Ethics: What Choices Do I Make?

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By Miki Fairley

Are you a good person?

Most people would say, 'Yes,' since we like to think of ourselves as good people. But do we always make sound ethical decisions? In a complex world, this is not always easy. Examining the ethical system we are operating within will help us make better decisions, noted Dr. Wilton H. Bunch, MD, PhD, MBA, in an interview with The O&P EDGE. He brings a unique perspective to ethics as it relates to medical practice and the allied health professions, since he has been a pediatric orthopedic surgeon, a past president of the Scoliosis Research Society, dean of a major university, and holds a degree in divinity.

Bunch noted that prosthetists and orthotists have generally thought of themselves as medical personnel bound by the ethics of "always do what's right for the patient." However, with the change in healthcare reimbursement and stronger competition, they are increasingly under pressure to think of themselves as businessmen. "The conflict between these two very different needs pose the most difficult questions in P&O," Bunch added.

Different Ethical Systems

There are three distinct ethical systems, Bunch said. The first is: "What does it mean to be a good person? What would a good person do in this situation?" Most of us gain our ideas on what makes a good person by observing someone we consider as a good person-for instance, our mothers, Bunch explained. We note how they react to situations and then we do the same. Unconsciously, we think, "She is a good person and this is what she does; therefore, this is what good people do." We don't always think our ideas out well; what we consider as what a good person does depends on who we are and what we have accepted as good.

Another system of ethics is based on "I always follow the rules."

Illustrating this, one driver stops at a red light because he is thinking, "I don't want to hit someone and hurt them." He's following the system of "what does a good person do." Another driver stops at the red light because it's the law. They both performed the same action but for different reasons.

A third system of ethics is consequential: "If the result is good or at least not harmful, then the action is ethical." A person following a consequences-based ethical system will say, "You weren't hurt by my actions, so they weren't unethical." In contrast, a law-based person might respond, "But you still broke the law."

"Most of the time, people have a preferred system, but will occasionally operate in a different system," Bunch said. "For instance, suppose you generally follow the 'good person' system, but a situation comes up in which you don't know what a good person would do, so you decide to do what the law says."

Consequences-based ethics can be a good choice sometimes, Bunch noted. "In medicine, you want a surgeon who thinks about consequences or outcomes." Consequences are important to a prosthetist/orthotist: "You want this person to walk better because of the device you provided."

Sometimes one hears about physicians who lie to insurers in order to obtain the care the doctor feels the patient needs, but which the insurance won't cover. Is this ethical? To the consequences-based physician, the answer might be 'yes," since the patient will have a better outcome. However, to the law-based person, and also possibly to the person following the 'what would a good person do, the answer would be "no, it's wrong to lie." Bunch commented, "This is an example illustrating the three systems."

There aren't black and white answers in every case, Bunch pointed out. For instance, most prosthetists and orthotists see themselves as caring persons wanting to help. But suppose someone has a need and no funds. The practitioner with the highly profitable business might say, 'No problem-I can provide charity care sometimes." However, the practitioner who is barely scraping by might make a different choice.

"I don't necessarily come up with all the answers, but I want people to think about their motives, their business, and what they would do if they find themselves in certain situations," Bunch said.

He concluded, "Almost all people make better ethical decisions if they have a chance to think about them."