Breaking up is hard to do: Ethics of maintaining vs. ending care

Course Overview

Trying to maintain our professional integrity while providing excellent care within the business model of health care can lead to ethical distress. The relative contributions of economics, social justice and our duties to multiple parties make this a particularly thorny issue. This presentation will focus on the inherent legal and ethical challenges of determining continuance of care versus discharging our patients who may not ever get “all better.” Any discussion of legal and ethical practice must begin with understanding the importance of obtaining and documenting informed consent/refusal. Informed consent/refusal will be discussed and built upon with the addition of the business aspects of health CARE. The Jimmo vs. Sebelius case established that coverage cannot be denied based on the lack of improvement, however reimbursement claims are still often rejected.

In today’s health care environment, it is important to understand our obligation to provide “skilled care” and how this is related to reimbursement challenges including private pay and avoiding overutilization of services. How should decisions be made when one party wants therapy to continue while another has decided that the patient has had enough? What are our duties and obligations to our patients, colleagues, families and insurers when there is disagreement about what is appropriate?

Course objectives:

By the end of this presentation, participants will be able to…

  • Discuss patient centered informed consent/refusal
  • Document informed consent/refusal
  • Identify strategies to resolve tensions that may arise due to differing perspectives
  • Identify legal documentation and ethical principles related to specific issues like reimbursement
  • Compare and contrast the business vs. professional aspects of the provision of health care services
  • Identify how evolving business models for health care reimbursement are changing our professional duties and relationships with others
  • Understand the implications of the Jimmo case in the provision of skilled maintenance care
  • Recognize when and how to determine the continuance vs. discharge of patients with chronic conditions
  • Apply the concepts presented in this course to case discussions and conflicts in one’s own practice

4 hours towards ethics and jurisprudence