the area I aspire to practice in. Given that I worked as a pharmacy technician in a hospital pharmacy in the past, I can more easily recognize ethical challenges that arise within this type of setting. I will thus select chapter 12 as the topic for my discussion.
Ever since I started this course, ethics and especially medical ethics have been occupying my mind quite a bit. Despite an awareness of the human sinful nature and our evil tendencies I think I possess, it is astonishing to be reminded of the human ability to intentionally cause harm to others. This is simply a confirmation of our brokenness but I cannot help feeling despair and helplessness when thinking of how much harm is done to others. I do not think that we always intend to harm others. Just as in cases of negligence when harm can be brought about through omission or commission of an act, so can we unintentionally hurt others when we choose to look the other way. Not doing something can be just as detrimental as actually doing something but I, at least, often excuse myself from holding myself accountable for those actions I should have performed but did not. This is similar to what the apostle Paul was confessing in Romans 7:19: “I do not do the good that I want to do, but I practice the evil that I do not want to do.” As Christians, we follow God’s moral code but cannot expect a society who is slowly removing God from its layers to follow the same precepts as we do. Ethical principles are more often than not determined by a society who killed God, as Nietzsche once said, so it is no wonder that life is no longer considered sacred or that man is no longer believed to have been created in God’s image. As followers or Christ, we are to put others above ourselves and look “to the interests of others” (Philippians 2:4). Engster (2014) is more pragmatic than Apostle Paul and, in his article, states that we should look to the interests of others because we may need a similar service at a later time in the future. As Christians, once more, we are called to a higher moral standard and to obey and please God through our behavior: “and do not forget to do good and to share with others, for with such sacrifices God is pleased” (Hebrews 13:16).
Ethical dilemmas are often discussed with more vehemence when they are “high drama and low incidence (Cooper et al., 2007, p. 92) but opportunities to choose to do the right thing arise routinely not only for health care professionals but for other professions as well. One can cause harm to another through omission, commission or simple ignorance (which is not excusable at all). We often classify what we do in terms of the impact it may have on others. Performing abortion, for instance, is usually considered as being more evil than performing improper hand hygiene, or the lack of it. Serious infections that can cause death especially in immunosuppressed patients, however, can be developed because health care professionals fail to abide by the infection control policies. I believe it is critical to put into perspective each action, consider the implications associated with an action, and commit to doing the right thing even when a particular action is erroneously rated lower on the “harmful actions” scale.
The law, policies and procedures are meant to provide a framework for doing the right thing. Even though some ethical principles are embedded in the law, individuals must also commit to abiding by the law when no one is present to witness what is being done. In pharmacy, aseptic techniques should be strictly enforced in areas where compounding is performed. There are many policies and procedures in place that can guide one in doing the right thing but these can be easily overlooked. To avoid infection and/or compromise compounded products, there is a certain method of washing one’s hands when ready to enter an admixture room; an established order of donning and doffing personal protective equipment; certain products that must be used when cleaning admixture hoods and how often cleaning must be completed; negative or positive pressure rooms depending what type of products are mixed; appropriately trained cleaning personnel, and so on. One might argue that these are indeed important but that mixing the right product trumps the items listed above. As I mentioned in the previous paragraph, one must put into perspective what an action can lead to. Skipping any of the steps necessary to ensure uncompromised products can lead to spreading infection to patients and can have serious health consequences.
Most pharmacy technician work is done independently and verified by a pharmacist when complete. At the time I left my technician life behind, there were many steps involved in getting a medication ready. I still remember the frustration we all felt when these extra steps were implemented because it slowed down one significantly. To mix a medication, multiple scans were required: scanning the printed label to match the scanned medication vial and solution bag (weighing the amount of mixed medication to ensure proper dosage was used was talked about as well but I am unsure whether that was implemented). One would think that no errors should ever happen with such strategies in place. However, in a worst case scenario, a technician could easily discard the drug in a waste container and infuse other solutions if she has evil intentions. Additionally, some drugs are extremely expensive and sometimes hard to manipulate. These drugs are usually closely monitored. I have made mistakes in the past where, due to a technique error, I lost or had to discard a certain drug that was extremely expensive. Fearing discipline or reprimand, one can easily pretend that the drug was mixed when in fact it was discarded. In a similar way, not mixing the required dose can be detrimental to a patient’s treatment plan as critical medications are usually calculated to meet specific patient needs.
One of the most notable pharmacy related fraud cases was the one implicating Robert Courtney, a Kansas pharmacist who provided multiple oncology patients with improper doses of prescribed chemotherapy medication (Simon, 2001). Courtney did so for financial gains as chemotherapy drugs can reach very high prices. Chemotherapy drugs, however, are more closely monitored that other drugs both at the pharmacy level and also at the sales level. More than other medications, the dosages for chemotherapy drugs are carefully calculated and evaluated on a regular basis (at the pharmacy I worked at, dosages were calculated daily and verified by at least two oncology pharmacists before accepted). Given that the patients who were administered drugs from Courtney’s pharmacy presented no increased side effects, which include hair loss, nausea, etc., an investigation was launched. When Courtney’s actions were uncovered, he was incarcerated, had all his assets sold and had fines that reached millions of dollars (Simon, 2001). It is unquestionable that Courtney’s actions were unethical and that lives were lost due to his unethical behavior. This is one of those cases referred to by Cooper et al. (2007) as “high drama and low incidence” but I do not think the level of gravity when speaking of consequences of an action should be a qualifier for what counts as ethical or unethical. Perceived small actions can have a significant impact on others and opportunities to perform such actions are more often encountered. Within this context, I am reminded of Luke 16:20: “whoever can be trusted with very little can also be trusted with much, and whoever is dishonest with very little will also be dishonest with much.” My prayer is that we, as Christians, will weigh our decisions more carefully for the wellbeing of others but also to honor God.
Cooper, R. J., Bissell, P., & Wingfield, J. (2007). A new prescription for empirical ethics research in pharmacy: a critical review of the literature. Journal of Medical Ethics; London, 33(2), 82. http://dx.doi.org.ezproxy.liberty.edu/10.1136/jme.2005.015297
Engster, D. (2014). The social determinants of health, care ethics and just health care. Contemporary Political Theory; London, 13(2), 149–167. http://dx.doi.org.ezproxy.liberty.edu/10.1057/cpt.2013.14
Kälvemark Sporrong, S., Arnetz, B., Hansson, M. G., Westerholm, P., & Höglund, A. T. (2007). Developing Ethical Competence in Health Care Organizations. Nursing Ethics; London, 14(6), 825–837. http://dx.doi.org.ezproxy.liberty.edu/10.1177/0969733007082142
Pozgar, G. D., & Santucci, N. M. (2019). Legal aspects of health care administration (13th edition). Burlington, MA: Jones & Bartlett Learning
Simon, S. (2001, September 3). THE NATION; Painful Uncertainty for Cancer Patients; Crime: Doubt haunts those who may have received diluted drugs from a Missouri pharmacist caught in a sting last month.: [Home Edition]. Los Angeles Times; Los Angeles, Calif., p. A.1.
Health care administration involves many diverse elements that function together to provide health care delivery through hospitals, clinics, and physician’s offices to name a few. Just as this career field is comprised of such diverse elements, the field of study lends itself to different focuses as well. Managing the human capital as it relates to the hiring, training, and termination of employment is the job and focus of the human resources division of health care administration. While this class has focused on the legal and ethical issues that plague the health care delivery system from the clinical perspective, it is essential to also mention the issues that occur within health care administration specifically as it relates to human resources. There are certain issues that occur within human resources that are not specific to an industry. For example, discrimination and sexual harassment are legal and ethical problems that happen within human resources of many different industries. It is the job of any human resource management team or department to not only ensure the hiring of competent employees, but also to provide relevant training that keeps the staff current on hospital related policies and procedures as well as to ensure that the staff has an understanding of federal and state policies and regulations that would impact their job and performance. The human resource management department’s role in minimizing the amount of legal and ethical repercussions being brought against the organization includes ensuring to all hiring and labor laws are adhered to during the hiring process, completing a thorough background check to be aware of the risks associated with hiring potential employees, and providing accurate training to all employees so that they aware of the actions prohibited legally and ethically within their position. In brief, this paper will acknowledge the legal and ethical issues that impact the human resource departments both in health care and those that are not industry specific. Upon recognition of these issues, advice will be provided on how to be proactive and avoid these issues when possible.
The credentialing committee ensures that clinicians have access to the privileges necessary to complete their job effectively by overseeing the application process that allows clinicians to gain and maintain those privileges (Pozgar, 2017). Much like the human resource department, this committee must conduct a thorough investigation of each applicant prior to allowing them access to clinical privileges. It is the job of this committee to protect the organization from corporate liability by ensuring that those that have access to clinical privileges are not clinicians that would put the organization at risk and that they have not had questionable behavior in the past. This committee has access to multiple resources such as the National Practitioner Data Bank as well as professional references from each applicant that provide insight into the information necessary to make a knowledgeable decision. Not all physicians receive the same privileges. Privileges are often based on job necessity as well as prior performance. A potential issue that could arise is that physicians will argue that they should have certain privileges that have not been granted, or they will argue that privileges have been delineated unfairly. The way to avoid this issue proactively is to have transparency as it relates to the delineation of clinical privileges. Ensure that the clinician is aware of the process and prevent any bias or conflict of interest from occurring during the process. Overall, the process of thoroughly investigating employees before allowing them certain accesses and privileges within the organization is an experience shared by the credentialing committee as well as those working within human resource management. Both sectors have the responsibility of protecting the organization from liability by ensuring that those brought on board provide minimal risk to the organization.
Ramadevi, Gunasekaran, Roy, Rai, and Senthilkumar (2016) associated patient outcomes to employee knowledge, skills, and abilities. It is the responsibility of the human resources department to hire competent individuals that have the acquired knowledge to effectively complete the duties of the job, and it is also the responsibility of the human resources department to provide continuing educational opportunities to ensure that the employees stay abreast to current policies procedures and information regarding their position. Because of the association involved with employee training and patient outcomes, it is essential that the human resource department protect the organization from liability risk by not only investing who is being hired, which is mentioned in the paragraph above, but also by providing opportunities for continuous education. Sample (2013) shared that human resources department has started implementing training for the sole purpose of limiting the risk of the legal consequences associated with lack of training. It has become imperative to ensure that all staff and employees have knowledge necessary to complete their jobs. Not only does lack of training have its legal ramifications, in Hosea 4:6 the biblical ramifications of the lack of knowledge is revealed. The scripture said, “My people are destroyed for lack of knowledge, because you have rejected knowledge, I will also reject you from being my priest. Since you have forgotten the law of your God, I will also forget your children” (AMP). This scripture not only highlights the need for knowledge, information, and training, but it also speaks to those in authority that are actively rejecting knowledge. The rejection of knowledge both biblically and practically prevents one from fully laying hold to what is necessary to fulfill their role.
The final human resource issue to be addressed is discrimination. Unfortunately, though it has been addressed through literature, training, and regulations, this issue continues to reveal itself in multiple organizations. There are multiple reasons that an employee can be discriminated against that include but are not limited to race, gender, disability, and/or religious beliefs. It is the job of the human resources department to ensure that the organization is protected from any claims of discrimination particularly as it relates to the hiring and managing of any of its employees. One proactive way to provide this protection is to ensure that managers are aware of policies and procedures that address certain things like disabilities. Martin, Woods, and Dawkins (2018) shared that as it relates to managing employees with disabilities managers need clarity on how to identify and implement appropriate work accommodations. The lack of clarity as to those policies that address such things as workplace accommodations leaves the organization open to the risk of discrimination be it intentional or not. Another proactive way to protect the organization is through maintenance of accurate paperwork on all employees. An organization leaves itself at risk when disciplinary actions are taken against and employee and there is no proof that these actions are justified. “Building a written file against employees and documenting complaints and problems with employees is a best practice” (Talesh, 2015, p. 230).
Overall, legal and ethical issues occur for those working in human resources from onboarding to training and discipline; however, the best way to protect the organization is to provide investigation, be intentional through both training and discipline, and always keep a paper trail.
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Martin, A., Woods, M., & Dawkins, S. (2018). How managers experience situations involving employee mental ill-health. International Journal of Workplace Health Management, 11(6), 442-463. doi:10.1108/IJWHM-09-2017-0069
Pozgar, G. D., & R2 Library (Online service). (2016). Legal and ethical issues for health professionals (Fourth ed.). Burlington, MA: Jones & Bartlett Learning.
Ramadevi, D., Gunasekaran, A., Roy, M., Rai, B. K., & Senthilkumar, S. A. (2016). Human resource management in a healthcare environment: Framework and case study. Industrial and Commercial Training, 48(8), 387-393. doi:10.1108/ICT-03-2016-0014
Sample, J. (2013). Legal liability and the OD practitioner. Organization Development Journal, 31(4), 15.
Talesh, S. (2015). Legal intermediaries: How insurance companies construct the meaning of compliance with antidiscrimination laws. Law & Policy, 37(3), 209-239. doi:10.1111/lapo.12037