Medical ethics and biomedical ethics and the Standard of Care regarding:
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- Patient privacy under HIPAA, Hybrid Entities under HIPAA and the Privacy Shield Standard as well as State privacy standards
- Conflicts of interest in serving as a Independent Review Organization (IRO) for the provider’s own patients
- Payments and inducements to provide vaccinations to non-U.S. citizens
- Conflicts of interest and self-referral under Stark Law and the Anti-Kickback Statute
Autonomy, beneficence, non-maleficence and justice, the four main principles of bioethics, are often utilized to shape our decision making within the medical field. While one does not take precedence over another, the concept of autonomy or self-rule has become the basis of patient decision making. Respecting autonomy allows patients to make decisions that are in their best interests, as they are usually the best judges of those interests.[i] In medicine a patient’s autonomy is the basis of decision making, but there remain many other factors that the physician is responsible for in this process. The physician needs to ensure the patient truly understands, taking the time when needed to counsel and listen to patients so that they can make informed decisions that correspond with their goals and values. [ii]
At the same time, there are many personal factors (e.g., commitment to the Hippocratic principles of beneficence and non-maleficence, surgeon autonomy in the operating room, non-abandonment) the surgeon faces that while not always discussed with their patients impact the surgeon, especially when contemplating surgical intervention in advanced illness. For surgeons taking care of patients facing the prospect of a palliative procedure or any surgical intervention at the end-of-life, there remains a lack of scientific data to guide decision making. Once a decision has been made, the surgeon retains a sense of responsibility to the patient to care for them not just during the operation, but afterwards. The unfortunate reality for patients in these situations is the poor outcomes many face and even though surgeons’ strongest desires are to fix their patients, death cannot be ‘fixed’. Ultimately, one must remember that often what patients near the end-of-life need most is for their physicians and surgeons to be sources of support during this time. [iii]
These ethical Standards apply to patient referrals and transfers to care.[iv]
[i] Wancata, L. M., & Hinshaw, D. B. (2016). Rethinking autonomy: decision making between patient and surgeon in advanced illnesses. Annals of translational medicine, 4(4), 77. https://doi.org/10.3978/j.issn.2305-5839.2016.01.36
[ii] Id.
[iii] Id.
[iv] XNnate D. A. (2021). Treatment withdrawal of the patient on end of life: An analysis of values, ethics and guidelines in palliative care. Nursing open, 8(3), 1023–1029. https://doi.org/10.1002/nop2.777 “Owing to his underlying health condition, a further assessment of James’ mental status showed that he seemed to lack capacity to express his preferences for care and a suggestion was to be made on transferring him to a hospice for end of life care. Although there was no formal advance statement about his future care needs, it was made known to the charge nurse by a relative that James wished not to spend his last days in a hospice but in his home. In such a situation, relatives who are not legally appointed as the patient’s welfare guardian may give relevant information about the patient’s previously expressed wishes, beliefs, values and preferences”
