Sunday, January 30, 2011

Essay on Medical Ethics

Essay on Medical Ethics

Moral management is always important in organizations, especially nowadays people are more sensitive to the issue of ethical behavior on both organization level and individual level in workplace. Healthcare today has become an increasingly complex and troubling enterprise for patients, families, healthcare professionals, and society. Moral management of healthcare organization, human treating human anatomically, physically and mentally, is more different and important than other the other common business. A real ethical story that was happened in U of M was presented here that involved some ethical issue on the individual and organizational behavior within the healthcare organization.

Moral management is always important in organizations, especially nowadays people are more sensitive to the issue of ethical behavior on both organization level and individual level in workplace. Healthcare today has become an increasingly complex and troubling enterprise for patients, families, healthcare professionals, and society. Advances in scientific technology and changes in the delivery of healthcare have made it increasingly evident that optimal healthcare requires more than scientific excellence. High quality healthcare also demands attention to ethics, including issues of human values, law, and public policy.

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The case I am presenting here is a real ethical story that happened in the University of Michigan.

Dr. Joseph Oesterling was a division head of the Division of Urological Surgery in the University of Michigan in the mid 90's, and he was a young, energetic and fast rising "star" in prostate cancer field in the nation. After his residency and specialist training in the John Hopkins University under the internationally renowned Urologic surgeon Patrick Walsh, he, at the age of only 36, joined and became head of the Urology at the U of M in 1992. He worked tirelessly in both treating patients and doing clinical research. He quickly became nationally recognized leading surgeon in the prostate cancer field and editor-in-chief in the international journal Urology (Advisory regarding Dr. Joseph Oesterling's resignation, 2003).

He treated his colleagues with warm and personal feeling. Indeed, just as what he claimed, he "works 15 hours a day, seven days a week, and hasn't taken a vacation in three years". But how can such a promising doctor perform the acts that don't seem to be ethical? Did he really do anything wrong? What exactly did he do wrong?

One day in 1996, a temporary secretary sorting mail for the Urology chief Oesterling opened an envelope and found a $5000 check. Unsure what to do with the check, she gave it to a boss. The check and an accompanying letter from a drug company alarmed the supervisor. The letter also mentioned an earlier $7500 contribution to the National Prostate Research Foundation at the U-M. But the boss soon learned no one at the U-M had heard of the foundation. Where would the money go? The check triggered an eight-month investigation on Dr. Oesterling and what they found was much more than what they could have expected.

They found Oesterling had established three Florida-based foundation/companies, not at the U-M. One of them was the National Prostate Research Foundation Inc. The foundation was Oesterling's primary company for attracting thousands of dollars in contributions from drug and medical device companies. Most of the money that was intended to contribute to the foundation for prostate cancer research was actually sent to Oesterling's home. Some of them were never deposited to the foundation's bank account but instead were cashed by him.

The report of the investigation showed Oesterling did not disclose any of his business contracts with outside companies to U-M, which is required, or fully described them to the American Urological Association, as the association requires when a doctor presents research at conferences. He received hundreds of thousands of dollars from more than a dozen drug companies that he failed to report. Such as in July 1996 he deposited $117,144 in his bank account, only $19,293 of that amount was from a U-M payroll check. Additionally, in several occasions, Oesterling double- and triple-billed to U-M, drug companies and medical device companies, and urological associations for the same trips, cab rides, hotel bills, and other expenses(Kamins, 2003).

Oesterling's research and prescribing practices also were in question because he made thousands of dollars from companies whose products he studied or promoted. For example, Oesterling wrote to pharmacies at U-M and the VA hospital in Ann Arbor to recommend a prostate cancer drug just three days after he received $25,000 to his prostate cancer foundation from the drug manufacturer. Oesterling served as a board director in a medical device company, VidaMed Inc., and received stock options for 10,000 shares while conducting a clinical trial study on two procedures using the device made by the company for treating enlarged prostate glands. The study required that patients be assigned randomly to receive treatment by either this device or the traditional procedures. But Oesterling selected patients in a nonrandom manner that might result a biased outcome in favor of the device. He presented his findings to the American Board of Urology; he praised the new procedure without disclosing his financial interest in the company. He also falsely claimed that none of the 20 patients treated with the device were anesthetized during the procedure, although all had been anesthetized (Kamins, 2003).

One side of this issue in the case is the individual ethics. Oesterling obviously behaved unethically in many situations. He knowingly and willingly allowed his clinical researches to be affected by outside force while pretending the researches were still unbiased. He took the matter of serious science that is directly related to human health in a rather indiscreet manner. He turned the serious medical performance into a money game, the money to feed his endless financial desire that is. Although it is very hard to fully understand what's in the back of his mind and why he did what he did in the double- and triple-billing episode, one thing that could be drawn out from it may be that his extravagant money desire is out of his moral control, or he had already lost it.

Although Dr. Oesterling is already in the leadership position within the division of a large medical school, he is still clearly lacking the basics of right medical ethics knowledge that every medical doctor should have in order to practice in medicine. He should re-learn the values and principles of what is right and what is wrong when treating patients. He should be advised to strengthen his cognition on the special importance on human being when using medical tools on them. He should deeply recognize that patients are not only customers in hospitals, also they are human and the objects they are dealing with are human body, not just a lifeless object, so the abuse of doctors' power would not only cause damages on them financially, but also may harm them physically, even loss of lives. He should strongly realize the medicine is not just an any kind of sciences; it's a very unique and serious science. It should be dealt very seriously. He should be taught that to mistreat patients just for increasing his own personal financial interest is absolutely unacceptable, unethical, even illegal, and will face severe consequences. Obviously the unethical acts of Oesterling's had been investigated by multiple agencies, he would be judged in the court of law and be penalized. After all these are over with satisfied results, Oesterling may be given second chance to practice in medicine under close supervision.

This case not only showed the individual unethical behavior in medical field, also revealed some unethical and immoral management in medical equipment companies and drug manufacturing companies. The higher authority in medical field should send a strong message to the top management team in these companies to ask them to change their organizational behavior to comply with ethical behavior in medicine. These top management teams should go through similar educational classes in ethics as what have been advised for Dr. Oesterling. All top executives as well as group managers in those companies should be taught and become vigilant on that the business they are in is not just an any kind of common business; it is directly related to human health and their product can be very powerful and even harmful if misused. These companies should clearly realize the nature of their products and the nature of the end customers of their products. Any serous offenders or repeat offenders in these businesses should be removed, fined or facing jail term.

"Cognitive moral development is referring to an individual's level of moral judgment with regard to right and wrong. People seem to pass through stages of moral reasoning and judgment as they mature." (Hellriegel, 2000, p. 55). In this case, Oesterling showed immaturity in his moral judgment in that his judgment was still very much influenced by outside illegitimate force and still was self-centered, as his behavior was saying "It's right because it's right for me".

His moral judgment needs to be re-evaluated and his level of cognitive moral development needs to be re-established and pushed higher. As a healthcare provider, this is basic requirement. Without the basic moral development and moral judgment, a performance with ethically justified behavior would be impossible, let alone to deal with the more difficult and complex ethical dilemmas faced by healthcare providers in recent years.

The other side of the ethical issue in this case is about the ethics and decision making in organization. In order to either quickly get their products out on the market or increase the sale of their products, many drug manufacturing companies and medical equipment and device companies would choose to influence doctors or researchers with financial incentives to intentionally prescribe more of their drugs or buy their product over the competitors. Simply speaking, they are buying their way to achieve their goals. By paying money, very often a huge amount of money like in this case, to a leading individual or individuals for a research project on its product, the organization is actually trying to tip the scientific balance leaning toward to its favor. In medical field, how a patient should be treated, or in clinical studies how they are conducted, should strictly be based on the medical science and should not be affected by any other influences and forces. In this field, very likely any business misconduct would not only hurt consumers financially but, more seriously, harm them physically and even lose their lives. This is not only unethical on organizational behavior, but also illegal on business practice. The behavior of the VidaMed Inc. Company as well as other unnamed companies in this case falls into this category.

I believed that healthcare organizations should create or reinforce an ethics monitoring committee to closely monitor staff members in their medical practice, clinical researches and basic medical researches. They should inspect and curb any unethical practice and unethical influences, especially from outside through improper financial grant support or any kind of financial incentives by healthcare product manufacturing companies. A code of ethics may be developed to support the staff in setting ethical goals and making ethical decisions.

Financial incentives in medicine, unfortunately, create a paradox that complicates the ability of health service providers to always make the judgment calls in favor of patients. This kind of immoral management by a company may exist in much wider latitude within drug companies and their distributors. These organizations almost always, either consciously or unconsciously, uses the financial incentives to tilt doctors' decision-making balance in favor of the business but not necessarily in favor of, sometimes even harmful to, patients. Therefore, the immoral management in medicine related field is not only immoral, but is particularly harmful and dangerous to humanity. "The opposite extreme from immoral management is moral management". "Moral management doesn't mean lack of interest in profits. However, the moral manager will not pursue profits outside the boundaries of the law and sound ethical principles" (Nelson, 1999, p. 56). Top executives, managers and employees in these companies should particularly recognize this significance at all time and raise their business moral standard to a higher level. If the immoral management in medicine related companies were allowed to continue, the long-term results of it would be that almost all human population, including those who work in these companies, could be its victims.

Healthcare has it own culture, own dynamics and involves a special passion and concern that makes it both intellectually fascinating and emotionally rewarding. The doctor-patient relationship is held by trust. Trust is one of the primary ethical issues that complicate the doctor-patient scenario. If the healthcare providers don't hold higher ethical standard, the trust is often challenged by the inevitable asymmetry of the power in the relationship between physicians and individuals seeking care. The sense of responsibility carried by the physician in the doctor-patient relationship is significant, as he or she uses a specialized, learned set of skills to respond to the needs of others. Medicine, inherently, is an altruistic act. Without high ethical standard, however, there won't be altruism, therefore, there won't be medicine.

Good ethics have a surprisingly positive effect on organizational activities and results. When organizations pursue "system wide ethics", performance improvement and business success should be significant. Moral management of healthcare, human treating human anatomically, physically and mentally, is more different and important than other the other general business. By fulfilling the highly moral obligation of helping others and providing a service, the efficient provision of medical care adds to the moral goodness in the world. The results of such moral actions, in the realm of modern medicine, make the world a better place by fighting against disease and promoting a focus on healthy living.

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