Online Course
NURS 692 Administration of Nursing and Health Care Services
Module 10: The Ethical & Legal Environment and Labor Relations
Ethical Health Care Issues
Which issues impact hospital administrators and clinical leaders the most? Healthcare Briefings spoke to a panel of experts to get their view of the top ethical challenges in healthcare that are facing today’s leaders:
1. Balancing care quality and efficiency
Many of the challenges facing the healthcare system in the future will be related to the overall challenge of balancing quality and safety with efficiency, said Cynda Hylton Rushton PhD, RN, the new Anne and George L. Bunting Professor of Clinical Ethics at Johns Hopkins University. “It raises a real question about whether the right values are driving our focus in our healthcare system,” she said. “Should efficiency be the driver?”
2. Improving access to care
Gerard Magill, PhD, professor with the Center for Healthcare Ethics at Duquesne University, notes that there are still questions about the implementation of the healthcare reform law, as well as Medicaid expansion efforts in the states. Most ethicists believe that access to basic care is a hallmark of a civilized society, he said, and if many people still do not have access, “that is a problem.”
3. Building and sustaining the healthcare workforce of the future
As the baby boomer generation continues to age, more healthcare professionals will be needed to take care of this population--to manage chronic illnesses, coordinate care and provide many other services. But will there be enough competent, compassionate people who not only enter the healthcare workforce but remain in it to provide that care?
Despite a recent influx of younger people into the nursing profession, for instance, many experts are forecasting a resurgence of the nursing shortage by the end of this decade--just when more nurses will be needed.
“This is not just a supply issue,” said Rushton. “This is a sustainability issue. And one of the real threats to keeping the people we train in practice is having an ethical practice environment where they can actually practice with integrity, and where they are not constantly barraged with morally distressing situations that burn them out.”
4. Addressing end-of-life issues
Nancy Berlinger, PhD, a research scholar with the Hastings Center, noted that end-of-life issues will also grow in importance as the population ages. The entire decision-making process, as well as the financing that pays for end-of-life care, will be up for discussion as these issues affect more people. But that is the reward for the great leaps in life expectancy that were achieved in the 20th century, she said.
“This is the ‘other shoe’ in the 21st century, the consequences of people living into their 90s,” she said.
5. Allocating limited medications and donor organs
Will there be enough critical medications available to meet people’s needs in the future, and if not, what can be done about it? How will organs be allocated in the future, when they are often in short supply? Medication shortages often happen because there’s not enough economic incentive for manufacturers. For example, certain intravenous medications that are generics tend to be the ones that become scarce because there’s not much profit in making them. Although some advances have been made to encourage the reporting of drug shortages in an effort to reduce them, the Food and Drug Administration still expects drug shortages to occur in the future.
One of the bigger problem is the ongoing shortage of donor organs. There are just not enough livers or deceased donor organs to meet the need. Here is where continued research, as well as more donations, would help.
For more on health care ethics:
System Overload: Pondering the Ethics of America’s Health Care System
Ethical Decision Making for Healthcare Executives
Ethical Riddles in HIV Research (Ted Talks Video)
What Really Matters at the End of Life? (Ted Talks Video)
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