Study: Attention to ethics needed in creating health care policy

January 13, 2014 by Rebecca Ayer

Just as the ethical standards for medical research require that scientists be aware of the effects their research has on persons in the study, researchers from the University of Georgia and Armstrong Atlantic State University argue that attention to ethical issues should be a critical component of health care policy development.

In a recent paper published online in the Journal of Gerontological Nursing, Dr. Toni Miles, professor of epidemiology and director of the Institute of Gerontology at the UGA College of Public Health, and Dr. David Adams, associate professor of health sciences at Armstrong, propose that a formal ethics review process could help anticipate the unintended consequences of new health care policies, such as the Affordable Care Act.

In 1978, the Belmont Report was published by the United States Government to provide a succinct description of the ethical principles and guidelines to be followed for research involving human subjects. The document highlighted three general principles-respect for persons, beneficence and justice-and further refined the series of international biomedical codes created after revelations of horrific medical experiments performed by Nazi doctors during WWII.

"Before the Belmont Report, a researcher could do whatever they wanted to with their human subjects," Miles said. "There was no commitment to treating patients in a humane fashion."

Today, medical research involving human subjects must be reviewed and approved by an Institutional Review Board of experts and subjects must voluntarily give informed consent to participate in research trials, Miles explained.

"The next logical stage would be to apply this same lens to the development of health care policy, especially now that we find ourselves in the midst of a movement focused on cost. The Belmont Report provides a platform for this process," she said.

Miles cited an example from the paper. "The Centers for Medicare and Medicaid Services have put policies in place that pay institutions for implementing measures that improve the quality of to its beneficiaries," she said.

One of these measures of quality is that patients over the age of 65 have a copy of their advance directive included in their chart. An advance directive, sometimes called a living will, is a legal document that expresses a person's wishes for the type of care he or she would like to receive should he or she become unable to make such decisions.

"CMS likes this advance directive policy because it saves costs on that some people don't want. Hospitals like it because they are going to get paid better for including this documentation," Miles said. "The question is does this policy pass a Belmont-style sniff test?"

In the article, Miles and Adams work through the application of the Belmont principles to current health care policies, like advanced directives. The first principle, respect for persons, requires that a policy respect personal autonomy or a person's ability to make an informed, un-coerced decision. The second, beneficence, would assess a policy for its ethical obligation to secure the participant's well-being or "do no harm." Justice, the third Belmont principle, would ask if the benefits and burdens of a policy are fairly distributed.

"Sometimes a new policy has an unintended, perverse effect and harms rather than helps," Miles said. "Medical researchers get help with this issue through the ethics review. Policy can influence the lives of so many people. There should be a process to help policy makers with this issue too."

Miles also points to the eligibility criteria for Medicaid as an area where a formal ethical review could be informative in developing better health policy.

"Is it respectful, harmless, and just to limit access? For example, young males who are unemployed are not a mandatory service group under Medicaid," Miles said. "Does this policy pass the Belmont criteria when you have a young man who cannot get a job because he has a chronic illness? Some people would argue, 'No, it's not fair and it certainly does not respect the rights of someone who is sick.'"

Explore further: Report: States can transform health care system

Related Stories

Report: States can transform health care system

January 8, 2014
The nation's governors and other state leaders can transform the current health care system into one that is more coordinated, patient-centered, of higher quality and less costly, according to a new report. The report by ...

Medicaid beneficiaries use emergency services due to lack of alternatives

December 30, 2013
A study from the University of Colorado School of Medicine shows patients with Medicaid insurance seeking care in an emergency department may be driven by lack of alternatives instead of the severity of their illness. The ...

Advance directives manage end of life care issues and reduce end of life medical costs

May 8, 2013
A new article available online in the American Journal of Public Health by two Johns Hopkins Bloomberg School of Public Health faculty makes a compelling case that end-of-life care issues need to become an integral part of ...

Experts propose overhaul of ethics oversight of research

January 23, 2013
The longstanding ethical framework for protecting human volunteers in medical research needs to be replaced because it is outdated and can impede efforts to improve health care quality, assert leaders in bioethics, medicine, ...

AAP updates medicaid policy statement with ACA changes

April 1, 2013
(HealthDay)—The implications of the expansion of Medicaid resulting from implementation of the Affordable Care Act (ACA) on children are discussed in a policy statement from the American Academy of Pediatrics (AAP) published ...

Community health centers integrate mental and medical services to address care gap

November 4, 2013
In recent years, there has been growing recognition that mental health status impacts physical health and vice versa. As a result, there is growing interest in the coordination of medical and behavioral health services as ...

Recommended for you

No evidence that widely marketed technique to treat leaky bladder/prolapse works

October 16, 2017
There is no scientific evidence that a workout widely marketed to manage the symptoms of a leaky bladder and/or womb prolapse actually works, conclude experts in an editorial published online in the British Journal of Sports ...

Ten pence restaurant chain levy on sugary drinks linked to fall in sales

October 16, 2017
The introduction of a 10 pence levy on sugar sweetened drinks across the 'Jamie's Italian' chain of restaurants in the UK was associated with a relatively large fall in sales of these beverages of between 9 and 11 per cent, ...

New exercises help athletes manage dangerous breathing disorder

October 16, 2017
A novel set of breathing techniques developed at National Jewish Health help athletes overcome vocal cord dysfunction and improve performance during high-intensity exercise. Vocal cord dysfunction, now also referred to as ...

Learning and staying in shape key to longer lifespan, study finds

October 13, 2017
People who are overweight cut their life expectancy by two months for every extra kilogramme of weight they carry, research suggests.

Blueberries may improve attention in children following double-blind trial

October 13, 2017
Primary school children could show better attention by consuming flavonoid-rich blueberries, following a study conducted by the University of Reading.

Menopause linked to changes in brain energy use

October 13, 2017
Researchers from Weill Cornell Medicine and the University of Arizona Health Sciences have found that women's brains use less energy during the menopause. The reduction in energy use by the brain was found to be similar to ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.