A report on Business Ethics in Healthcare

1. ETHICS IN HEALTH CARE
Submitted by: Group 5
Franklin Aloysius (11078)
Annie Jenifer (11067)
Priyanka Shukla (11098 )
Swarupa Rani Sahu (11116 )
Tejas Savani (11118)
[Pick the date]

2. INTRODUCTION
Patients, families and healthcare professionals sometimes face difficult decisions about
medical treatments. These decisions may conflict with a patient and/or family's morals, religious
beliefs or healthcare guidelines. Healthcare ethics is a thoughtful review of how to act in the best
interest of patients and their family. It is also about making good choices based on beliefs and values
regarding life, health, suffering and death.
The ethical and/or moral premises of healthcare are complex and intricate. To consolidate
such a large segment of moral philosophy, it becomes important to focus on what separates
healthcare ethics from other forms of morality. And on the whole, it can be said that healthcare itself
is a "special" institution within society. With that said, healthcare ought to "be treated differently
from other social goods" in a society. It is an institution of which we are all a part whether we like it
or not. At some point in every person's life, a decision has to be made regarding one's healthcare. Can
he/she afford it? Does he/she deserve it? Does he/she need it? Where should he/she go to get it? Does
he/she even want it? And it is this last question which poses the biggest dilemma facing a person.
After weighing all of the costs and benefits of her healthcare situation, the person has to decide if the
costs of healthcare outweigh the benefits. More than basic economic issues are at stake in this
conundrum. In fact, a person must decide whether or not his/her life is ending or if it is worth
salvaging. Of course, in instances where the patient is unable to decide due to medical complications,
like Acoma, then the decision must come from elsewhere. And defining that "elsewhere" has proven
to be a very difficult endeavour in healthcare philosophy.
Whereas bioethics tends to deal with more broadly-based issues like the consecrated nature of
the human body and the roles of science and technology in healthcare, medical ethics is specifically
focused on applying ethical principles to the field of medicine. It is a large and relatively new area of
study in ethics. And one of the major premises of medical ethics surrounds "the development of
valuation measures of outcomes of health care treatments and programs. Terms
like beneficence and non-maleficence are vital to the overall understanding of medical ethics.
Therefore, it becomes important to acquire a basic grasp of the varying dynamics that go into a
doctor-patient relationship.Six of the values that commonly apply to medical ethics discussions are:
Autonomy - the patient has the right to refuse or choose their treatment.
Beneficence - a practitioner should act in the best interest of the patient.
Non-maleficence - "first, do no harm".
Justice - concerns the distribution of scarce health resources, and the decision of who gets
what treatment.
Dignity - the patient (and the person treating the patient) have the right to be treated with
dignity.
Truthfulness and honesty

3. CASE1:
Myers Squibb Co. bribed doctors to prescribe its drugs. It is one of the largest health care
fraud case ever handled by US. The suit claims company salespeople plied physicians with speaking
fees, expensive meals, gifts and trips to induce or reward them for prescribing large amounts of its
drugs, which were billed to private insurers. Doctors were offered golf outings, basketball camps,
samba lessons and luxury suites. Low-prescribing doctors were threatened with loss of perks.
Merck, a US based pharmaceutical company, agreed to pay $950 million and has pleaded
guilty to a criminal charge over the marketing and sales of the painkiller “Vioxx”. The
pharmaceutical giant copped to a misdemeanour, urging MDs to prescribe Vioxx for Rheumatoid
Arthritis.
The FDA had initially approved Vioxx in May, 1999 to treat osteoarthritis, acute pain, and
menstrual cramps. By September 30, 2004, when Merck announced its “voluntary recall,” some 25
million Americans had been prescribed the widely hyped drug. Evidence suggest that using Vioxx
doubled the patient‟s risk of suffering a heart attack or stroke ,based on a review of 1.4 million
patients‟ records. 55,000 people died, and many more were permanently disabled. The Merck
executives‟ real crime was conspiracy to commit murder. The murders perpetrated by Merck
executives were intentional. An early clinical trial had alerted them to the fact that Vioxx caused
coronary damage. Once Vioxx was approved, Merck spent more than $100 million a year
advertising it. Merck execs continued to ignore and suppress indications that their new blockbuster
was causing strokes and heart attacks. Sales hit $2.5 billion in 2003. If these MDs had declared their
conflicts of interest, Vioxx would have been pulled from the market before , Merck made an extra
billion or two, and killed 6,000 more Americans.
The corporate boo-boo in this instance involved pay-offs to doctors who purchase drugs for
state-owned institutions overseas. Johnson & Johnson recently settled a similar bribery case. Merck,
AstraZeneca, Bristol-Myers Squibb, and GlaxoSmithKline are all in settlement negotiations with the
government.
On the home front, Pfizer has paid $2.3 billion for violating the federal False Claims Act and
bribing institutional purchasers in connection with Bextra, Lipitor, Viagra, Zithromax, Norvasc,
Lyrica, Relpax, Celebrex, and Depo-provera.
The systemic corruption is getting worse. In the 15 years between 1991 and 2005, according
to Public Citizen, drug companies paid the government $5 billion in penalties and settlements in
connection with kickbacks and false claims.

4. CASE 2
Since many people can benefit greatly in terms of length and quality of life from organ and
tissue transplants, the demand usually exceeds the supply. The costs related to some organ transplants
are very high as well. Therefore, many questions are raised today regarding how best to procure more
organs, how to fairly distribute limited resources, and whether all transplants should be covered by
public funds.
The multi-billion rupee Gurgaon kidney scandal came to light in January 2008 when police
arrested several people for running a kidney transplant racket in Gurgaon, Harayna. Kidneys from
most of the victims, who were the poor hailing from the nearby western Uttar Pradesh,were
transplanted into clients from United States, United Kingdom, Canada, Saudi Arabia and Greece. The
police raid was prompted by complaints by the locals from Moradabad about illegal kidney sales. The
man accused of the scandal, Amit Kumar, was arrested in Nepal on 7 February 2008. Dr.Amit Kumar
and his accomplices had performed 600 kidney transplants in the past decade 6 years
Medical Errors
It is not expected that medicine can cure everyone; it might be expected that it makes no one
worse than he or she was before. Patient safety has always been an important principle in the practice
of medicine. The Institute of Medicine reports, To Err is Human and Crossing the Quality
Chasm, have increased awareness of patient safety issues both within the health care professions and
in the mind of the public. Even more well-known is the principle "first, do no harm," which is an
essential feature of the foundation of the practice of medicine since Hippocratic times. In fact the
Hippocratic writings consider avoiding harm to be a moral imperative of physician behaviour.
No maleficence, the contemporary articulation of the obligation to avoid causing harm, is not
restricted to deliberate harm. Harm committed with the intent of healing is no less prohibited by this
principle than malicious harm, and every physician must assume the duty of preventing all harm.
Harm from errors, system flaws, accidents, complications, and known risks are all consequences that
must be avoided wherever possible. This is an aspirational goal, meaning medicine should strive to
eliminate all potential harm from health care, but reality dictates that we will never fully succeed. The
fact that there will always be ways to improve patient safety is the main reason that it always has
been and always should be such a prominent feature of medical practice and medical ethics.
Injury due to error is especially destructive to the patient-physician relationship because it
lowers expectations of high quality care and dedication from physicians and other health care
professionals. Errors seem to imply lack of concern and dereliction of duty, when in fact; many errors
are the result of poor systems and inadequate infrastructure. Several articles in this issue address
these concerns.

5. If we take a broad look at a variety of approaches to reducing medical errors and improving
patient safety.In doing so we hope to create the foundation for physician activism in this arena as well
as to promote attitudes of personal responsibility for preventing errors and minimizing the impact of
errors that occur. There are a number of ways physicians can be active in protecting patients and
reducing error. Preventing harm is one of the most basic duties of a physician. Therefore physicians
at all levels of training should devise multiple mechanisms to prevent error and improve outcomes.
By not disclosing a medical error, the doctor conspicuously places his own interests above
that of the patient to the detriment of the patient, thereby violating a patient-centred ethic. Moral
courage is therefore needed if doctors are to do the right thing when medical errors occur. This moral
courage can be facilitated by institutions having policies and guidelines on disclosure of errors in
place, training doctors and other hospital staff on how to disclose medical errors and providing
emotional support for doctors who make mistakes in their efforts to treat patients and save lives.
Medical waste discharge
Indiscriminate disposal of infected and hazardous waste from hospitals, nursing homes and
pathological laboratories has led to significant degradation of the environment, leading to spread of
diseases and putting the people to great risk from certain highly contagious and transmission prone
disease vectors. This has given rise to considerable environmental concern. The first standard on the
subject to be brought out in India was by the Bureau of Indian Standards (BIS), IS 12625 : 1989,
entitled „Solid Wastes- Hospitals-Guidelines for Management‟ but it was unable to bring any
improvement in the situation. In this scenario, the notification of the „Biomedicalwaste (Management
& Handling) Rules, 1998‟ assumes great significance. According to these rules, it shall be the duty of
every occupier of an institution generating bio-medical waste, which includes hospitals, nursing
homes, clinics, dispensaries, veterinary institution, animal houses, pathology laboratories, blood
banks etc., to take all steps to ensure that such wastes are handled without any adverse effect to
human health and the environment.
Euthanasia
In some countrieseuthanasia is accepted as standard medical practice. Legal regulations
assign this to the medical profession. In such nations, the aim is to alleviate the suffering of patients
from diseases known to be incurable by the methods known in that culture. In that sense, the "Primum
no Nocere" is based on the belief that the inability of the medical expert to offer help, creates a known
great and ongoing suffering in the patient.

6. Ultrasound testing
Foetal ultrasound screening has become routine practice in many western countries. During
the last decade, such screening has led to frequent situations characterised by clinical uncertainty due
to the disclosure of soft markers in the unborn child. Soft markers are minor anatomical variations
indicating a somewhat increased likelihood that the foetus has a chromosomal aberration, most
frequently trisomy 21 (Down syndrome). This paper presents the results of a comprehensive literature
search of the National Library of Medicine with emphasis on the chronological development of
scientific knowledge in relation to soft markers and the link between advancing imaging technology
and clinical counselling dilemmas. An analysis of the literature makes evident that many ultrasound
examiners have counselled individual pregnant women on the basis of insufficient data. Moral
dilemmas have thus emerged as a direct result of advancing medical technology, and healthy foetal
lives prove to have been lost due to invasive diagnostic testing aimed at resolving clinical
uncertainty. Ultrasound examiners have warned against a policy of disclosing all findings of soft
markers to expectant parents, but no exploration of experiential aspects linked to the disclosure of
foetal soft markers has yet been published in the medical literature. The emotional reactions of
mothers are important to consider given their potential impact on the biological development of the
foetus.
Right to health
In cases were patient needs emergency treatment, the role of medical institutions becomes
important, as the first few moments after the accident, i.e., the Golden Hour, are very precious and
crucial . Many lives can be saved and disabilities can be prevented by providing timely proper care,
that is, by providing immediate treatment to the victims of accidents. But unfortunately, in India,
emergency care is the most neglected area of health care today. According to a leading daily, over
30% of the emergency patients in the country die before they reach the hospital. Over 80% of the
accident and emergency victims never get quality medical care during the Golden Hour.
One major reason for which hospital/ clinics /doctors refuse to treat accident cases is the
potential medico-legal complications associated with such patients. In other cases, the victim is
refused either due to want of bed or other necessary medical equipment/systems.
PrithvirajBiswas, a student of the National Institute of Design, died in a tragic hit-and run
accident hospital, but the staff there refused to treat him. His classmates strongly believe that Biswas
could have been saved, if the doctors at V.S. Hospital had attended to his injuries, instead of refusing
to treat him and referring him to the civil Hospital at the other end of the City, where he was declared
“dead on arrival.

7. Although a doctor is free to choose whom he will serve, his liberty does not extend to
accident, injury and emergency cases. As per law, hospitals, nursing homes and clinics of doctors, that
declare, or profess, in writing that they provide emergency sevices/24 hour services are legally bound
to attend all the cases. Failure to have the requisite equipment in working order and non-availability of
competent staff within reasonable time would be inferred as medical negligence.
In many cases it has been observed that doctors wait for the arrival of the police before
attending accident victims, especially with head and burn injuries. In such cases, the Supreme Court
directives are very clear:
There are no provisions in the IPC or CPC, which prevents doctors from promptly attending
to seriously, injured persons and accident cases before the arrival of the police.
The treatment of the patient should not wait for the arrival of the police or completing legal
formalities. All government hospital and medical institutions should be asked to provide immediate
medical aid to all the cases, whether medico-legal or not.
The Supreme Court further observed that Article 21 of the Constitution imposes an obligation
on the State of safeguard the “Right to Life” of every person. Preservation of human life is, thus, of
paramount importance. The government hospitals run by a state and the medical officers employed
therein are duty-bound to extend medical assistance for preserving human life. Failure on the part of a
government hospital to provide timely medical treatment to a person in need of such treatment results
in violation of his ”Right to Life”, guaranteed under Article 21.
Can doctors resort to strikes?
Resident physicians in several hospitals in Jodhpur, Rajasthan started an indefinite “doctors‟
strike” to protest alleged lathi-charge by the police. The regular services in government hospitals were
paralyzed bringing endless miseries for the innocent patients, mostly from the impoverished section of
the society who cannot afford the expensive treatment in private hospitals. And after almost three
days of extreme medical muddle created by the agitating healers, the striking medicos withdrew the
strike after the government bowed down to their demands of disciplining the police but not before
dozens of the defenceless patients including many children succumbed to their illnesses as a result of
absence of treatment in the hospitals.
“Doctors‟ strike” has become a routine affair in India these days. Indian medicos frequently choose to
cease work or “strike” in order to settle their scores against the government or hospital authorities. But
do our healers have any moral, ethical or legal rights to join a “strike” that denies essential medical
services from the ailing people? Who should be held responsible if innocent patients die without
treatment because of a “doctors‟ strike”? In fact, the “Code of Ethics” of the Medical Council of
India (MCI), reads, “The prime object of the medical profession is to render service to humanity;

8. reward or financial gain is a subordinate consideration”. But yet it is a common knowledge that
financial profit is the principal motivating force for a large fraction of the medical community in India
today. Mushrooming private hospitals and nursing homes on almost every street corner bear
irrefutable testimony that practice of medicine has turned into a highly lucrative business in modern
India.
But the ultimate price of any “doctors‟ strike” is always paid by the defenceless patients- often with
their lives as so many patients have already died as a result of the only 3-day “doctors‟ strike” in
Jodhpur. Obviously, doctors do not have a moral right to go on a “strike” at the expense of the
vulnerable patients.
Organizations
The World Medical Association (WMA) is an international organization representing
physicians. It was founded on 17 September 1947, when physicians from 27 different countries met
at the First General Assembly of the WMA in Paris. The organization was created to ensure the
independence of physicians and to work for the highest possible standards of ethical behaviour and
care by physicians, at all times. The Declarations, Resolutions and Statements cover a wide range of
subjects, including an International Code of Medical Ethics, the rights of patients, research on human
subjects, care of the sick and wounded in times of armed conflict, torture of prisoners, the use and
abuse of drugs, family planning and pollution.
The Council for International Organizations of Medical Sciences (CIOMS) is an
international, nongovernmental, not-for-profit organization established jointly
by WHO and UNESCO in 1949. CIOMS serves the scientific interests of the international
biomedical community in general and has been active in promulgating guidelines for the ethical
conduct of research, among other activities.

9. CONCLUSION
Most people have gotten a doctor's prescription at some point in their lives for a medicine they have
needed. Some people need prescription medication on a regular basis due to their medical problems.
The question is, to what degree can you trust that your doctor writes a prescription based only on your
best interests as a patient?
That seems like a strange question - after all, what else would a doctor have in mind? Shouldn't the
doctor's choice of medication depend solely upon what your needs are as a patient? That does sound
like the way things should be, but recent revelations suggest that something very different is going on:
pharmaceuticals companies may be exercising undue and unethical influence on doctors and what
doctors prescribe.
Speak Up For Your Safety
1. Speak up if you have questions about the treatment. You have a right to know!
2. Pay attention to the treatment you receive
3. Educate yourself about your diagnosis, and all medical tests you are undergoing
4. Ask a trusted family member or friend to be your advocate
5. Understand all informed consent documents or other medical forms you are asked to sign.
6. Refuse a medical treatment you‟re not comfortable with other measures
7. Educating health care professionals so that they understand patient‟s perspective
8. Governmental Reform-enforcement of stringent rule
There is a critical need for healthcare professionals who understand the importance of ethics
in health care. People worship doctors as being next to god. Medical professionals should save life.
They should keep their vested interest aside. Ethical values cannot be compromised. An awareness of
the importance of ethical values can help clinicians, educators, researchers, and leaders in healthcare
to face ethical challenges and uphold ethical environments. It is important that all healthcare
professionals value and support their peers who have the courage to stand up and speak out against
unethical behaviour even when others are silent or differ in opinion.
Government should enforce stringent rules to curb unethical practices in health care. Public
can be educated to create an awareness. People should raise their voice and stop the unethical
behaviour of a doctors and healthcare units. It is essential that the healthcare industry develops
leaders with strong ethical values, leaders who are willing to live these values with integrity and
courage, even when doing so risks their professional relationships and their position in their
organizations.

10. BIBLIOGRAPHY
1. Wikipedia
2. New York times
3. Proquest Data
4. Times of India
5. CNBC news channel