Ethical Dilemmas and Conflict of Interest Massachusetts General Hospital Boston

Ethical dilemmas and conflict of interest at Massachusetts General Hospital Boston

Did you know Massachusetts General Hospital, Boston is ranked top five of the best hospitals in the United States? Therefore, they are expected to serve their patients diligently while maintaining and strengthening their trust and confidence as they undertake their treatment. The healthcare workers are expected to demonstrate the highest standard of professional competence, efficiency, and effectiveness between themselves and the patients. Massachusetts General Hospital is a medical, surgical, and educational facility. Thus the healthcare workers are expected to use their power and resources accredited to them by the hospital management for the patient interest, following the laws and regulations of the hospital. This means that each healthcare worker should be accountable for their decision and be able to justify their decision and actions to the management in case they are faced with a challenging scenario. However, recent reports show that the hospital faces a conflict of interest among its employees. Therefore, this essay examines the causes of conflict of interest in this hospital and the possible ways of resolving them.

The purpose of codes of ethics in the hospital

Every public institution has its ethical code of conduct that governs every employee. Each employee is expected to conduct themselves according to the institutional culture and ethical values; however, some employees have often been criticized for being too abstract to be meaningful in that they question why there should even be a code of ethics in the institution. The major reason for having codes of ethics in the Massachusetts General Hospital is to specify acceptable and unacceptable behaviors of professionalism that each healthcare worker should adhere to (Svara). Besides, this code tells the patients and people out there what they should expect from the hospital. However, the recent report showcases that Massachusetts General Hospital suffers from a conflict of interests whereby some employees have failed to promote ethical decision-making in their duties. As defined by Oxford Dictionary, conflict of interest is any situation that involves two parties; however, their aims are incompatible. For instance, when one of the healthcare workers at Massachusetts General Hospital or a group is in a position to derive personal benefits from the actions made in their official capacity.

Conflict of interest arising from doctor's activities and relationships

The most important duties of healthcare workers are to provide quality and effective care services to their patients and ensure they are comfortable as they undergo their treatment plans. However, to enhance their lifestyle, Massachusetts General Hospital had given them the mandate to participate in many other economic activities. For instance, teaching students in medical centers, supervising doctor's training, or even helping develop and invent new drugs and vaccines. Besides, they need to participate in educational activities to enhance their professional skills (Muth). This has enabled them to create many associations. Furthermore, since they have been given this power to set their standards, it comes with certain tensions. Although the hospital has enhanced numerous ethical goals to ensure doctors are protected with self-interests, privileges, and prerogatives, some healthcare workers have been victimized by being affected by conflict of interests.

The medical practice environment is changing drastically, and healthcare workers responsible for providing patients with care are experiencing reduced autonomy, increased administrative burdens, and declining incomes. Therefore some of the healthcare workers in Massachusetts General Hospital often found themselves in inappropriate clinical practice related to payment arrangements with their patients. This happens in the essence that each method of paying healthcare workers has the potential of putting the physician's primary interest in promoting their patient's best interest practice at odds with a secondary financial interest.

Based on some research, it was concluded that paying healthcare workers for each service they offer motivates them to increase their services, which results in a gradual increase in the funds generated from patients' spending on their treatment plans. This has resulted in appropriate pricing of services being a major concern in that the patients who are not well orientated with how the hospital system operates end up paying for services they are not sure they are supposed to be paying for (Muth). Some healthcare providers have categorized the higher and low levels of reimbursement in that each has to be conducted in different environments; some have to be conducted in hospitals and others from the physician's office. This has promoted conflict of interest among some of the physicians. National surveys indicate that some healthcare workers are overcharging their services, which contributes to higher costs. Therefore, they are advocating that the hospital policy maker needs to revisit the regulations of physician's conflict of interest and consider how their charges for consultation fees should align.

Self-referrals of doctor's conflict of interests

There has a conflict about the dual roles that healthcare professionals have subjected themselves to in that they are serving patients at hospitals and at the same time referring to themselves as business people. This has been a major dilemma not only for Massachusetts General Hospital but also for other healthcare institutions. Furthermore, the practice has been much more intense for the healthcare workers providing outpatient diagnostic services. This has triggered healthcare providers to have divided personalities in that when treating patients at Massachusetts General Hospital; they tend to refer them to their private hospitals, which are extremely expensive (Muth). Furthermore, retaining their allured of profitable services has made them increase physician ownership of ambulatory surgical and other freestanding facilities, resulting in an expensive treatment plan. These referrals of patients to physician hospitals have been a major contributory to the conflict of interest since their secondary interest has the potential bias of overcharging the treatment fee. Incorporating such services due to physicians not following the hospital's code of ethics might harm the patient by subjecting them to many unnecessary services. This calls for the passage of complex federal legislation and the implementation of regulations to regulate the cost of receiving treatments in private hospitals due to referral programs. Although many physicians are doing this without informing the Massachusetts General Hospital management since their code of ethics prohibits healthcare workers from referring patients to other private hospitals, more so if the physician or any of the family members are directly linked with the ownership of such healthcare institution.

Managing conflict of interest in Massachusetts General Hospital using Cooper's ethical decision-making model

In every public institution, employees are faced with decisions regarding their approach to finding solutions. However, sometimes this might be accompanied by ethical dilemmas, which are major situations in which one is prone to decisions resulting from multiple courses of action. Besides, this could not be the best solution; this resulted in Terry Cooper developing a model to help public workers find the best solution to an ethical dilemma.

Therefore, business ethics addresses the right and responsibilities of a public administrator to the public, which is the same case with the Massachusetts General Hospital management. It tries to advocate for fairness in inpatient treatment without being biased on the patient's race and ethnicity (Bradley). The management deals with the moral choices of the physicians while administering their daily duties and holding them accountable for their actions. Besides many healthcare workers who have been victims of conflict of interest, Terry Cooper advised a method in which people could do their duties while thinking about the consequences of their ethical decisions. Therefore, Cooper developed a sequential but logical approach to help decision-making. Thus, he advocated for four procedural processes for resolving public institutions' conflicts of interest.

Distinguishing the ethical problem

Based on Cooper's model, the ethical problem is always presented as a fragment in that the consequences of such actions are less known at the beginning. However, the hospital's management is in a better position to address this matter, although their ignorance leaves it to escalate. For instance, the hospital needs to create awareness among the physicians regarding their code of ethics that should always be upheld, and those healthcare workers that break them should be subjected to fines or some form of punishment (Blake et al.). Besides, since this is an institution that employs many people, the management should encourage the employees to report any unusual activities or challenges they encounter daily so that the management can look for possible ways of resolving them. For instance, senior doctors could encourage their juniors to open up to them regarding any issues interfering with the normal healthcare treatment plans, even if they seem trivial.

Defining the problem

Once the ethical problem has been distinguished and outlined, it is the responsibility of the hospital management to define it. This entails analyzing the contributory factor that led to the emergence of such code of ethics misconduct and other issues that are not being addressed locally. Often, ethical problems in the hospital could constitute more than one issue. For instance, physician behavior or attitude could be due to the environment they are working in. Other contributory factors are the organization's cultural challenges and concerns in that the management is ignorant in addressing institutional challenges. Or they are working in favor of some employees in that if they have broken any code of ethics, no legal action is taken against them. Therefore in defining these ethical problems, the management needs to understand that all ethical situations are different; thus, the cause of action needs to differ depending on the situation and the intensity of the matter (Bowman and Knox). Thus, any practical approach to address the matter should consider any inconsistencies between the problem's appearance and what it is. For instance, if the cause of the problem is the patient-physician relationship which is a major contributor to many of the codes of ethical misconduct, the hospital management should strengthen this relationship. A conflict of interest could result in patients failing to trust the healthcare worker when being treated since they will see it as an economic factor that will lower the patients' confidence when undergoing treatment.

Courses of actions and consequences

When the healthcare management is done with their analysis and sufficient evidence on the code of ethics misconduct, they can look for possible ways to resolve the matter. At this point, while trying to resolve the matter and restore dignity to the hospital, any possible solution can be tried, even those that seemed initially implausible. There are instances that the solution could have never been tried out, but the management feels it fits that particular context nicely. Therefore, it is wise to weigh the disadvantages and benefits of such a solution to determine which one carries more weight and where there are more benefits, such a solution is recommended (Chandler). Therefore, the hospital management should apply good decision-making, especially if it matters with healthcare reimbursement due to economic influence. It should examine the complexity of reimbursement and the various revenue streams that could have created mistrust between the physician and the patient to retain the hospital's dignity. However, they should be more cautious to avoid complicating the situation while looking for a solution since that may increase moral hazard and entitlement to physicians.

Balancing the Element

Based on Cooper's ethical decision-making model, the ideal solution is to balance the key elements. The hospital has its own moral rules that have been articulated and issued to every healthcare worker; these are supposed to be attributed to the alternative of the consequences. If the hospital management feels the physician has committed something illegal that abuses their code of ethics, they should not cover for him but instead subject him to the right procedure for handling issues (Chandler). After implementing alternative consequences that need to be rehearsed, every healthcare worker should have them at their fingertips. These are the intensity of the alternative solutions to ensure they align with the hospital culture and code of ethics. In assessing ethical problems in the hospital, it might become clear that there is a lot of competition for some values. For instance, the hospital database where all patient records are kept is being compromised and butted against a viable request for personnel information. This will need the hospital to create a hierarchy of moral values that will have a bigger impact on their final decision. Besides, the hospital management should always consider the aftermath since that earns them a good reputation and makes many people recommend them for their quality services.

On the other side, establishing a code of ethics is vital since it helps the administration think about the problem more dynamically, considering the conflicting responsibilities of the employee, patient, and management. Thus, health workers need to weigh the organizational principle to recall their ethical code to abide by it since it provides a starting point and foundation of the hospital's general work. There are instances when the management is faced with difficult decisions; this requires the organization to apply a strong code of ethics to build a strong framework around the problem to stimulate questions relevant to the issue; thus, resolving it becomes easy (Varady et al.). Besides, some employees are generally ignorant, and enacting a code of ethics in the organization will help them to be morally upright; therefore, resolving the issue based on the institutional code of ethics will act as guidance and prevent the problem from occurring in the future. This will also educate them that the organizational code of ethics should always be respected regardless of the situation.