Ethical and Legal Issues in Diagnosis

There are certainly some potential issues that need to be addressed when balancing desires of managed care and the ethical diagnosis and treatment of individuals entrusted to our care.  First among my concerns are situations where an individual is in obvious need of treatment but the necessary treatment falls outside of managed care coverage.  This may occur because they do not fit the standard illness category or because treatment recommendations fall outside of what the managed care organization deems the best course of action.  “Many insurance carriers will not pay for treatment that is not defined as an ‘illness’ for which treatment is medically necessary.”  (Corey, Schneider-Corey, & Callanan, 2007, p. 427)

This may tempt a clinician to engage in some unethical and inaccurate diagnosis practices in effort to get the client the help they need.  I believe most clinicians would do this out of what they consider to be the best interest of the individual clients themselves.  However, “the road to hell is paved with good intentions.”  (Kristian Delaney, personal communication) “Under no circumstances should clinicians compromise themselves regarding the accuracy of a diagnosis to make it ‘fit’ criteria accepted by an insurance company.”  (Corey et al., 2007, p. 427-428)

Personally, I see some benefits to managed care that I think we as practitioners sometimes choose to neglect.  Honestly, even if therapy was covered just by my insurance, EAP (managed care) usually provides 6 sessions every year with zero deductible.  We use them every year without fail, and there are some situations where we use them “just because they are there…”  If they cost us anything, even a deductible… we probably wouldn’t utilize the sessions.  Although I think the short sessions do frustrate some practitioners, especially those who have to deal with extremely complex situations in as little as 6 sessions… I think the primary source of frustration is the paperwork!  From what I gather, submitting paperwork for reimbursement to some of these managed care organizations (Magellan, etc) is a real pain.  I don’t understand why they have to make it so difficult… I don’t think there’s any situation where we should spend more time on paperwork than we do with clients.

Reference

Corey, G., Schneider-Corey, M., & Callanan, P. (2007). Issues and ethics in the helping professions (8th ed.). Belmont, CA: Brooks/Cole.

Morals – Pass Them On

It seems there are more and more people who lack any type of morals or ethics.  There are many people who feel it’s ok to keep the couple of bucks the cashier accidentally gave them and explain it away by saying it was owed to them from days or months ago when so-and-so ripped them off.  These tiny acts define a person, and when a person is constantly inconsiderate to other people, or is always putting themselves first, it becomes obvious that person has no problem inconveniencing others for the sake of making their life easier, and most of the time it is because they are lacking morals.  There are people who are polar opposite as well.  These are the people who try to live “by the rules” and it is because of this high level of morals and ethics a conflict can arise when they find themselves surrounded by people who don’t care about the rules as much.

These people are considered “sensitive”.  When one person is sensitive to these types of actions they can easily become overly cautious about how they treat other people.  They most likely try to be more considerate of the people around them and more often try to think about how their actions at that point will affect the next person. People are human and they can’t always achieve these noble acts, nor will they ever always achieve it, but for the most part the hope is that by trying to be considerate and doing the right thing they can show the person next to them that having consideration for other people is necessary in our world.  In a way this single person is hoping their actions will be noticed by people who need to notice, and the actions will affect those people in such a way that they will start to think about changing the way they are toward the people they interact with.

There is a commercial where one person smiles at someone, and then that person feels better and smiles at someone else and on and on, most people probably look at something like that and think it is a bunch of bunk, but truly, positive begets positive and it gets passed on to other people.  When you start to behave this way on purpose, there comes a point when you just do it and it becomes part of your life, like a habit.  The next step could be to get to a place where other people’s actions don’t affect you at all so that you can be an example for others.

Moral Principles to Guide Decision Making – Aspirational Goals of Universal Healthcare

The purpose of this article is to frame the rational discussion of universal healthcare and equal access as it relates to the moral principle of justice.  Although the definitions of justice are many, for purposes of this discussion we will recognize the American Psychological Association’s (APA) official definition of justice as cited in the APA ethical code.  The complexity of the issue, compounded by the intensity of the debate, will inevitably raise more questions than answers.  The rationale is that by employing a decision-making model to the ethical dilemma of universal healthcare, we can guide the discussion in a productive manner by attempting ask educated questions.

The APA is unambiguous regarding equal access to psychological services.  The affirmation positions equal access as a mandatory requirement, not an aspirational goal.  Psychologists recognize that fairness and justice entitle all persons to access to and benefit from the contributions of psychology and to equal quality in the processes, procedures, and services being conducted by psychologists.  (American Psychological Association [APA], 2003, p. 3)  We could extrapolate that statement as an admission of support for the underlying principles of universal healthcare.  The class text echoes this very sentiment with the declaration that Everyone, regardless of age, sex, race, ethnicity, disability, socio-economic status, cultural background, religion, or sexual orientation, is entitled to equal access to mental health services. (Corey, Schneider-Corey, & Callanan, 2007, p. 21)

Equal access is a challenging proposition in a nation that cannot come to consensus on universal healthcare.  The political right would have us believe that’s not what the medical community or the patient population want.  The dwindling number of doctors who accept Medicare patients resent politicians and government bureaucrats threatening their fees and meddling with their judgment.  This has aided the rapid expansion of private “concierge” medicine for seniors who can afford it and for physicians who demand more than what Medicare offers. (Gingrich, 2009, p. 7)

Meanwhile, the frontlines of U.S. healthcare providers are clamoring for a single-payer universal healthcare system.  The California Nurses Association/National Nurses Organizing Committee (CNA/NNOC) co-president Geri Jenkins said any measures short of extending Medicare to provide universal coverage would fail, adding “That’s the majority of the nation’s nurses and doctors – the very people who have the most daily interaction with our healthcare system and see its failures and tragedies up front, favor a single-payer approach, or expanding Medicare to all.” (“Nurses call”, 2009, p. 3)

References

American Psychological Association. (2003). Ethical principles of psychologists and code of conduct. Retrieved March 18, 2010, from http://www.apa.org/ethics/code/index.aspx

Corey, G., Schneider-Corey, M., & Callanan, P. (2007). Issues and ethics in the helping professions (8th  ed.). Belmont, CA: Brooks/Cole.

Gingrich, N. (2009, Feb). The Market Can Fix the Problem. U.S. News & World Report, 146(1). Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=36883618&site=ehost-live

Nurses call for universal healthcare in US. (2009, Apr). Australian Nursing Journal, 16(9), 2/5. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=37215736&site=ehost-live