PUBH6597: Legal & Ethical Considerations in Health Services Organizations

The course is oriented to current and future healthcare professionals and administrators who have not had previous academic exposure to legal theory, caselaw, statutory interpretation or health law related issues, and those who may or may not have previous coursework in ethics or moral philosophy. The course presents an overview of the American legal system and some of the ethical and health law issues health care leaders confront in health care service organizations. Although this course introduces basic areas of American health law and ethics, the course will emphasize contemporaneous legal and ethical issues arising in the course of everyday work of a health care leader in a health organization. Health care is one of the most heavily regulated and legally complex industries in the United States. The course begins with a short introduction to ethics as compared with and contrasted to the American legal system and its weighing of policy values, legal precedent and intertwining of judicial, statutory and regulatory authorities. In particular, we will examine how disparities in health outcomes are created or exacerbated by these legal structures and systems and explore the ethical ramifications that result. We will explore how the law affects the internal governance and decision making processes of health care organizations, while identifying ways that decisions made solely on the standards found in legal authorities often falls short of accounting for important ethical issues and values that arise in health care situations. Examples of specific areas we will explore include the ethical considerations or expectations and legal duties: • In multiple contexts between an individual and a provider, a health plan, or an employer, especially with respect to perceptions or values of power, duty and autonomy; • Confidentiality, patient privacy and data security and their limits; • Unique standards imposed in health care transactions to prevent fraud or behaviors deemed unethical or inappropriate, such as anti-trust, false claims and anti-kickback laws; • Obligations or expectations to provide care, especially with respect to uninsured patients and those with emergency medical conditions; • Quality and safety of care including malpractice, doctrines of negligence including community standard of care, disclosure of mistakes or adverse health events; • Values and laws regarding health plan and benefit design, including interpretations and perspectives of what constitutes and who decides what is “medically necessary;” and • Care decision making including informed consent and end-of-life decisions. Health care situations raising complex legal and ethical issues involve competing perspectives, values or interests in topic areas that can be controversial in nature. This course does not aim to resolve those controversies or reach conclusions about which perspectives or interests have more merit than others. Instead, the course and our discussions will seek to highlight the tensions and balancing of interests that often underly ethical considerations and guide the legal analysis in specific situations, and how these different perspectives and interests lead to changes in society’s perceptions of ethics and its laws, and in some circumstances, to litigation as parties attempt to resolve disputes and establish ethical norms between competing interests.

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