The rule of law is expressed by codified legal standards. In the United States, and most other democracies, laws spell out how we will govern ourselves. Over centuries, laws have evolved based on commonly understood societal concepts of right and wrong. Even in the present, the law is evolving to reflect not only our history but also current ideas of how we want to be governed. Knowing we can depend on the law provides stability for the country and for ourselves.
So, what is ethics? Ethics is the area of philosophical study that examines values, actions, and choices to determine what is right and wrong. Core principles that have been foundational for ethical behavior were established millennia ago by the great philosophers Aristotle, Plato, and Socrates. In the fourth century B.C. they defined ethics as “the science of morals.”
Ethics lays down the principles of human behavior. For example, we can debate the principle of the greatest good for the greatest number. (“Should this sweet little girl be given a heart transplant even though many others are ahead on the list?”). Ethics constitutes moral principles, and values are related more to an individual’s personal set of standards (Townsville Community Legal Services, 2014).
Morals, on the other hand, has to do with day-to-day actions based on these principles. “Should I steal coins from the collection basket?” Virtually every culture forbids stealing, though some give it a wink and a nod. “Should I have sex without a condom?” Morals vary from one society to another. In some parts of Africa the husbands have refused to wear condoms even though they are having extramarital sex, and thus they expose their wives to HIV.
There is an ongoing debate about the relationship of the law and morality. In 1958 the Harvard Law Review published the famous Hart Fuller Debate, which addressed the relationship of law and morality (Harvard Law Review, 1958). Hart held that morality and law are separate and Fuller asserted that morality is the source of the law’s binding power. Laws bind every citizen to abide by them; however, moral standards depend upon an individual’s upbringing, values, religious background, and culture.
Hippocrates defined ethical standards for the practice of medicine. In addition to his famous vow (“First, do no harm”), he underscored the principles of beneficence, nonmaleficence, autonomy, and justice (Entwistle et al., 2016). These standards of doing good, doing no harm, allowing patients to make their own choices, and fairness are the foundations for all professionals in healthcare.
Test Your Knowledge
What are the four foundational values of medical ethics?
- Beneficence, justice, autonomy, and liberty.
- Justice, nonmaleficence, autonomy, and peace.
- Beneficence, justice, autonomy, and equality.
- Beneficence, nonmaleficence, autonomy, and justice.
There are limits to the law. The law cannot make people honest, caring, or fair. For example, lying, or betraying a confidence, is not illegal but it is unethical. While not every healthcare profession requires adherence to a code of ethics, all require adherence to the law. Finally, ethics and the law address similar issues (see box).
Issues Addressed by Both Ethics and Law
- Access to medical care
- Informed consent
- Exceptions to confidentiality
- Mandatory reporting
- Privileged communication with healthcare providers
- Advance directives
- Physician-assisted suicide
People have the legal freedom to express themselves; however, their expressions may still be ethically offensive and immoral. On the contrary, some people may express opinions based on their ethical or moral positions; however, the way they express those opinions may actually be illegal.
Did You Know. . .
Not all laws may be ethical and not all ethical decisions are legal! Healthcare professionals may sometimes face a dilemma in balancing the two domains of ethics and law.
Ethics is the aspect of philosophy that addresses questions about human conduct. For healthcare professionals, the professional code of ethics determines the acceptable behavior for that profession, within and supported by the legal standards. The Certified Case Manager Code of Ethics also clearly outlines what is ethical behavior for a case manager when dealing with patients (CCMC, 2015). The American Nurses Association code of ethics for nurses defines ethics as “reasons for decisions about how one ought to act based on principles and virtues” (ANA, 2015).
Certified Case Manager Code of Ethics
The code of professional conduct for case managers is based on the following Principles:
Principle 1: Board-Certified Case Managers (CCMs) will place the public interest above their own at all times.
Principle 2: CCMs will respect the rights and inherent dignity of all of their clients.
Principle 3: CCMs will always maintain objectivity in their relationships with clients.
Principle 4: CCMs will act with integrity and fidelity with clients and others.
Principle 5: CCMs will maintain their competency at a level that ensures their clients will receive the highest quality of service.
Principle 6: CCMs will honor the integrity of the CCM designation and adhere to the requirements for its use.
Principle 7: CCMs will obey all laws and regulations.
Principle 8: CCMs will help maintain the integrity of the Code by responding to requests for public comments to review and revise the Code, thus helping ensure its consistency with current practice.
Source: CCMC, 2015.
In addition to the code’s principles of practice, the CCMC also outlines six rules governing professional conduct.
Rules Governing CCM Conduct
Rule 1: A CCM will not intentionally falsify an application or other documents.
Rule 2: A CCM will not be convicted of a felony.
Rule 3: A CCM will not violate the code of ethics governing the profession upon which the individual’s eligibility for the CCM designation is based.
Rule 4: A CCM will not lose the primary professional credential upon which eligibility for the CCM designation is based.
Rule 5: A CCM will not violate or breach the Standards for Professional Conduct.
Rule 6: A CCM will not violate the rules and regulations governing the taking of the certification examination and maintenance of CCM Certification.
Source: CCMC, 2015.
Test Your Knowledge
Which of the following principles is not included in the Certified Case manager’s code of ethics?
- CCMS will respect the rights and dignity of clients.
- CCMS only need to obey all state regulations that control their licensure.
- CCMS will maintain their competency at the level that ensures high quality for clients.
- CCMs will always maintain objectivity in their relationships with clients.
The law has several sources, including commonlaw, administrative law, and statutory law. Commonlaw has been established over centuries as a result of prior court decisions. Administrative law, or regulatory law, is passed by executive agencies; for healthcare professionals an example is found in state certification. It is also under administrative law that a state administers its Medicare services. Statutory law is written law that is enacted by a legislative body.
Laws governing healthcare professionals reflect the principles of justice, confidentiality, and the right to privacy, as well as informed consent and freedom from abuse (eg, assault and battery by a healthcare worker). Patients also have the legal right to information and accommodation of needs (eg, spouses rooming together). Most hospitals publish and provide all patients the formal patient bill of rights.
Exceptions to the patient’s right of privacy include reporting of communicable diseases when the rights of the public to safety outweigh the individual (ie, greater good for the greater number), and also include reporting of violent crimes such as child or elderly abuse. Originally, the rights of privacy and confidentiality were considered ethical principles but since 1996 confidentiality of personal health information is now mandated by the Health Insurance Portability and Accountability Act, known as HIPAA (see Module 7) (US HHS, 2018).
Test Your Knowledge
Which of the following is an example of administrative law?
- The Case manager must retain legal licensure by the state board where she is practicing.
- A patient has sued the hospital for malpractice?
- A client of yours has been raped and wants to press charges against her perpetrator.
- A client has had a worker’s compensation claim against his employer for faulty equipment which caused him to fall and become injured.
Potential ethical dilemmas for case managers can be any of the following:
- Type 1: Case manager actions are both ethical and legal.
- Type 2: CM actions may be considered ethical but not legal.
- Type 3: CM actions may be considered legal but not ethical.
- Type 4: CM actions are neither ethical nor legal.
Ethical dilemmas can also be categorized by the following:
- Beneficence: choosing between good vs. harmful
- Autonomy: maximizing a patient’s ability to choose for self
- Justice: dividing health resources fairly
- Nonmaleficence: avoidance of harm to the patient vs electing a procedure/treatment that may cause harm though expected to help
- Confidentiality: respecting patient’s rights of privacy vs. sharing needed information
Test Your Knowledge
A hospital is about to break ground for a new wing. People chain themselves to a number of old trees that will be lost if the building goes forward. These people are behaving
- Legally but unethically.
- Legally and ethically.
- Unethically and illegally.
- Ethically but illegally.
Apply Your Knowledge
Who are you allowed to share confidential information with? How would you explain the difference between the principle of confidentiality and the law of HIPAA?
Answer: DBack Next