Discrimination in Healthcare.pptx

Discrimination in
Healthcare
Prepared by Deus Mugume,
U/23030014/MDU.
MAY, 2023.
1
DEUS MUGUME U/23030014/MDU.

Definition.
• Discrimination in the healthcare setting can be defined as negative actions
or lack of consideration to an individual or group that occurs because of a
preconceived and unjustified opinion.
• Doctors take an oath to treat all patients equally, and yet not all patients
are treated equally well. The answer to why is completed!
• We now recognize that racism and discrimination are deeply ingrained in
the social, political and economic structures of our society.
• For minorities, these differences result in unequal access to quality of
healthcare and education, healthy food, livable wages and
affordable housing.
• In the wake of multiple highly publicized events, movements have come up
to address this ingrained, or structural, racism, as well as implicit bias.
2

Introduction
• The ethical principle of justice concerns closely intertwined concepts such
as “justice in health,” “discrimination,” and “equity.”
• The European Institute of Bioethics defines the concepts of justice and
equity in health as follows: “justice in health means the lack of systematic
and potentially resolvable differences in one or more aspects of health in a
population and economic, social and geographical subgroup.”
• Accordingly, discrimination is the opposite of justice in health-care
provision.
• Discrimination in health care means a lack of provision, incomplete
provision, or different provision of health care to an individual or group of
individuals because of their individual and social characteristics.
• Discrimination in health care is experienced by many in the community, but
reported only by some, most of whom are minorities in terms of race,
ethnicity, or certain diseases or conditions, such as physical and mental
disability.
3

Introduction; cont'd.
• In explaining the current situation, Javier & Luis (2013) reported three
common forms of discrimination in health care in the EU member states,
namely, age, sex, and disability discriminations. Among European
countries, Britain and Cyprus had the highest and lowest reports of
discrimination in health care, respectively. Low income and high-school
education were among the factors blamed for discrimination in health
care.
• Various organizations, particularly the WHO, have designed and
implemented various strategies to combat discrimination in health care
such as continuous education of ethical principles for health-care
providers, continuous review of health-care policies, supporting
community members, and emphasizing their reporting in case of
experiencing discrimination in clinical settings but discrimination continues
to occur in health-care provision.
4

Introduction; cont'd.
• Discrimination in health care has significant consequences, and one
of the most important of these consequences is visitor’s and patients’
loss of confidence in medical staff. Other important consequences
include exposure to stress and experience of further tensions- with
their specific complications, anxiety, depression, rising blood
pressure, and even risk factors for developing certain health problems
such as obesity, breast cancer, and drug abuse.
5

Classifications.
• Unintentional discrimination including forced discrimination, guided
discrimination, and lack of resources. In this study, the participants
emphasized that they unintentionally discriminate health-care
provision to patients due to various factors, including managers’
pressure and lack of resources, as well as professional challenges such
as lack of medical ethics knowledge.
• Forced discrimination category indicates that health-care providers are
forced to discriminate in health-care provision to maintain their jobs or
to comply with orders. This category was formed based on the
subcategories of:
> superiors’ pressures and executive orders.
> occupational concerns.
> fear of the superiors, based on the analysis of initial codes.
6

Classifications.
• Guided discrimination category refers to the fact that lack of professionalism in
medical science, which can be attributed to failure to explain ethical codes as well
as the lack of knowledge and training on the principles of medical ethics for
physicians, nurses, and other health-care providers, which made
health-care providers to have discriminatory behaviors. This category has three
subcategories of professional challenges, managers’ policymaking, and lack of
medical ethics knowledge.
• Lack of resources: This category refers to the resources needed to provide health
services, but when these resources are defective or scarce, the health-care
provider is unintentionally forced to discriminate. Two subcategories of
discrimination due to workforce shortage and lack of medical equipment
emerged from the data analysis.
7

Classifications.
• Everyday discrimination in medical centers: This subcategory includes the
discriminatory provision of medical services by physicians, nurses, and other
health care providers to patients with different conditions. In fact, health service
providers declared this as a normal, and even inseparable, part of providing
health care in medical centers.
• Ignoring patient rights: This subcategory is concerned with patients experiencing
a lack of attention from medical staff during doctor’s visits and in matters such as
patient’s condition and appointment time when patients attend medical centers
and clinics to receive outpatient medical services. After such an experience,
patients attempt to establish contact by searching for an acquaintance in these
medical settings.
• Lack of trust in medical staff:In this subcategory, the participants stated that until
there is total trust between medical staff (including physicians and nurses) and
patients, discrimination between patients will persist in medical settings. In fact,
patients not trusting physicians’ and nurses’ performance look for a mediator to
be assured of the performance of health care providers.
8

Classifications.
• Expectations of associates: In this subcategory, medical staff
described their discriminating conduct toward patients because of
previous acquaintances with some of them, as well as the
expectations of these acquaintances to receive exclusive and more
health services.
• Respect for colleagues and friends: In this subcategory, medical staff
(physicians and nurses) cited their friendly relationships with
colleagues and their desire to maintain mutual respect and
relationship with colleagues as the grounds for discriminating
between patients in particular situations. When colleagues or their
family members were hospitalized, the staff treated them differently
compared to other patients and argued that the reason for providing 9

Classifications.
• Possibility of the occurrence of similar situations: This subcategory
concerns the possibility that medical staff or their family members
may find themselves in a situation where their colleagues in other
medical centers could provide them with preferential and different
care compared to other patients. Bearing this possibility in mind,
medical staff provide their colleagues with preferential care. In fact,
based on the idea that the same could happen to them, physicians,
nurses. and other medical personnel provide different and fuller
medical and nursing care compared to what they do for ordinary
patients.
• Reciprocating people’s favors: According to this subcategory, the
medical staff show discriminatory behaviors in providing preferential
care and services to reciprocate for favors they have received from 10

Classifications.
• Shortage of medications and medical facilities and equipment: In this
subcategory, shortage of medical equipment such as ventilators and ICU beds and
also vital medications, on which patients’ health depends, creates a situation in
which these services are provided preferentially to people who are in a particular
condition or are associated with or recommended by a particular person or
organization. The shortage of medical equipment also causes physicians and
nurses to unintentionally differentiate between patients.
• Heavy workload: The shortage of physicians, nurses, and other health service
providers leads to non-provision of the necessary care and even reduced quality
of services and subjects the medical staff to heavy workloads. This forces them to
discriminate in providing health care.
• Lack of access to physicians: In this subcategory, based on their experiences,
nurses cited a lack of access to physicians as one of the reasons for discrimination
between patients. Since the probability of a patient’s family members meeting
the physician is usually very low, they try to find other ways to be more in touch
with the physician.
11

Classifications.
• Medical centers’ infrastructure: In this subcategory, serious deficiencies, mainly physical,
in the infrastructure of medical centers were identified as a facilitator of discrimination in
health care. Congestion of visitors seeking outpatient clinical and paraclinical services,
caused by inefficient queuing systems, unsuitable physical conditions, and similar factors,
drove visitors to seek medical services through other means.
• Discrimination in care because of ethnicity: This subcategory mentions that medical
staff regard ethnicity as a factor in providing medical care and provide better services to
people of their ethnicity.
• Favoritism as a common practice: This subcategory mentions favoritism by the staff, as
well as by patients and visitors to health care centers, as a common and normal way of
receiving medical services, so that the first thing visitors do in order to be hospitalized
and receive services is to find an acquaintance, who will ultimately accelerate the
provision of health services.
• Favoritism as the ultimate solution to treatment problems: This subcategory points out
that recipients and providers of medical services consider finding an acquaintance a
strategy and a solution to their problems. The patient and medical staff both believe that
having an acquaintance could help them in medical settings.
12

• The basic dilemma regarding the scope of patient autonomy relates
to patients who demand that their healthcare provider be of a certain
race or ethnic group.
• The American College of Physicians’ Ethics Manual affirms that “a
patient is free to change physicians at any time.”
• The American Medical Association’s Code of Medical Ethics similarly
affirms a patient’s right “to a second opinion” and “reasonable
assistance in making alternative arrangements for care,” if changing
care.
• To the extent possible, hospitals should try to accommodate such
reasonable requests, whether they are based on religious beliefs,
cultural norms or personal values.
13

Standard Code of Ethics.
• The Code of Ethics is clear in its expectations for healthcare providers
and practitioners in terms of discrimination.
• Healthcare providers are called to promote “a culture of inclusivity
that seeks to prevent discrimination on the basis of race, ethnicity,
religion, gender, sexual orientation, age or disability.”
• In relationship to their respective responsibilities to the clinical
setting, they are to “avoid practicing or facilitating discrimination and
institute safeguards to prevent discriminatory organizational practice.
14

Discrimination’s Effect on Staff.
• However, other types of patient requests or demands regarding their
choice of caregiver seem less ethically clear. One example is when a
patient demands that his or her caregiver be of a specific race due to
racist beliefs.
• Consider a white male patient who demands that his ED physician not
be African-American or a Christian female who requests that no
caregivers of Muslim faith be involved in her care while in the hospital.
• Discrimination in healthcare is an unpleasant topic. Yet, like other
disturbing issues that resonate in our society, we need to address
discrimination’s impact on clinical care and the delivery of healthcare.
15

• Such situations raise challenging ethical and legal issues and affect
the caregiver-patient relationship. Hospitals that stipulate policy that
requires clinicians to fulfill such patient requests pose a dilemma, as a
hospital leader would neither want to condone discrimination nor
allow doctors to fail to provide appropriate care.
• In addition, hospital caregivers may experience moral distress when a
patient expresses preferences based on discriminatory thinking. The
presence of moral distress can have a major impact on morale and
staff burnout.
• With the emphasis on patient-centered care has come related ethical
concerns that ask the question, are there limits to a patient’s
autonomy?
16

Organizational Response to Discrimination.
• Because these sorts of encounters occur in the context of a healthcare
organization, administrative and clinical leaders have an important role to
play in addressing this concern.
• Practice guidelines can unify responses in patient-care decisions and
contribute to staff morale by offering a comprehensive approach for
responding to these situations.
• Their guidelines describe clear cases involving either patients who are
medically stable or those who lack decisionmaking capacity.
• A key factor in determining whether to accommodate is the availability of
resources. Some healthcare settings, such as small, rural or critical access
hospitals, have limited medical personnel and resources to meet this
demand.
• A medically stable patient can accept the available resources or agree to be
transferred to another facility that can accommodate the demand.
17

• Another potential disqualifier for accommodation is when a stable
patient absolutely refuses to negotiate or compromise his or her
discriminatory position and is verbally abusive in the exchange.
• If all staff approaches for accommodation have been exhausted, the
patient has been warned not to abuse staff and he or she continues to
be uncooperative, then the patient may be deemed as undeserving of a
replacement caregiver.
• “No ethical duty is absolute, and reasonable limits may be placed on
unacceptable patient conduct.” Unfortunately, no algorithm can provide
easy answers to these complex clinician scenarios.
18

• The concept of patient-centered healthcare is challenged by
discriminatory patient demands. Healthcare professionals have an
ethical responsibility to ensure that patients receive needed care.
• As frustrating as it may be for clinical staff, meeting the patient’s
healthcare need may include attempting to accommodate the patient’s
discriminatory demand by transferring the patient to another provider.
• Organizational practice guidelines can provide ethical and legal guidance
to caregivers for identifying and resolving those rare situations in which
refusing discriminatory requests is justified.
19

Guidelines for Addressing Discrimination Among
Patients.
• Recognize that discrimination exists in the delivery of healthcare and
that it creates moral stress and uncertainty for staff.
• Develop practice guidelines to assist clinicians. The guidelines should
be carefully written based on the thoughtful advice of legal counsel, an
ethics committee, human resources, administration and clinician
services representatives. Practice guidelines can promote a consistent
response to discriminatory demands.
• Develop an education program to familiarize staff with the ethical and
legal underpinning of the practice guidelines. Training should cover
how to effectively communicate and negotiate with patients who
express discriminatory demands.
20

Guidelines for Addressing Discrimination Among Patients
• Ensure that helpful resources, such as an ethics committee or risk-
management staff, are readily available when clinicians face challenging
situations.
• Assess the practice guidelines and any related programs to determine if
they foster a consistent ethically and legally grounded approach to patient
centered care and address staff’s uncertainty and stress. Whenever such a
patient encounter occurs, a retrospective review should be undertaken to
evaluate what was done well and what could have been better.
• This evaluation process can improve future patient-staff encounters
when the issue recurs. It also benefits the involved parties and creates a
culture of open reflection. Reprinted with permission.
21

END.
ASANTENI.
22

Discrimination in Healthcare.pptx

Recommended

Recommended

More Related Content

Similar to Discrimination in Healthcare.pptx

Similar to Discrimination in Healthcare.pptx (20)

More from Josephmwanika

More from Josephmwanika (14)

Recently uploaded

Recently uploaded (20)

Discrimination in Healthcare.pptx