Medical Ethics and Healthcare Management: 12 Key Issues

The National Practitioner Data Bank and Fourth Amendment Concerns

The National Practitioner Data Bank (NPDB) collects information regarding the professional competence and conduct of physicians, dentists, and other healthcare providers. The Fourth Amendment to the United States Constitution limits unlawful search and seizure. These two provisions are not in conflict.

The NPDB does not conflict with constitutional principles or with Fourth Amendment protections against unlawful search and seizure. The Fourth Amendment protects the personal papers and effects of individual citizens, not information maintained by others relating exclusively to professional competence in regulated industries. There is no constitutional right to practice medicine; it is a privilege requiring specific academic credentials and satisfaction of state and federal licensing standards.

Provided the privilege is administered and regulated impartially and without violations of other constitutional protections — such as prohibitions on racial discrimination — there is nothing unconstitutional about regulatory entities ensuring the competence of professional medical service providers by maintaining information relevant to their qualifications. The nature of medicine is such that the industry absolutely requires efficient regulation and oversight for the health and safety of patients. That concern outweighs any privacy issues with respect to information relevant to a physician's competence and ability to treat patients safely.

Root Cause Analysis and Sentinel Events

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires that organizations experiencing a sentinel event conduct a root cause analysis to identify the basic or causal factors of that event. Whether in healthcare or any other field involving multiple disciplines, responsibilities, and technologies, sentinel events must be analyzed to identify the root causes of failure and negative outcomes. In this respect, the JCAHO performs a function analogous to that performed by the Federal Aviation Administration (FAA) in its forensic examination of aviation crashes.

Root cause analyses can disclose design flaws in surgical equipment and materials, procedural errors, contraindicated medicines, and other forms of therapeutic intervention. They also help identify and address unanticipated complications and interrelationships between factors not expected to impact the success of medical treatments and follow-up care. Without a root cause analysis, mistakes and negative outcomes are destined to be repeated. With a root cause analysis, future incidents of the same kind and cause can be prevented through appropriate investigation of a single sentinel event.

Conscientious Objection, Stem Cell Research, and Religious Belief

Individuals have a recognized right to refuse participation in abortions as a matter of conscience or religious or moral conviction. The question of whether this premise should be expanded to include participation in stem cell research raises serious concerns.

Allowing individuals licensed by the government to refuse to participate in routine procedures within their practice based on religious beliefs is a dangerous idea. One could also argue that, where an industry requires state licensing, allowing religious beliefs to interfere with professional duties raises constitutional questions. While it may be understandable to accommodate practitioners who wish to avoid procedures requiring contact with porcine products — such as certain implantable heart valves — that is very different from allowing them to impose their philosophical objections by refusing to participate in medical procedures involving patients who do not share their religious beliefs.

This premise should not be expanded to stem cell research or to any other medical area. Perhaps medicine is not an appropriate career choice for individuals whose religious beliefs oppose certain medical procedures, just as military or law enforcement careers may be inappropriate for pacifists.

Right to Die Versus Physician-Assisted Suicide

The right to die and physician-assisted suicide are related but meaningfully distinct concepts. Most importantly, the right to die necessarily involves patients who are already dying; physician-assisted suicide is not necessarily limited to patients who are already dying. Second, the right to die entails the passive removal or discontinuation of medical treatments that are prolonging life, whereas suicide — with or without the assistance of a physician — entails an affirmative act or series of acts intended to end life, rather than the termination of processes that are artificially prolonging it.

Beyond this distinction, the Hippocratic Oath would seem to prohibit any physician involvement in assisted suicide. However, many physicians also recognize that modern technology may require a reevaluation of principles established to govern the profession long before anyone could have envisioned the degree to which quality-of-life issues would arise (Humphry, 1991).