Group publishes code in nick of time
Colorado pioneers statewide ethics effort
It's all in the timing. That adage certainly holds true for the Rocky Mountain Center for Healthcare Ethics in Denver. In light of recent attention on patient and physician frustration with managed care organization policies, the organization is publishing a code of ethics in the nick of time.
The Colorado Code of Ethics for Healthcare is for anyone involved in providing, receiving, or paying for health care services, says Liz Whitley, RN, PhD, executive director of the center.
"The code is meant to be a practical, everyday document, not a scholarly work of art. And this project is something that can easily be replicated in other parts of the country," says Whitley.
Committee takes charge
The first step for the center was to establish a steering committee comprised of representatives from all facets of the health care system. In turn, the 25-member committee developed a list of goals and objectives. "The committee identified more than 50 ethical issues that we collapsed into four main themes," she says.
Work groups were created for each main theme. Participants were recruited through referrals from health care providers, managed care organizations, and newspaper ads in the community. Because each group consisted of a mix of participants from different perspectives on how health care should be delivered, "it took the first couple of meetings just to get beyond the emotional aspects, and by the third or fourth meeting, the group had developed a level of trust and understanding," she adds.
The work groups submitted draft statements to the steering committee, which in turn tested the code of ethics within two health plans for the second phase of the project. The health plans then presented their recommendations to the steering committee.
The finished product, published in late September, reflects the work of more than 700 participants, notes Whitley. "The biggest component of phase three is educating the public on the document. It's not as consumer-friendly upon the first reading. We're publishing a consumer guide to the code that will provide examples of how the document is helpful to the public," she explains.
The document presents the seven principles, a value statement, and standards for each value statement. Also included are sections on how to use the code and definitions of terms used in the code. (See sample, p. 111.)
For other groups considering developing a code of ethics, Whitley suggests identifying issues from the beginning that can't be changed. "We identified three issues that we called contextual elements that are broader than the abilities of our goals."
The first issue the group identified was that health care ethics in its current state is not satisfactory for evaluation. The second issue was the multiple paradigms affecting health care delivery.
"The Hippocratic tradition is still in practice among physicians, and that conflicts with the managed care paradigm of population-based health care," explains Whitley.
"The last issue was that some social issues are more appropriately addressed at the national level, such as whether health care is an entitlement or commodity, whether health care is a benefit of employment, and coverage for the under- or uninsured. We realized we couldn't do anything about those."
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