Legal

Discuss how the federal statutes protect individual’s rights (e.g. privacy and self-determination) 230 words

Chapter 7

Government Ethics

and the Law

William A. Myers, Ph.D.

Learning Objectives (1 of 2)

• Describe some of the reasons why there has

been a loss of trust in government.

• Explain the purpose of various government

committees on ethics.

• Discuss how public policy protects the rights of

citizens.

Learning Objectives (2 of 2)

• Describe federal laws designed to protect each

individual’s rights.

• Explain the concept of political malpractice.

• Understand the importance of ethics in public

service.

Let every American, every lover of liberty, every

well wisher to his posterity, swear by the blood

of the Revolution, never to violate in the least

particular, the laws of the country; and never to

tolerate their violation by others.

—Abraham Lincoln

Executive Branch:

U.S. Office of Government Ethics

• Exercises leadership in the executive branch to

prevent conflicts of interest.

• Resolves those conflicts of interest.

• Fosters high ethical standards for employees.

• Strengthens public confidence in government

business.

House of Representatives:

Committee on Ethics

• Designated the “supervising ethics office” for the

House of Representatives.

• Only standing committee of the House of

Representatives with membership divided

evenly by party.

Committee on Ethics:

Common Ethical Issues (1 of 2)

• Gifts from outside sources

• Gifts between employees

• Conflicting financial interests

• Remedies for financial conflicts of interest

• Impartiality in performing official duties

• Seeking other employment

Committee on Ethics:

Common Ethical Issues (2 of 2)

• Misuse of position

– Outside activities

– Post-employment

– Representation to government agencies and

courts

– Supplementation of salary

– Financial disclosure

Senate: Select Committee on Ethics

• Authorized to receive and investigate

– Allegations of improper conduct that may reflect upon

the Senate

– Violations of law

– Violations of the Senate code of official conduct

– Violations of rules and regulations of the Senate

– Recommend disciplinary action

– Recommend additional Senate rules or regulations to

ensure proper standards of conduct

– Report violations of law to federal and state

authorities.

Office of Congressional Ethics

• Independent, nonpartisan office

• Governed by a board composed of private

citizens

• Provides more public review and insight into the

ethical conduct of members of the House of

Representatives

• Mission is to assist the House in upholding high

standards of ethical conduct for its members,

officers, and staff.

U.S. Judicial Code of Conduct

• Provides guidance for judges on issues of

– Judicial integrity and independence

– Judicial diligence and impartiality

– Permissible extrajudicial activities

– Avoidance of impropriety or even its

appearance

Public Policy: A Principle of Law

Principle of law that holds no one can lawfully do

that which tends to be injurious to public.

Sources of Public Policy

• Legislation

• Administrative rules, regulations, or decisions

• Judicial decisions

• Professional code of ethics may contain an

expression of public policy

Sources of Public Policy:

Veterans Administration

• House Committee on Veterans’ Affairs

– Reviews veteran programs

– Examines current laws

– Reports bills and amendments to strengthen

existing laws concerning veterans and the

Department of Veterans Affairs (VA):

• Health care and disability compensation

• Headlines suggest failure in providing

health care

Laws Influence Ethical Principles:

Protecting Individual Rights (1 of 2)

• 1868: Fourteenth Amendment to U.S.

Constitution

• 1964: Title VI, Civil Rights Act of 1964

• 1890:

Sherman Antitrust Act

• 1974: Privacy Act

• 1996: Health Insurance Portability and

Accountability Act

• 1986: Emergency Medical Treatment and Active

Labor Act

Laws Influence Ethical Principles:

Protecting Individual Rights (2 of 2)

• 1986:

Health Care Quality Improvement Act

• 1989: Agency for Healthcare Research and

Quality

• 1989: Ethics in Patient Referral Act

• 1990:

Patient Self-Determination Act

• 2002: Sarbanes-Oxley Act

• 2010: Patient Protection and Affordable Care Act

Fourteenth Amendment

to U.S. Constitution
States

– Cannot deny any person equal protection of

law.

– Shall not make or enforce any law which shall

abridge privileges or immunities of citizens.

– Shall not deprive any person of life, liberty, or

property, without due process of law.

– Shall not deny any person equal protection of

laws.

Title VI: Civil Rights Act of 1964

• Racial discrimination prohibited.

• HHS program discrimination prohibited.

Sherman Antitrust Act

• Contracts in restraint of trade illegal

• Areas of concern for health care

– Reduced market competition

– Price-fixing

– Preferred-provider arrangements

– Exclusive contracts

Privacy Act of 1974

• Safeguards individual privacy

• Provides individuals access to records

• Established Privacy Protection Safety

Commission

Health Insurance Portability

and Accountability Act

• Designed to protect the privacy, confidentiality,

and security of patient information.

• Standards are applicable to all health

information in all of its formats:

– Electronic

– Paper

– Verbal

Emergency Medical Treatment

and Active Labor Act

• Hospital emergency departments are

– Required to provide an appropriate medical-

screening exam.

– Forbidden to “dump” patients from one

emergency department to another.

Case: EMTALA Violated (1 of 2)

In Burditt v. U.S. Department of Health & Human

Services, EMTALA was violated by a physician

when he ordered a woman with dangerously high

blood pressure (210/130 mm Hg) and in active

labor with ruptured membranes transferred from

the emergency department of one hospital to

another hospital 170 miles away.

Case: EMTALA Violated (2 of 2)

• What are the main issues in Burditt?

• What ethical theories, principles, and values are

of concern? Describe them.

Health Care Quality Improvement Act

• Restricts ability of incompetent physicians to
move from state to state without disclosure of
incompetence.

• Provides professional review bodies limited
immunity from damages.

• Facilitates exchange of information among
professionals conducting peer review.

• Protects physicians improperly subjected to
disciplinary action.

Agency for Healthcare

Research and Quality

• Improve quality of health care

• Reduce healthcare costs

• Broaden access to essential healthcare

services

Ethics in Patient Referral Act

• Prohibits physicians who have ownership

interest or compensation arrangements with

clinical lab from referring Medicare patients to

that lab.

• Requires Medicare providers to report names

and provider numbers of all physicians or their

immediate relatives with ownership interests in a

provider entity.

Patient Self-Determination Act

• Right to be informed of rights.

• Right to execute advance directives.

• Right to accept or refuse medical care.

• States required to provide description of state

laws regarding advance directives to providers.

• Providers ensure written policies and

procedures regarding advance directives are

established.

Sarbanes-Oxley Act

The Sarbanes-Oxley Act was signed into law by

President Bush on July 30, 2002, in response to

the Enron debacle and high-profile cases of

corporate mismanagement.

Sarbanes-Oxley Act:

Promoting Due Diligence

• Act is not about regulation; it is about self-
regulation.

• Selecting a leader with morals and core values.

• Examining incentives.

• Monitoring the organization’s culture.

• Building a strong, knowledgeable governing
body.

• Searching for conflicts of interest.

• Focusing attention on the right things.

• Having the courage to speak out.

Sarbanes-Oxley Act:

Know Your Moral Values

• Be willing to stand up for them.

• Be prepared to pay the cost.

Sarbanes-Oxley Act: The “System”

Do not think lightly of evil, saying, “It will not come

to me.” By the constant fall of water drops in a

pitcher, a pitcher is filled, accumulating evil little by

little, becomes full of evil.

— Buddha, Dhammapada, verse 121

Patient Protection Affordable Care Act

• A federal statute that contains a set of

healthcare reforms passed by Congress and

signed into law by President Barack Obama on

March 23, 2010.

Hope remains that ethics will become something of

value that is practiced both in the workplace and in

one’s personal life. It is more meaningful than a

word to discuss, a book to read or a course of

study.

Ethics in Practice

Political Malpractice

• Political malpractice is the negligent or unethical

conduct on part of an elected official.

1. Duty to care

2. Breach of duty

3. Injury

4. Causation

• Foreseeability

– Nonaction seems to be harming the nation

(e.g., Veterans care)

Review Questions

1. Discuss how the various branches of

government address ethical issues.

2. Discuss how public policy protects individual

rights (e.g., privacy and self-determination).

3. Discuss the legal and ethical implications of the

public policy acts presented here.

4. Describe how the concept of “political

malpractice” is similar to “medical malpractice”

as discussed in this chapter.

5. Should the role of an ethics committee be

expanded from one of consultation to that of a

decision-maker? Support your position. Here

there is no right or wrong answer, but a better

answer.

Review Questions