How Should We Judge Whether and When Mission Statements Are Ethically Deployed?

K. Schuler & D. Stulberg
AMA J Ethics. 2020;22(3):E239-247.
doi: 10.1001/amajethics.2020.239.

Abstract

Mission statements communicate health care organizations’ fundamental purposes and can help potential patients choose where to seek care and employees where to seek employment. They offer limited benefit, however, when patients do not have meaningful choices about where to seek care, and they can be misused. Ethical implementation of mission statements requires health care organizations to be truthful and transparent about how their mission influences patient care, to create environments that help clinicians execute their professional obligations to patients, and to amplify their obligations to communities.

Ethics, Mission, Standard of Care

Mission statements have long been used to communicate an organization’s values, priorities, and goals; serve as a moral compass for an organization; guide institutional decision making; and align efforts of employees. They can also be seen as advertising to prospective patients and employees. Although health care organizations’ mission statements serve these beneficial purposes, ethical questions (especially about business practices seen as motivating profit by rewarding underutilization) arise when mission implementation conflicts with acting in the best interests of patients. Ethical questions also arise when religiously affiliated organizations deny clinically indicated care in order to uphold their religiously based mission. For example, a Catholic organization’s mission statement might include phrases such as “faithful,” “honoring our sponsor’s spirit,” or “promoting reverence for life” and likely accords the Ethical and Religious Directives for Catholic Health Care Services, which Catholic organizations’ clinicians are required to follow as a condition of employment or privileges.

When strictly followed, these directives restrict health care service delivery, such that patients—particularly those seeking contraception, pregnancy termination, miscarriage management, end-of-life care, or other services perceived as conflicting with Catholic teaching—are not given the standard of care. Federal and state laws protect conscience rights of organizations, allowing them to refuse to provide services that conflict with the deeply held beliefs and values that drive their mission.6 Recognizing the potential for conflict between mission statements and patients’ autonomy or best interests, we maintain that health care organizations have fundamental ethical and professional obligations to patients that should not be superseded by a mission statement.

The info is here.

Don't Blame PPC, Blame Poor Ethics

Kyle Infante
Forbes.com
Originally posted on February 2, 2018

Here is an excerpt:

To sum up the entire debacle in a nutshell: Marketing entities would create referral ads and websites to bid on highly sought after addiction keywords, drive traffic to their call centers and send people to facilities-based purely on profit. There was no clinical or medical prescreening being conducted, no thought put into placing that individual with the appropriate level of care. Suffering addicts and alcoholics were being misled by strategic digital marketing tactics and pushed to the highest bidder. Often, these high bidders had a slew of ethical issues. This drove the cost per click for each ad through the roof, and soon enough only the Goliaths could compete on PPC (pay per click). Unless you had the money to hire an advertising agency or had an in-house marketer with extensive digital experience, there was no way to survive.

Recently, Google stepped in and placed restrictions on these ads to curb the gross abuse of the market. In September 2017, Google began to limit the kinds of ads facilities could create and just this year placed a temporary ban on all recovery ads to audit the entire industry.

The article is here.

Would You Like to See a Christian Psychologist?

By Sam Knapp, Ed.D., ABPP
Director of Professional Affairs

Some patients will request a psychologist of a particular gender, and psychologists will usually try to accommodate those concerns. For example, a female patient with sensitive sexual or gender-related issues might not feel comfortable raising them with a male psychologist, and an effort will be made to find a woman psychologist. However, is it possible to implicitly accept or endorse discriminatory practices by agreeing to other similar requests? For example, should psychologists respect the preferences of prospective patients who want to have Christian psychologists?

Some conservative Christians fear that psychologists will mock their religious beliefs or try to blame their problems on their religion. Consequently, having a Christian psychologist may be very important for them. Most non-Christian psychologists I have spoken to have received phone calls from prospective patients who ask them if they are Christian. One psychologist commonly responds, “no, but I am very respectful of Christian beliefs and will help you formulate goals consistent with your beliefs.” So far, no prospective Christian patient has ever failed to make an appointment after that conversation.

How should a psychologist respond if asked to provide a referral for a Christian psychologist? Perhaps one response would be to anticipate the concern of the patients, which is to have someone who respects their beliefs, without necessarily restricting the referrals to a psychologist who happens to be a Christian. It could be possible to respond by saying, “Psychologists are expected to respect the religious beliefs of their patients. I don’t have a list of Christian psychologists, but here are psychologists whom I know to be respectful of Christian beliefs.”

Should race, ethnicity, or sexual orientation be a factor in making a referral? On the one hand, it seems reasonable that some patients may want assurance that the psychologist they have will understand their racial or cultural background or respect their sexual orientation. It is possible to imagine a prospective patient who has not had a history of positive experiences with European Americans, or who has had a background with issues or struggles that even a sensitive European American would have difficulty understanding. Or, consider the case of a European American family who adopted an African American child who generally did well in school and at home. However, as a teenager he struggled to consolidate his racial identity and asked to speak to an African American psychologist.  It appears that race would be a relevant factor in making that referral.

On the other hand, psychologists who defer to patient preferences for race may inadvertently reinforce racist attitudes. So, the perception of the clinical relevance of the request appears important. Psychologists can decide how to respond to these requests by looking to three overarching ethical principles. First, we generally want to respect patient autonomy, including respecting their preferences in a health care professional. Second, we typically want to give patients a referral based on beneficence and nonmaleficence; that is, we want to provide a referral based on who we think can help the prospective patient. Finally, we are also guided by the overarching ethical principle of justice wherein we refuse to engage in unfair discrimination based on race, religion, gender, national origin, or other factors. Often justice is sufficiently important to trump other ethical principles.

I once had a patient who wanted a referral to a different psychiatrist because he said the one I had sent him to was not a “real American” (the psychiatrist was an American citizen of Filipino descent and highly competent). I refused to give him a new referral, and he stayed with the Filipino American psychiatrist, who was of benefit to him. In this case, the overarching ethical principle of justice trumped the other ethical principles. However, I might have responded differently if this patient were highly suicidal or homicidal. Then I would have made inquiries about his concerns, but ultimately deferred to his wish if doing so substantially reduced the risk of death.

Please feel free to contact me with your thoughts on this issue.