Featured Research

from universities, journals, and other organizations

Health-care Reform Must Respect Patient Autonomy, Experts Urge

Date:
August 5, 2009
Source:
Beth Israel Deaconess Medical Center
Summary:
As President Obama and Congress weigh changes in the nation's health-care system they must avoid creating a system where physicians are financially motivated to pressure patients into mandated treatments that conflict with their values and needs, physicians warn.

As President Obama and Congress weigh changes in the nation's health care system they must avoid creating a system where physicians are financially motivated to pressure patients into mandated treatments that conflict with their values and needs, two Beth Israel Deaconess Medical Center physicians warn.

Writing in the Aug. 6 edition of the New England Journal of Medicine, Pamela Hartzband, MD, and Jerome Groopman, MD, caution that health care reform carries with it the potential to create a clash between two recent trends in medicine – the humanism movement that focuses on individual values, goals and preferences – and the move toward evidence-based practice where data and guidelines standardize therapies and procedures.

In particular, they raise concern over the potential to include mandated rather than recommended treatment guidelines as part of Medicare reforms. Mandated treatments have been proposed as part of "value-based purchasing" and "pay for performance."

"These guidelines will have the unintended consequence of misaligning the goals of doctors and patients," they write. "Physicians will face a new conflict-of-interest: they will be financially motivated to pressure patients into accepting a mandated treatment regardless of whether it is compatible with their values or preferences or to avoid caring for patients who refuse the mandated treatment."

Not only are there serious ethical concerns about mandated guidelines, but also significant scientific limitations to this approach to treatment. "Because guidelines are derived from clinical studies carried out in selected groups of patients and their statistical conclusions are based on study populations, they may not apply to an individual patient, especially if he or she has coexisting conditions."

Hartzband and Groopman believe the skills associated with medical humanism – specifically dignity for individuals and families and the autonomy to make their own decisions – will play an even bigger role in a reformed health care universe as people who previously relied on emergency rooms or other acute care facilities are brought into the mainstream.

"These groups … are disproportionately composed of poor Americans, members of racial and ethnic minorities, recent immigrants and young adults. Complex psychological, sociological and cultural factors will challenge the successful integration of these groups into the health care system."

Yet this "shared decision-making" model of medical treatment could be on a collision course with the cost containment goals of reform. One particular area of conflict could be in decisions surrounding end-of-life care.

"As we develop scientific guidelines that reflect what will surely be highly charged conclusions about which treatments are actually beneficial at this stage, we will need to draw on medical humanism to apply information in ways that are compatible with the cultural and religious values of our diverse population.

Hartzband and Groopman suggest the concept of shared decision-making be applied to the deliberative process. All national guidelines should acknowledge dissenting opinions of experts and should indicate the specific population studied. This information is essential to enable physicians to judge how guidelines should apply to individual patients.

They also caution against the potential for guidelines to be influenced by financial support from pharmaceutical or devices companies as is allowed under current practice.

"In order to assure the public that there is no potential for a conflict-of-interest that would taint the guidelines, an independent government body should be established to develop guidelines without industry support – analogous to the role of the Food and Drug Administration as an unbiased party of the approval of treatments."

Hartzband is an Assistant Professor of Medicine at Harvard Medical School. Groopman is the Dina and Raphael Recanati Chair of Medicine at Harvard Medical School and is Chief of Experimental Medicine at the Beth Israel Deaconess Medical Center.


Story Source:

The above story is based on materials provided by Beth Israel Deaconess Medical Center. Note: Materials may be edited for content and length.


Cite This Page:

Beth Israel Deaconess Medical Center. "Health-care Reform Must Respect Patient Autonomy, Experts Urge." ScienceDaily. ScienceDaily, 5 August 2009. <www.sciencedaily.com/releases/2009/08/090805171105.htm>.
Beth Israel Deaconess Medical Center. (2009, August 5). Health-care Reform Must Respect Patient Autonomy, Experts Urge. ScienceDaily. Retrieved September 17, 2014 from www.sciencedaily.com/releases/2009/08/090805171105.htm
Beth Israel Deaconess Medical Center. "Health-care Reform Must Respect Patient Autonomy, Experts Urge." ScienceDaily. www.sciencedaily.com/releases/2009/08/090805171105.htm (accessed September 17, 2014).

Share This



More Health & Medicine News

Wednesday, September 17, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

President To Send 3,000 Military Personnel To Fight Ebola

President To Send 3,000 Military Personnel To Fight Ebola

Newsy (Sep. 16, 2014) President Obama is expected to send 3,000 troops to West Africa as part of the effort to contain Ebola's spread. Video provided by Newsy
Powered by NewsLook.com
Man Floats for 31 Hours in Gulf Waters

Man Floats for 31 Hours in Gulf Waters

AP (Sep. 16, 2014) A Texas man is lucky to be alive after he and three others floated for more than a day in the Gulf of Mexico when their boat sank during a fishing trip. (Sept. 16) Video provided by AP
Powered by NewsLook.com
Ivorians Abandon Monkey Pets in Fear Over Ebola Virus

Ivorians Abandon Monkey Pets in Fear Over Ebola Virus

AFP (Sep. 16, 2014) Since the arrival of Ebola in Ivory Coast, Ivorians have been abandoning their pets, particularly monkeys, in the fear that they may transmit the virus. Duration: 00:47 Video provided by AFP
Powered by NewsLook.com
Study Links Male-Pattern Baldness To Prostate Cancer

Study Links Male-Pattern Baldness To Prostate Cancer

Newsy (Sep. 16, 2014) New findings suggest men with a certain type of baldness at age 45 are 39 percent more likely to develop aggressive prostate cancer. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

    Environment News

      Technology News



      Save/Print:
      Share:

      Free Subscriptions


      Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

      Get Social & Mobile


      Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

      Have Feedback?


      Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
      Mobile: iPhone Android Web
      Follow: Facebook Twitter Google+
      Subscribe: RSS Feeds Email Newsletters
      Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins