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Ethical Dilemmas in Managed Care One Case Manager’s Reflections

Creator: Charles B..
Material type: ArticleArticle Media type: Article Subject(s): Ètica | Gestió de casos | Gestió de cures infermeres In: Professional Case Management 2014 Des; 19(6): 298-300Summary: The role of a case manager within a managed care organization or other health care setting varies extensively. Some of the common functions of a case manager include (1) educator/communicator, which involves educating patients and/or their family members and/or significant others, to empower informed decision-making, as well as communicating with all parties involved regarding patient care as needed; (2) facilitator, which involves assisting patients with transitioning from one setting to another; (3) coordinator of care, which involves coordinating services needed while facilitating access to care; and (4) advocate, which involves advocating for the patients and/or their family members to ensure that the patient is receiving high-quality and cost-effective care (Fero, Herrick, & Hu, 2011).The primary ethical principles that should guide a case manager's decision making are beneficence, justice, and autonomy. "Awareness of the five basic ethical principles and how they are applied: beneficence (to do good), nonmaleficence (to do no harm), autonomy (to respect individuals' rights to make their own decisions), justice (to treat others fairly), and fidelity (to follow through and to keep promises; Case Management Society of America, 2010, p. 21). Beneficence is the ethical principle that promotes good, justice calls for equality/fairness, and autonomy calls for respect for one's opinion and freedom to choose and make health care decisions. These principles, in combination with the Core Principles of the Standards of Case Management Practice, give support and guidance to the case manager. One of the core principles specifically directs case managers to "promote patient safety" (Case Management Society of America, 2010, p. 9). These noble ideologies oftentimes fly in the face of day-to-day realities.I am a case manager for a managed care company. Advocating on behalf of patients frequently creates ethical dilemmas. When planning and coordinating discharge, even when that - See more at: http://www.nursingcenter.com/lnc/JournalArticle?Article_ID=2599079&Journal_ID=54025&Issue_ID=2598819#sthash.1fyAW97X.dpuf
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