Question

An issue exists when medical providers, or their representatives, utilize the various anonymous, quality-rating websites to their advantage. Examples of this may include completing their own surveys and giving themselves high marks to increase their average quality scores, as well as providing positive commentary about themselves, acting as if they were an actual patient. Furthermore, such a dishonest medical provider with a strong local competition could even go so far as to provide negative commentary and feedback on his/her competitors' websites, with intentions of directing patients away from the local competition and hopefully towards his/her healthcare organization. What kind of ethical implications does such action(s) create? If dishonest medical providers participate in skewing online representations of quality, how does this affect the various ethical principles associated with medicine and patient care previously discussed in this chapter? What technological resources could be developed or utilize to prohibit such dishonesty?

Answer 1

The Four Principles of Health Care Ethics

The basic definitions of each of the four principles of health care ethics are commonly known and used often in the English language, but they take on special meaning when being utilized in a medical setting. All of these principles play a key role in ensuring optimal patient safety and care.

1. Autonomy: In medicine, autonomy refers to the right of the patient to retain control over his or her body. A health care professional can suggest or advise, but any actions that attempt to persuade or coerce the patient into making a choice are violations of this principle. In the end, the patient must be allowed to make his or her own decisions – whether or not the medical provider believes these choices are in that patient’s best interests – independently and according to his or her personal values and beliefs.

2. Beneficence: This principle states that health care providers must do all they can to benefit the patient in each situation. All procedures and treatments recommended must be with the intention to do the most good for the patient. To ensure beneficence, medical practitioners must develop and maintain a high level of skill and knowledge, make sure that they are trained in the most current and best medical practices, and must consider their patients’ individual circumstances; what is good for one patient will not necessary benefit another.

3. Non-Maleficence: Non-maleficence is probably the best known of the four principles. In short, it means, “to do no harm.” This principle is intended to be the end goal for all of a practitioner’s decisions, and means that medical providers must consider whether other people or society could be harmed by a decision made, even if it is made for the benefit of an individual patient.

4. Justice: The principle of justice states that there should be an element of fairness in all medical decisions: fairness in decisions that burden and benefit, as well as equal distribution of scarce resources and new treatments, and for medical practitioners to uphold applicable laws and legislation when making choices.

Health care in America today leaves much to be desired. Among its glaring deficiencies are fragmented and impersonal delivery of service, high costs, and adverse events.1 Moreover, physicians now march to bureaucratic drummers, have little or no autonomy, suffer diminishing prestige, and exhibit sagging professionalism.2,3 To make matters worse, many recent medical graduates lack the clinical skills necessary for good patient care.4,5

A further element in this medical mess is dishonesty—an embarrassment that pervades our profession and undermines its core values of truth, integrity, philanthropy, and altruism. Without question, dishonesty comes in all shades, and at times it can be a matter of interpretation. That said, dishonesty (as defined here) encompasses any form of professional or academic misconduct, including fraud, deceit, cheating, lying, shirking responsibility, abuse of authority, conflicts of interest, plagiarism, alteration of medical records, forgery, false representation, and knowingly assisting another person in dishonest acts.

I examined this issue 24 years ago,6 but dishonesty in medicine has grown substantially in the interim. This editorial expands my original report and provides an overview of dishonesty as it currently exists in a variety of medical settings.