THE MOST CHALLENGING HEALING: Human, Financial and Ethical Considerations in Health Care

1. THE MOST CHALLENGING HEALING:Human, Financial and Ethical Considerations in Health Care Oklahoma Ethics Group Bruce Lawrence, President and CEO Beth Pauchnik, Managing Director, Chief Legal Counsel, and CAO

2. INTEGRIS Health Overview MISSION To improve the health of the people and communities we serve VISION Most trusted name in health care VALUES Love, Learn and Lead CORE COMPETENCIES • Delivering the most challenging healing through leading edge clinical care • Collaboration to create our future • Community focus 2

3. INTEGRIS Health Overview • 8 Acute Care Hospitals • 122 INTEGRIS Family Care and Affiliated Clinics • 9,590 Staff Members • 1,400 Physician Staff • 47,333 Inpatient Discharges • 640,626 Outpatient Registrations • 648,358 Physician Clinic Visits • 237,528 Emergency Department Visits • E-Health services since 1994 • TeleHealth • INTEGRIS Virtual Visit – newest access point INTEGRIS Heart Hospital Hough Ear Institute Jim Thorpe Rehabilitation Hospital Nazih Zuhdi Transplant Institute Paul Silverstein Burn Center James R. Daniel Cerebrovascular & Stroke Center INTEGRIS Cancer Institute Henry G. Bennett, Jr. Fertility Institute M.J. and S. Elizabeth Schwartz Sleep Disorders Center CENTERS OF EXCELLENCE 1

4. INTEGRIS Health Overview • Agenda for Today • Define Health Care Ethics • Main Ethical Principles • Access to Health Care • Clinical Ethics 3

5. Definition of Healthcare Ethics A set of moral principles, beliefs and values that guide us in making choices about medical care Nicomachean Ethics - Aristotle 4

6. Main Principles In the U.S. four main principles define the ethical duties that healthcare professionals owe to their patients: • Autonomy: to honor the patients right to make their own decisions • Beneficence: to help the patient advance his/her own good • Non-maleficence: to do no harm • Justice: to be fair and treat all cases alike 5

7. Improving Access to Health Care • As the number of Americans without health care coverage continues to increase, access to care is a major political, economic and policy problem. • Unequal access to healthcare is also an ethical issue. 6

8. Improving Access to Health Care Three core American values are at stake: • Equality of opportunity • Justice • Compassion 7

9. Improving Access to Health Care “The enjoyment of the highest standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition”. World Health Organization (1946) 8

10. Improving Access to Health Care The Ethical Force Program four ethical obligations regarding access to health care: • First, every member of society must have an adequate array of core health care benefits. 9

11. Improving Access to Health Care • Second, the contents and limits of health care benefits must be established through an ethical process. • Transparent • Participatory • Equitable and Consistent • Sensitive to Value • Compassionate 10

12. Improving Access to Health Care • Third, the health care system must be sustainable. • Fourth, the health care system must ensure that its stakeholders have clear responsibilities for which they are accountable. 11

13. Improving Access to Health Care Scenario Long Term Patients in an Acute Care Setting • Patient exhausted payor sources. • Care required does not meet criteria for inpatient acute care. • No real options so continue as an inpatient. • Consider paying for the 24 hour monitoring the patient needs 12

14. Improving Access to Health Care Scenario Employer on Employee Benefits • You have 5,000 employees. • Seven employees who have chronic hepatitis represent a significant percent of the organization’s health care costs due to the inordinately expensive hepatitis drugs. • Do you stop covering these drugs next plan year? • What if you are a health care organization, does that elevate the ethical conundrum? 13

15. Clinical Ethics • When we think of health care ethics, most people think of: • Life Sustaining Treatment • Euthanasia • Abortion • The Role of Advance Directives 14

16. Micro Ethics Clinical ethics plays out daily in ways you may not expect. • Anesthesia informed consent for a routine low-risk anesthesia. All anesthesia carries the risk of death. Some anesthesiologists never mention it, some always do and some customize their approach. “Relational judgments” framed as “ethical decisions”. • Constant small ethical decisions play out every day in clinical work. 15

17. Micro Ethics Very individual to the clinician, based on how communication occurs and how decisions made Managing medical information. • Should information be withheld from patients for therapeutic reasons? 16

18. Clinical Ethics Ethics Committee - How it Functions and Ethical Framework • Core Principles: Autonomy, beneficence, non-malfeasance, justice. • Framework: Information, identification, clarification, assessment, recommendation and documentation. • Increase provider awareness. 17

19. THE MOST CHALLENGING HEALING:Human, Financial and Ethical Considerations in Health Care Conclusion Thank you 18