Identifying and navigating ethical issues in healthcare


The first and most important maxim of the healthcare industry is Primum non nocere, or “First, do no harm.” It sounds simple enough, but the healthcare industry is complex, and anyone in this demanding field faces difficult choices every day. Understanding the various ethical challenges in healthcare can empower you to make smart decisions that are better for patients. 

High ethical standards are a must for anyone in healthcare, whether it be doctors, nurses, or administrators. To help you navigate these standards, here’s a summary of current legal and ethical issues in healthcare and how to handle ethical violations.

What are ethical issues in healthcare?

When it comes to healthcare, ethical issues are a field of applied ethics concerned with the moral decision-making medical staff must apply when making decisions. Moral and ethical views in medicine tend to vary based on the country and culture. Tom L. Beauchamp and James F. Childress have developed a standard approach to ethical topics in healthcare that cross borders and cultures.

This ethical framework embraces four key principles of ethical decision-making within the healthcare sector.

  1. Autonomy – Obtain the wishes of the patient so that their autonomy can be protected.
  2. Beneficence – To seek to act in the patient’s best interest.
  3. Justice – Navigate due process to determine where the limits on healthcare lie.
  4. Non-Maleficence – Designate harm and determine how to avoid it.

Healthcare practitioners must collaborate with patients to understand and balance their needs and desires. For example, would it be ethical to provide a blood transfusion to a Jehovah’s Witness even if it would save their life?

Modern healthcare is collaborative, and talking to patients is key to avoiding ethical violations in healthcare. Medical practitioners should never make assumptions about a patient’s needs and desires.

Examples of ethical issues in healthcare

Whenever a patient undergoes treatment, there are always medical ethical issues to negotiate. Issues with waiting lists, access to medical resources, and decisions on the correct course of treatment all pose ethical dilemmas. Take note: ethical is not the same as lawful. Something can be unethical but perfectly legal.

Issues with waiting lists, access to medical resources, and decisions on the correct course of treatment all pose ethical dilemmas

For example: if the emergency room is constantly backlogged, it’s not legally required for healthcare staff to speed up their work. On the other hand, it could be considered ethical to raise the matter with the hospital’s management team to find ways to help more patients, faster.

Some other examples of ethical issues in healthcare are the prioritization of treatment. Who needs immediate attention, and who should wait? Within organ donation, is it ethical to give a matching liver to an older patient who suffered from alcoholism when a younger patient would also benefit from that liver?

Ethical issues in healthcare are complex, and sometimes even the right decision might not feel like the most ethical approach.

5 ethical issues in healthcare

The medical world is constantly evolving, and as medical technology changes, doctors are left with a host of new ethical issues. In a recent Sermo survey asking physicians the top medical issues they faced, the top result was balancing care quality and efficiency. Responses included:

  • 21% Balancing care quality and efficiency
  • 17% Allocating limited medications or tools of support 
  • 17% Addressing end-of-life issues 
  • 15% Addressing access to care 
  • 15% Doctor and patient confidentiality
  • 13% Allocating limited donor organs 

When asked what other top ethical issues physician face in medicine, responses included:

Insurance dictating medical care. Insurance companies delaying or denying surgeries.

Neurosurgery, U.S.

You cannot report to the ones who may actually be getting paid to be the underlying cause of the problem. 

Internal Medicine, U.S.

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Overcoming an ethical issue in medicine isn’t black and white, as is the case with lawful/unlawful actions. Let’s examine some of the key medical ethical issues facing healthcare staff today.

1. Do-Not-Resuscitate (DNR) Orders

DNR orders have always been controversial, as shown by the 17% of survey respondents claiming end-of-life issues as one of the top ethical issues they face. This order instructs any healthcare practitioner not to perform cardiopulmonary resuscitation (CPR) if the patient’s heart stops beating or they stop breathing. These orders may only be written in consultation with a physician and a patient. Yet one ethical issue in medicine is what happens when a patient clearly displays a DNR order?

In 2017, one Florida man had a DNR order tattooed across his chest. Although the seriousness of the tattoo was questioned, the man could not breathe and could not talk, so the ICU unit decided to honor the message and opted not to initiate CPR.

From an ethical standpoint, DNR orders must balance the degree of pain involved in treatment when compared to the potential benefits. As a result, addressing end-of-life issues can be challenging for physicians. 

For more information about DNR orders, check out this resource.

One of the biggest legal and ethical issues in healthcare is patient confidentiality

2. Patient Confidentiality

One of the biggest legal and ethical issues in healthcare is patient confidentiality which is why 15% of survey respondents noted that doctor-patient confidentiality is their top ethical issue in practicing medicine. Healthcare practitioners have an obligation to secure and protect the privacy of all patient medical records. Under the Health Insurance Portability and Accountability Act (HIPAA), violations could lead to suspension and termination.

Yet, there are gray areas, which could inadvertently lead to some ethical violations in healthcare. For example, would it cause more harm than good to withhold aspects of a patient’s medical condition? Likewise, the opposite could be true. 

For more information on patient confidentiality, check out this deepdive into patient confidentiality in healthcare.

3. Mandatory COVID-19 Vaccinations

According to Sermo’s survey, 73% of respondents believe that ethical issues have increased since the start of the pandemic. 

Public health bodies worldwide have discussed the merits and drawbacks of implementing mandatory COVID-19 vaccination policies. This is an issue that impacts the entire healthcare industry. Many countries have made vaccinations mandatory for all staff within the healthcare sector, including in Europe and Asia.

This is one of the most hotly debated current ethical issues in healthcare because it’s brought serious questions into the spotlight. Where do individual medical liberty stop and the needs of wider society start? Is it ethical to force someone into treatment if they don’t wish to undergo that treatment?

For further reading, here are ethical considerations for a COVID-19 vaccine mandate.

4. Healthcare Accessibility

According to figures from the United States Census Bureau, 294.6 million people had health insurance in 2017, which is a record high. Despite this, one in five U.S. adults decided not to seek healthcare in 2017 because they had no insurance. The soaring cost of both healthcare and associated insurance policies leads to ethical issues, which is why 15% of our survey participants highlighted this as their top ethical issue. 

Is it ethical to reject someone who needs treatment based on their insurance status? Is it ethical for hospitals to charge so much for treatment? This is not only an ethical issue in medicine, but it’s a discussion often taken up in politics regarding how society wants to operate its healthcare system. It’s a debate that has raged for decades in the U.S., with no end in sight. Politically, the U.S. will see this as the defining ethical issue of our time, with profitability vs. health coming into direct conflict.

13% of Sermo’s survey respondents felt that allocating limited donor organs is the top ethical issue in healthcare

5. Allocating Limited Donor Organs, Medications and Tools of Support

13% of Sermo’s survey respondents felt that allocating limited donor organs is the top ethical issue in healthcare, while 17% felt the same way about medication and tools. And it’s not surprising considering that in the United States, more than 95% of North Americans are in favor of being an organ donor yet only 58% are actually registered donors. With less than 4% of the population being on the waiting list for a donor, it can be seen that most organs in the U.S. come from deceased donors and only a small percentage come from living ones.

This is why research on the ethical issues of limited donor organs is very important in order to increase the number of living donors. For more information on ethical issues in organ donation, check out Ethical principles in the allocation of human organs.

Additionally, medications and tools of support can be difficult ethical issues to manage. Medication, for instance, is the best way to cure disease. Plus, acutely acting medications are used as adjunctive therapy to a primary treatment method (e.g., surgery). However, some medications are in limited supply meaning not all patients receive the medication they need. 

The same is true of tools of support for physicians. Different regions often offer varying degrees of support and a wide range of tools. Unfortunately, many rural areas suffer the most from lack of modern tools. Support, though, speaks more widely than to just physical components of a practice.

A doctor’s work is never done, and when on-call at the hospital, there are few moments of rest in-between shifts. In order to be a hero to patients, doctors need support from colleagues and loved ones for this tough work. As a result, it’s imperative that doctors find a way to balance helping patients without neglecting family, friends, or hobbies. Notably, when asked where they found support for dealing with healthcare issues 31% of survey participants mentioned colleagues while 30% looked to professional superiors for help.

How to handle ethical violations in healthcare

Moral and ethical issues place a burden on nurses, doctors, and administrative staff. Although the priority should be prevention, confronting ethical missteps is a part of the profession. This is necessary because 47% of physicians have had to address ethical violations in their own practice. So, how can you best handle these violations?

Our recent survey regarding this question provided the following results:

  • 36% Report the conduct to appropriate clinical authorities, such as the peer review body of the hospital, or the local or state medical society
  • 22% Protect the privacy of the patient 
  • 17% Report the suspected violation to appropriate authorities
  • 14% Confront the people who are involved in the ethical violation
  • 9% Report the conduct directly to the state licensing board

Sermo members can see the full poll results in the community. Physicians get access for free!

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Here is a step-by-step example of how to address ethical violations at your practice. Firstly, acknowledgment and investigation of potential ethical issues in healthcare is a must. Bring together different disciplines and create an environment where people are allowed to and feel comfortable speaking up, regardless of their seniority.

Next, an ethical violation should be categorized as a process issue or a regulatory issue. Remember, something can still be unethical even if it happens to be lawful. For example, when a patient’s wishes are at odds with the wishes of their families and the patient cannot speak out, what is the clinic or hospital’s policy on the right way forward?

Ethical violations may require an update to internal rules and work processes. This will require consultation with frontline staff members, the administrative body, and the legal team. The best way to handle ethical problems in medicine is to adopt the following:

  • Provide regular refreshers on ASHA’s Code of Ethics.
  • Break silos and allow for different staff members to come together to discuss the issue.
  • Establish a clear chain of command for when ethical issues need to be escalated.
  • Create an environment where the patient’s wishes are prioritized.
  • Employ ethics experts to work alongside medical teams.

There’s no getting around it: ethical issues will happen. Key ethical talking points are rarely straightforward, and there are no right and wrong answers. What matters is that as part of a patient-centered care system, ethics are at the forefront.

Conclusion

Facing tough moral decisions places heavy stress and self-doubt upon healthcare professionals. Get guidance on confronting specific situations or simply ask for support navigating ethical issues in healthcare from doctors who have gone through similar situations. Enter the virtual doctor’s lounge and explore opinions from over 1 million doctors across 150 countries. 

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