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Investor Interests and Professional Ethics in Healthcare Decisions.

Posted Dec 23 2008 9:14pm
On several occasions I have penned a few thoughts regarding the business of healthcare and how healing the ill and injured of our country has become much less of a fiduciary responsibility, and much more of a commercial enterprise. Despite the rhetoric of many leaders in healthcare today, some circles suggest the focus of the healing arts has shifted away from improving the quality of life of others through medical means, to expanding profit margins.

In some sense it seems wrong that for years hospitals and other healthcare related organizations have been making billions of dollars from the pain and suffering of others. Clearly no one in healthcare will publicly admit that their principle driving motivation for caring for others is money related. However in some instances it may be difficult to see otherwise.

Lisa Day RN, CNS, PhD has authored an excellent article that has been published in the American Journal of Critical Care that looks at this issue. The notion of professional ethics as Dr. Day illustrates has become besieged by greed and exploitation such as with the high profile case of Enron. In her article Day outlines some of the testimony during a June 2007 President’s Council for Bioethics (PCBE) gathering, where Arnold Relman, Professor Emeritus s of Medicine and Social Medicine, Harvard Medical School stated the following:

“[T]he current focus on money making and the seductions of monetary reward have changed the climate in U.S. medical practice at the expense of professional
altruism and the moral commitment to one’s patients. The vast amount of money in play in our medical care system and the manifold opportunities for physicians to
make money has made it difficult, almost impossible for far too many physicians
to function as moral agents, as true fiduciaries for their patients.”

Day goes further to explain the introduction of investors to healthcare in the 1960s acted as a catalyst that would change healthcare from that point on. The infusion of investor interests into healthcare continued for some twenty years.

One of the many concerning issues regarding healthcare today with reference to investor interests that Day brings out are the fiduciary responsibilities that healthcare organizations have to their patients. Relman’s contention during the June PCBE was that the decisions made by healthcare leaders were now based in part by their obligations [either perceived or actual] that they had to investors and not the interests patients.

The corporate business model that Day so eloquently describes shows us that investor interests are designed to gain something from their input. The motive is not philanthropically based, the motive is simple gain. Utilizing a business concept, once can see that healthcare leaders can be and in this case are likely to be persuaded during the decision making process to make choices that are not patient driven but focused on a return for investors.

A final thought and comment; to be fair it should be stated that not all decisions in healthcare are fiscally driven. Several key and influential leaders in healthcare do exercise their fiduciary responsibility to patients despite other interests. At the end of the day though, we will experience corruption in the industry, and the lure or financial gain will entice some to breech their professional ethics. All we can hope for is that the majorities of today’s healthcare leadership maintains their high degree of ethical status and continue to subscribe to the model of patient centered care.

Day, L. (2008). Commercialism and the professional practice of healthcare providers. American Journal of Critical Care, 17(2), 164-167.
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