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.

Answer: D

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).

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).

In addition to the code’s principles of practice, the CCMC also outlines six rules governing professional conduct.

Answer: B

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).

Answer: A

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:

1. Beneficence: choosing between good vs. harmful
2. Autonomy: maximizing a patient’s ability to choose for self
3. Justice: dividing health resources fairly
4. Nonmaleficence: avoidance of harm to the patient vs electing a procedure/treatment that may cause harm though expected to help
5. Confidentiality: respecting patient’s rights of privacy vs. sharing needed information

Answer: D