Ethical Dimensions in Health
The HIPPA privacy regulations were formulated to safeguard patients personal health information in the possession of entities covered by the act and provides patients with an assortment of rights in relation to their medical information. Simultaneously, the privacy regulations have been balanced so that it accommodates the disclosure of critical, personal health information required for optimum patient care and other essential functions. To enhance the efficiency and usefulness of the medical care system, HIPPA 1996, incorporated administrative simplification stipulations that necessitate the department of health and human services to espouse national standards for digital medical care transactions and canon sets, exclusive health identifiers and safety (HIPAA, 2011).
HIPPA seeks to develop standardized mechanisms for digital data exchange, safety and confidentiality of all medical care related data. The Act dictates; regulated formats for all patient medical, administrative, and monetary data; distinguished identifiers for each medical care entity, including persons, employers, health schemes and health care givers. They also include security measures to ensure privacy and data integrity for and data that identify a person. HIPPA categorically addresses matters concerning the privacy of the patients, safeguarding all identifying information such as an individual’s name, date of birth, persona phone number and social security registration number. Under this new regulation, patients will be required to give or provide a written consent before any of their private information can be shared with a third party. The Act dictates that patients have a right to access and make changes to their own health records. The exception considered to be in relation to psychiatric records. Patients will also be required to fill official forms indicating the changes they want to make and the reasons that led them to make the changes (HIPAA, 2011).
The Health Information Technology for Economic and Clinical Health Act (HITECH) was part of the section of the American recovery and reinvestment Act (ARRA) enacted in 2009. HITECH widens the scope of confidentiality and security regulations already encompassed in the HIPPA act. This legislation also increases the legal liability for not complying the legal provisions and provides stringent enforcement. HITECH necessitates data breach notification for unsanctioned uses and disclosures of personal medical information that is not secured. These breach notification stipulations are similar to many state breach regulations related to individually identifiable information. For medical care providers with digital health records systems in place, it mandates that patients have a right to view their personal health records or data. The patients can permit the sharing of the medical information with a third party at a fee which is equivalent to the labor cost of production. Additionally, HITECH has transformed it such that business associates like billing firms, law agencies and accounting firms of institutions subject to HIPPA, for example, pharmacies and health care givers will also be subjected to similar regulations. The Act provides that, by the year 2011, health care givers will be provided with financial subsidies for illustrating meaningful application of electronic health records. Incentives will be available until 2015, after which fines might be charged for failing to show such application. The Act also creates grants for educational centers for the staff required to support a medical information technology infrastructure (Brokel, 2010).
Traditionally, institutional and legal regulations have concentrated upon disclosure of information from the medical care giver to the patient, apart from the two way interaction that has described by some scholar as shared decision making. Constricted interpretations of consent that comprise of one way channel of information from the doctor to the patient result in unsatisfactory, naive model of information communication, which takes the form of health providers talking ‘at’ and not ‘with’ patients. This has resulted into considerable misinterpretation of consent in the medical practice context. Consent is commonly referred to as a deed such as a patient consenting. Viewed from this perspective, the purpose of consent is to avoid litigation and follow institutional guidelines instead of improving communication with clients. Such an understanding usually results to a perfunctory methodology to consent (Purtilo & Doherty, 2011).
Consent is better perceived as two way traffic of shared and informed decision making process. This framework maintains as its core focus the independence and the interests of the patient but evades a naive health professional-patient separation of labor and the division between facts and information while, on the other hand, beliefs, choices and likes. This framework acknowledges that health professionals are not just value-neutral givers of evidence related to diagnosis, treatment and prognosis options but are autonomous moral agents with well structured professional roles. Decision making is unequivocally shared because each person brings their own convictions and knowledge to the therapeutic association. Clinical, ethical practice requires much more of the medical professional as compared to superficial identification of the patient’s self- fortitude. Whereas consents may be superficially perceived as acting, an authentication of an intervention, in a broader sense it is a core and continuing part of the phases of shared decision making. From this point of view, the development of legal regulations of disclosure, and better organizational guidelines for consent might be less significant than making sure that professional training includes the learning of efficient communication skills and associated values to all medical care professionals (Purtilo & Doherty, 2011; Curtis, 2002).
Appropriate administration of ethical issues in medical care is critically dependent on competent communication amongst health professionals, members of the medical team, the patient and the patient’s family. Communication is a dynamic process and various factors, including the immediate environment, constraints of time, training in communication skills and disparities between the medical professionals and patients in level of education, social status, cultural backgrounds, age, sex, social morals or convictions have a lot of influence on the quality of interaction. Not only does the failure of communication erode the quality of and gratification with medical care, it also increases the probability of litigation as a result of adverse occurrences. Disappointingly, hospitals and health care institutions rarely provide an ideal environment in which interaction can easily occur. It is critical that health professionals should know how to pay attention to patients, to acknowledge their autonomy, to offer time for reactions and to respect and acknowledge cultural diversity where they are manifested. Conflict usually arises between the patients and health care providers when health workers insist that, in the interest of the patient, a blood transfusion should be carried out. The patient and family will strongly object to this and will not be willing to submit a written consent to this effect. The law allows patients to reject any medical procedures or treatment, despite the fact that many health practitioners find it hard to accept it. Three strategies, coercion, deception and mutual trust, are applied to solve the conflict. Coercion is evident when the courts grant the parent autonomy, and fail to give the same treatment to children. Deception is used where doctors make transfusions and never inform the patients. The shared decision making structure argues that, in most cases, coercion and deception cannot be justified because they undermine the patient- doctor relationship (Curtis, 2002; Kerridge, Lowe & McPhee, 2005).
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