The Road To Ethical Decision Making Guidelines
By Sharon J. Randolph, JD, RHIA

In January 2000, I was asked to be a contributing author of a book chapter for a new textbook for HIM programs. The textbook publication is titled "Ethical Challenges in the Management of Health Information". The majority of the contributing authors are HIM professionals with experience in traditional and non-traditional roles. Chapter topics include privacy and confidentiality; compliance, fraud and abuse; coding; quality review; research and decision support; public health; managed care; electronic patient record; drug, alcohol, sexual, and behavioral health information; information security; software development and implementation; e-health; genetic information; adoption information; entrepreneur. After receiving a copy of the publication, I reviewed a number of the chapters. My main reaction to the book was it should have been written for HIM practitioners, because at some point on our professional career, we have been challenged with making ethical decisions. Some have been easy and some have been rather difficult. Hopefully, when we were faced with the challenge, we made the right ethical decision.
Reviewing this book from the standpoint as a good source of reference, the chapter that has gotten me to rethink my approach to addressing/resolving ethical issues was on ethical decision making guidelines. The author recommends a seven-step process when faced with making an ethical decision. They are as follows:

Step 1: Identify the ethical question
o What is being asked of me to do or not to do
o When the question is not clear cut, look at what should or ought to happen according to norms or standards

Step 2: Determine the facts in the case
o Known facts - what is already available
o Facts to be gathered - what additional facts are needed to make an informed intelligent decision

Step 3: Determine what values are at stake from the perspectives of all stakeholders
o Identify who are the stakeholders (those who will be affected by the decision to be made)
o What is their perspective - what do they have to gain or lose

Step 4: Identify the available options in the case

Step 5: Determine what you should do, based on the best available data (best available documented facts and additional facts gathered)

Step 6: Justify your choice by providing reasons to support it based on values at stake
o Example - coding based on documentation in medical record vs. upcoding for maximum reimbursement for the hospital

Step 7: Explore how this ethical problem might have been prevented
You may want to ask yourself:
o Am I keeping my knowledge and skills up-to-date on coding guidelines to address most coding issue
o Am I up-to-date on the newest state and federal regulations/requirements (HIPAA, Patient Privacy)
o Do I support my institution's philosophy on specific compliance issues

By incorporating this seven-step process you may feel more confident in addressing the ethical challenges that will present themselves in your professional career.

Reference: Ethical Challenges in the Management of Health Information by Laurinda Beebe Harman, PhD, RHIA, Aspen Publishers, Inc., 2001, pp. 25-38.

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