Dynamic Moral Status among Hospital, Patient and Physician Chih-Jaan Tai, MD., MSc. Department of Health Services Administration, China Medical University, Taiwan Department of Otolaryngology, China Medical University Hospital, Taiwan C. J. TAI
Contents • The dynamic status among the principles of medical ethics • The dynamic status between physician and patient • The dynamic status between hospital and patient • The dynamic status from society to patient
Preface: The movement of medical ethics • BC 460 Non-maleficence: “Do no harm” by Hippocrates • ~ AD 1900s Beneficence: • from passive to active • paternalism and moral attitude • AD 1950s-70s Autonomy: • Nuremberg code • Patient bill of right • AD 1980 Fidelity: • Confidentiality, veracity • AMA: from paternalism to patient rights • AD 1999 Non-maleficence: • IOM “ To err is human”, Patient safety • AD 2000s Justice: • Resource allocation
The Ethical Obligation of Physician • Prima facie principles • Beneficence • Non-maleficence • Respect for autonomy • Justice • Dilemma in practice • Priority among principles?
Between Physician and Patient • Dilemmas • Patient’s autonomy versus professional value and professionalism • Respect for autonomy versus beneficence • Disclosure of information to patient
Between Physician and Hospital • Partnership or employment • Dilemma: employee’s loyalty and professional ethical requirement
Between Hospital and Patient • Cost contain from the third party payer • Managed care: gatekeeper, case management, utilization review, practice profile
Physician to Society • Does physician have social obligation? • Narrow physician-individual patient framework or have to consider family, community, and the general society?
Hospital to Society • Service, but not profitability • Maximize community benefits • Protect the commonweal
Dilemmas in hospital administration • Profit or services • Market share to survive • No margin, no mission? • Resources allocation and resources restraint
Patient to Society • Patient’s social obligation • Equally treated and resource allocation • Resource restraint