This document discusses ethics and bioethics in healthcare. It describes the ethical responsibilities of healthcare professionals to patients, employers, and their professions. Key ethical principles discussed include autonomy, beneficence, nonmaleficence, and justice. Professional codes of ethics provide guidance for protecting health information and patient privacy. Ethical decision making models can help analyze complex issues around topics like beginning and end of life, genetics, and the intersection of technology and medicine.

1. © 2017 American Health Information Management Association© 2017 American Health Information Management Association
Chapter 2: Introduction to the
Fundamentals of Law
Fundamentals of Law for Health
Informatics and Information
Management, Third Edition

2. © 2017 American Health Information Management Association
Law and Ethics
• Law
• Ethics
– Moral values
• Applied ethics
– Medical ethics
– Professional ethics
• Bioethics

3. © 2017 American Health Information Management Association
Ethics in Healthcare
• HIM and informatics professionals have an
ethical responsibility to
– Patients
– The profession
– Their employers
• Patient rights
– Privacy
– Confidentiality
• Unethical behavior can have same
repercussions as illegal behavior

4. © 2017 American Health Information Management Association
Ethical Theories
• Utilitarianism—Best option in any
decision is based on which choice
provides greatest advantage or benefits
the greatest number of people
• Deontology—Duty-based ethics
– Individuals should be ethical because it is
their duty

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Ethical Theories (continued)
• Right-based ethics—The primary goal of
decision making should be maintaining the
rights of every individual
• Virtue-based ethics—Seeking the good
life. An individual's positive moral
principles lead them to do positive things

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Ethical Principles
• Autonomy—Recognizing the right of a person
to make one’s own decision
• Beneficence—Doing good, promoting the
health and welfare of others, demonstrating
kindness, showing compassion, and helping
others
• Nonmaleficence—Do no harm
• Justice—Obligation to be fair in the
distribution of benefits and risks

7. © 2017 American Health Information Management Association
Examples of Ethical Principles
• Autonomy requires HIM
professional to ensure
patient, and not a spouse or
third party, makes decision
regarding access to his or
her health information.
• Beneficence requires the
HIM professional to ensure
information is released only
to individuals who need it to
do something that will
benefit patient (payment for
an insurance claim).
• Nonmaleficence requires
the HIM professional to
ensure the information is not
released to someone who
does not have authorization
to access it and who might
harm patient if access were
permitted (newspaper
seeking information about a
famous person).
• Justice requires HIM
professional to apply the
rules fairly and consistently
for all and not to make
special exceptions based on
personal or organizational
perspectives.

8. © 2017 American Health Information Management Association
Professionalism
• Professionalism—The qualities that
characterize a particular profession
– Changes based on age, education, position, or
work setting
• Conflict of interest—When a conflict arises
between personal interests and official
responsibilities or duties
– Often occurs when an individual has power to
make decisions involving finances or the
opportunity for financial gain

9. © 2017 American Health Information Management Association
Professional Code of Ethics
• Reflects the values and principles defined by
a profession as acceptable behavior within a
practice setting
• Guiding principles by which a profession
governs the conduct of its members
• Used as a benchmark for what constitutes
acceptable practice in malpractice,
negligence, or other litigious situations
• Dynamic in that they change as societal and
practice expectations change

10. © 2017 American Health Information Management Association
Examples of Professional
Codes of Ethics to Protect
Health Information
• American Medical Association (AMA)
– Code of Medical Ethics Principle IV of the code
states: “A physician shall respect the rights of
patients, colleagues, and other health
professionals, and shall safeguard patient
confidences and privacy within the constraints of
the law.”
– Chapter 3 specifically addresses privacy,
confidentiality, and medical records including
electronic data

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Examples of Professional
Codes of Ethics to Protect
Health Information (continued)
• American Health Information Management Association
(AHIMA)
– The Code of Ethics are Tenets I, III, and IV that specifically
address protecting the privacy and confidentiality of health
information and records (see figure 2.2)
– The Health Information Bill of Rights for protecting
healthcare consumers lists seven measures designed to
• Safeguard an individual’s right to lawful access of their personal
health information
• Prevent unauthorized access to that information
• Promote its best possible accuracy
• Seek proper remedy when any such privilege is violated

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Examples of Professional
Codes of Ethics to Protect
Health Information (continued)
• American Medical Informatics Association
(AMIA)
– The Code of Professional Ethical Conduct
specifically addresses use of patient information
in its first ethical guideline and also offers ethical
guidance as related to patients, employers,
colleagues, society, research and general
performance (see figure 2.3)
– Addresses ethical issues of vendor-user contracts
related to EHR systems, associated devices and
health-related software applications

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Ethics Committee
• Provides a standardized approach to ethical
decision making in the healthcare
organization
• Members analyze ethical decisions and make
recommendations
• Must take into consideration the mission and
vision of the healthcare organization as well
as any applicable laws and regulations

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Making Ethical Decisions
• 7 step ethical decision making model
1. Define the problem
2. Seek out relevant assistance, guidance and
support
3. Identify alternatives
4. Evaluate the alternatives
5. Make the decision
6. Implement the decision
7. Evaluate the decision

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Making Ethical Decisions
• 3 step Blanchard-Peale ethics check
1. Is it legal?
2. Is It balanced?
3. How will it make me feel about myself?

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Bioethics
• When ethical issues arise as a result of
advancements in technology leading to
disease detection, medication
interventions, and enhanced treatments
• Often subject of much debate as the fields
of biology and technology intertwine
• Dilemmas often are seen in beginning and
end of life stages of treatment

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Bioethics—Beginning of Life
• Procreation—The beginning of life
• Many ethical issues surround the creation
of life
– In vitro fertilization
– Embryonic stem cell research
– Contraception and sterilization

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Bioethics—End of Life
• End of Life often presents ethical issues in
terms of:
– Terminal patients who wish to forgo treatment
– Hospice care—Palliative care to make
terminally ill patients more comfortable
– Euthanasia
– Conflict between a patient’s wishes and their
family or loved ones’ wishes

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Bioethics—Genetics
• Technology has advanced the discovery of
genetic codes and research focuses on
identification of diseases at the genetic level
• Gene testing and gene therapy can be
ethically challenging for patients and families
• Production of more genetic information
requires additional protection of that specific
data

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Law and Ethics
• Professional codes of ethics impose a duty on
healthcare professionals to conform to
professional standards of practice.
• As patients and professionals are presented with
ethical decisions, utilizing standardized decision
making models can be beneficial in considering all
influences, avenues, and barriers to make the best
decision.
• Advancements in science and technology now and
in the future continue to create ethical issues for
both patients as well as HIM professionals.