Assignment Prompt & Instructions
**files (4)**
– ## LawandEthicinHealthcare-Week2DicussionExplanation.docx
– ## Week2Discussion11.docx
– ## LawandEthicsinHealthcare-Week2LearningResources.docx
– ## Week2DiscussionResponse-LawandEthicsinHealihcare.docx
**## LawandEthicinHealthcare-Week2DicussionExplanation.docx**
**Law and Ethics in Healthcare**
**Week 2 Discussion**
**Conflicts Between Ethics and Financial Incentives**
Patient dumping or turfing is a systemic problem in our healthcare system. Usually associated with hospitals or providers refusing to treat certain patients, this frequently results from inadequate insurance, complex diseases and diagnoses, complex mental health issues without bed space, or inadequate social safety nets for those not fully fit to care for themselves. Patient dumping can occur within diverse healthcare settings, including emergency departments and long-term care health or rehabilitation facilities.
Healthcare organizations are often under immense financial pressure and commonly operate on narrow margins. When a hospital closes in a community it can have widespread negative impacts for that community’s access to care and population health. While policies should be in place for proper discharge of patients, there have been numerous cases of inappropriate patient discharge that do not support patients’ rights or sound ethical decision making. This has resulted in stories that run in the media and, ultimately, devastating financial penalties for hospitals and high-risk negative outcomes for patients.
**To prepare for this Discussion:**
· Watch the NBC News video
_Hospital Outrage, Patient Dumping in a Baltimore Hospital_ and reflect on the Learning Resources this week.
· As a healthcare administrator, consider how policies, organizational culture, and other factors can lead to patient dumping. How does the professional code of ethics apply to this situation?
**Post** your Discussion, to include the following:
· Explain the factors that contributed to the case of patient dumping presented in the video resource. Be sure to use an ethical framework for your analysis.
· From an organizational culture perspective, what could have been done to prevent this incident from happening again? As a healthcare leader at this facility, what would you have done to ensure patient’s individual and legal rights, dignity, and safety were preserved?
**Support your response by identifying and explaining key points and/or examples presented in the Learning Resources.**
**## Week2Discussion11.docx**
**Week 2 Discussion: Law and Ethics in Healthcare**
The NBC News video depicted a patient-dumping incident that stemmed from issues in ethical decision-making, patient advocacy, and discharge planning. Hospital staff left a mentally ill and disoriented woman outside in freezing temperatures while she wore only a hospital gown and socks. Using the ethical principles of beneficence, nonmaleficence, justice, and respect for persons, the hospital’s actions were clearly unethical. Beneficence calls for the best outcome to a patient, and nonmaleficence calls for avoiding harm to a patient. Leaving a vulnerable patient without proper support exposed her to physical and emotional harm. Justice was also breached since we are being dealt unfair and inappropriate treatment when we do not require it based on our level of mental health or financial status. To ensure ethically sound healthcare choices, the patient's welfare and safety must be given priority (Pozgar, 2023).
At an organizational level, this incident is illustrative of an absence of an ethical and patient-centered culture. The American College of Healthcare Executives (2020) says that healthcare organizations should encourage accountability, compassion and dignity toward human beings. With better discharge protocols, education on the ethical standards of staff members and clearer procedures for treating patients who fall into a more precarious condition, the hospital could have avoided this incident. As ethicist Pozgar (2023) discusses, ethics committees may have assisted in making challenging choices relating to patients with mental health needs. A culture that allows staff to talk about and point out wrong conduct might have prevented this from happening.
As a healthcare leader, I would ensure that every decision for a patient to be discharged also had a documented assessment on patient safety, mental status, need for housing and support services available. Before releasing high-risk patients, I would need every physician, nurse, social worker and case manager to come together. I would also periodically review discharge processes and give periodic ethics training based on the AACHE Code of Ethics (2023). Such actions would be intended to safeguard the legal rights, dignity, and safety of patients and uphold ethical accountability across the organization. The objective would be to make sure no patient is released into situations that could endanger their health or welfare.
**References**
American College of Healthcare Executives. (2020, November 16).
_Creating an ethical culture within the healthcare organization_.
[https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization)
American College of Healthcare Executives. (2023, December 5).
_Code of ethics_.
[https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics)
NBC News. (2018, January 12).
_Video shows Baltimore hospital’s “patient dumping” | NBC Nightly News_ [Video]. YouTube.
[https://www.youtube.com/watch?v=HbuArN_wFlQ](https://www.youtube.com/watch?v=HbuArN_wFlQ)
Pozgar, G. D. (2023).
_Legal and ethical issues for health professionals_ (6th ed.). Jones & Bartlett Learning
**## LawandEthicsinHealthcare-Week2LearningResources.docx**
**Law and Ethics in Healthcare**
**Week 2 Learning Resources**
**Required Readings**
· Pozgar, G. D. (2023).
_Legal and ethical issues for health professionals_ (6th ed.). Jones & Bartlett Learning.
· Chapter 3, “End-of-Life Dilemmas” (pp. 103–133)
· Chapter 4, “Health Care Ethics Committee” (pp. 135–147)
· Chapter 8, “Organizational Ethics and the Law” (pp. 221–263)
· American College of Healthcare Executives. (n.d.).
[_Ethics toolkitLinks to an external site._](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization/ethics-toolkit) _._ https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization/ethics-toolkit
· American College of Healthcare Executives. (2023, December 5).
[_Code of ethicsLinks to an external site._](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics) _._ https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics
· American College of Healthcare Executives. (2020, November 16).
[_Creating an ethical culture within the healthcare organizationLinks to an external site._](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization) _._ https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization
· Enck, G. (2014).
[Six-step framework for ethical decision makingLinks to an external site.](https://search.ebscohost.com/login.aspx?direct=true&AuthType=shib&db=mnh&AN=24326675&site=eds-live&scope=site&custid=s6527200).
_Journal of Health_ _Services Research & Policy_,
_19_(1), 62–64. https://doi.org/10.1177/1355819613511599
· Görgens, S. (2023).
[Turfing USALinks to an external site.](https://go.openathens.net/redirector/waldenu.edu?url=https%3A%2F%2Fdoi.org%2F10.1001/amajethics.2023.857).
_AMA Journal of Ethics_,
_25_(12), E857–E860. https://doi.org/10.1001/amajethics.2023.857
· Krishnamurthy, K. B. (2023).
[Should physicians be able to refuse to care for patients insured by Medicare?Links to an external site.](https://go.openathens.net/redirector/waldenu.edu?url=https%3A%2F%2Fdoi.org%2F10.1001/amajethics.2023.861) _AMA Journal of Ethics_,
_25_(12), E861–E863. https://doi.org/10.1001/amajethics.2023.861
· Roytman, M. (2023).
[AMA Code of Medical Ethics’ opinions related to “turfing.”Links to an external site.](https://go.openathens.net/redirector/waldenu.edu?url=https%3A%2F%2Fdoi.org%2F10.1001/amajethics.2023.898) _AMA Journal of Ethics_,
_25_(12), E898–E900.
[https://doi.org/10.1001/amajethics.2023.898](https://doi.org/10.1001/amajethics.2023.898)
**Required Media**
· NBC News. (2018, January 12).
[_Video shows Baltimore hospital’s ‘patient dumping’ | NBC Nightly NewsLinks to an external site._](https://youtu.be/HbuArN_wFlQ)[Video]. YouTube.
[https://youtu.be/HbuArN_wFlQ](https://youtu.be/HbuArN_wFlQ)
**Optional Resources**
· Ethics & Compliance Initiative. (n.d.).
[_ECI recent research_ Links to an external site.](https://www.ethics.org/knowledge-center/eci-recent-research/). https://www.ethics.org/knowledge-center/eci-recent-research/
**## Week2DiscussionResponse-LawandEthicsinHealihcare.docx**
**Law and Ethics in Healthcare**
**Week 2 Discussion Response**
**Colleague 1**
Marie Reed
Hello,
The patient dumping incident presented in the NBC News (2018) report illustrates a profound failure in organizational ethics, patient advocacy, and professional accountability within a healthcare setting. In the Video, a hospital employee is observed leaving a disoriented patient unattended at a bus stop, clothed only in a hospital gown and socks. This incident underscores how deficiencies in organizational policy, inadequate oversight, and a compromised ethical culture can culminate in actions that violate both legal mandates and fundamental ethical obligations.
From an ethical standpoint, Enck's (2014) six-step framework for ethical decision-making offers a valuable structure for examining this case. First, the ethical dilemma centers on the tension between organizational pressures, such as patient throughput, resource allocation, and operational efficiency, and the fundamental obligation to safeguard vulnerable individuals. Second, the range of stakeholders includes not only the patient but also healthcare providers, organizational leadership, and the broader community. Third, core ethical principles, such as beneficence, nonmaleficence, justice, and respect for people, were clearly compromised. The patient's unsafe discharge demonstrates a failure to ensure the patient's well-being, thereby violating the duty to do no harm and to protect individuals who lack the capacity to care for themselves. This outcome reflects a broader breakdown in both professional responsibility and organizational ethical standards.
In reviewing this case, several organizational factors likely contributed to this failure. Pozgar (2023) emphasizes that organizational ethics in healthcare requires the development and enforcement of policies that prioritize patient welfare while simultaneously ensuring compliance with legal and professional standards. When healthcare institutions prioritize efficiency, financial performance, or bed turnover at the expense of patient-centered care, there is a risk that staff may become desensitized to ethical responsibilities. In such environments, patients may be perceived as operational burdens rather than individuals entitled to dignity, compassion, and respect. Furthermore, the American College of Healthcare Executives (ACHE, 2020) asserts that ethical organizational cultures are cultivated through strong leadership commitment, transparency, accountability, and continuous ethics education. The circumstances of this case suggest the absence of these foundational elements, including insufficient reporting mechanisms and a lack of psychological safety that would allow staff to raise concerns without fear of retaliation.
If I were a healthcare leader within this organization, it would be imperative to implement a comprehensive corrective action plan centered on protecting patients' rights, dignity, and safety. First, discharge protocols should require documented verification that each patient has access to safe transportation, an appropriate discharge destination, and the cognitive ability to comprehend discharge instructions. Second, mandatory staff education should be instituted, focusing on patient rights, ethical decision-making frameworks, and the protection of vulnerable populations. Third, an interdisciplinary ethics committee should be actively engaged in reviewing high-risk discharge cases and organizational practices to proactively identify systemic issues before patient harm occurs. Additionally, leadership must model ethical behavior and foster an environment that encourages open communication and ethical accountability. Employees should feel empowered to report unsafe practices without fear of reprisal. The ACHE Code of Ethics (2023) explicitly requires healthcare executives to prioritize the needs and welfare of patients above organizational interests, upholding principles of integrity, fairness, and respect for human dignity. Had these ethical standards been effectively embedded within the organizational culture, it is likely that this patient dumping incident would have been prevented.
Ultimately, healthcare organizations bear both a legal and moral responsibility to ensure all patients are treated with compassion, dignity, and respect, regardless of their socioeconomic status or mental health condition. This case serves as a critical reminder that ethical leadership and robust organizational safeguards are essential to preventing harm and maintaining public trust in healthcare systems.
References:
American College of Healthcare Executives. (2020, November 16). Creating an ethical culture within the healthcare organization.
[https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization\
Links to an external site.](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization)
American College of Healthcare Executives. (2023, December 5). Code of ethics.
[https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics\
Links to an external site.](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics)
Enck, G. (2014). Six-step framework for ethical decision making. Journal of Health Services Research & Policy, 19(1), 62–64.
[https://doi.org/10.1177/1355819613511599\
Links to an external site.](https://doi.org/10.1177/1355819613511599)
NBC News. (2018, January 12). Video shows Baltimore hospital's "patient dumping" [Video]. YouTube.
[https://youtu.be/HbuArN_wFlQ\
Links to an external site.](https://youtu.be/HbuArN_wFlQ)
Pozgar, G. D. (2023). Legal and ethical issues for health professionals (6th ed.). Jones & Bartlett Learning.
**Colleague 2**
Vazyria Brewster
Using the ethical framework of principlism, the patient-dumping incident demonstrates several serious violations of healthcare ethics. One of the most significant ethical principles breached was beneficence, which requires healthcare professionals and organizations to act in ways that promote the well-being of patients. Healthcare providers have a responsibility to ensure that patients are discharged to safe environments and have access to the resources necessary to support their continued care. In this case, leaving a vulnerable patient outside in cold weather without adequate clothing, shelter, or support did not serve her best interests and failed to protect her welfare. Instead of providing care that improved the patient's situation, the actions taken exposed her to additional risks and hardships.
The principle of nonmaleficence, commonly referred to as the obligation to "do no harm," was also violated. Healthcare organizations must avoid actions that could reasonably be expected to cause injury, suffering, or unnecessary risk. Discharging a patient who appeared unable to adequately care for herself created a foreseeable risk of physical harm due to exposure to harsh weather conditions as well as emotional distress and psychological trauma. The circumstances suggest that insufficient consideration was given to the patient's safety after discharge, resulting in a situation that could have had severe consequences for her health and well-being.
Another ethical concern involves the principle of justice, which emphasizes fairness, equality, and equitable access to care. Justice requires healthcare organizations to treat all patients with the same level of respect and consideration, regardless of their mental health status, financial situation, or social circumstances. By releasing a vulnerable patient into an unsafe environment without ensuring appropriate support services were available, the hospital failed to provide equitable treatment. This raise concerns that the patient's mental health challenges and apparent lack of resources may have influenced the discharge process and the level of care she received (Beauchamp & Childress, 2019).
Several organizational factors likely contributed to this incident. These may have included inadequate discharge planning procedures, insufficient staff training regarding ethical and legal responsibilities, poor communication among healthcare team members, and a lack of accountability within the organization. In addition, an organizational culture focused heavily on operational demands rather than patient-centered care may have influenced decision-making. The patient's vulnerability and need for additional social and mental health support services appear not to have been adequately addressed.
From an organizational culture perspective, preventing similar incidents requires a strong commitment to patient safety, dignity, and ethical care. The hospital could have strengthened discharge policies, required social work consultations for high-risk patients, and provided ongoing education regarding patient rights and ethical obligations. As a healthcare leader, I would ensure that discharge decisions consider not only a patient's medical condition but also their social, environmental, and psychological needs. I would encourage a culture of accountability where employees feel empowered to report concerns without fear of retaliation. Regular reviews of discharge practices, staff training, and compliance monitoring would also help ensure that every patient's legal rights, dignity, safety, and overall well-being are protected throughout the continuum of care.
**References:**
Beauchamp, T. L., & Childress, J. F. (2019). *Principles of biomedical ethics* (8th ed.). Oxford University Press.
Görgens, S. (2023).
[Turfing USALinks to an external site.\
Links to an external site.](https://go.openathens.net/redirector/waldenu.edu?url=https%3A%2F%2Fdoi.org%2F10.1001/amajethics.2023.857).
_AMA Journal of Ethics_,
_25_(12), E857–E860. https://doi.org/10.1001/amajethics.2023.857
NBC News. (2018, January 12).
[_Video shows Baltimore hospital’s ‘patient dumping’ | NBC Nightly NewsLinks to an external site._ Links to an external site.](https://youtu.be/HbuArN_wFlQ)[Video]. YouTube.
[https://youtu.be/HbuArN_wFlQ\
Links to an external site.](https://youtu.be/HbuArN_wFlQ) [Minimize Video](https://waldenu.instructure.com/courses/227012/discussion_topics/3490417?module_item_id=9837228)
[Links to an external site.](https://youtu.be/HbuArN_wFlQ) [Minimize Video](https://waldenu.instructure.com/courses/227012/discussion_topics/3490417?module_item_id=9837228) Pozgar, G. D. (2023).
_Legal and ethical issues for health professionals_ (6th ed.). Jones & Bartlett Learning
## image1.png
**## Week2DiscussionResponse-LawandEthicsinHealihcare.docx**
**Law and Ethics in Healthcare**
**Week 2 Discussion Response**
**Colleague 1**
Marie Reed
Hello,
The patient dumping incident presented in the NBC News (2018) report illustrates a profound failure in organizational ethics, patient advocacy, and professional accountability within a healthcare setting. In the Video, a hospital employee is observed leaving a disoriented patient unattended at a bus stop, clothed only in a hospital gown and socks. This incident underscores how deficiencies in organizational policy, inadequate oversight, and a compromised ethical culture can culminate in actions that violate both legal mandates and fundamental ethical obligations.
From an ethical standpoint, Enck's (2014) six-step framework for ethical decision-making offers a valuable structure for examining this case. First, the ethical dilemma centers on the tension between organizational pressures, such as patient throughput, resource allocation, and operational efficiency, and the fundamental obligation to safeguard vulnerable individuals. Second, the range of stakeholders includes not only the patient but also healthcare providers, organizational leadership, and the broader community. Third, core ethical principles, such as beneficence, nonmaleficence, justice, and respect for people, were clearly compromised. The patient's unsafe discharge demonstrates a failure to ensure the patient's well-being, thereby violating the duty to do no harm and to protect individuals who lack the capacity to care for themselves. This outcome reflects a broader breakdown in both professional responsibility and organizational ethical standards.
In reviewing this case, several organizational factors likely contributed to this failure. Pozgar (2023) emphasizes that organizational ethics in healthcare requires the development and enforcement of policies that prioritize patient welfare while simultaneously ensuring compliance with legal and professional standards. When healthcare institutions prioritize efficiency, financial performance, or bed turnover at the expense of patient-centered care, there is a risk that staff may become desensitized to ethical responsibilities. In such environments, patients may be perceived as operational burdens rather than individuals entitled to dignity, compassion, and respect. Furthermore, the American College of Healthcare Executives (ACHE, 2020) asserts that ethical organizational cultures are cultivated through strong leadership commitment, transparency, accountability, and continuous ethics education. The circumstances of this case suggest the absence of these foundational elements, including insufficient reporting mechanisms and a lack of psychological safety that would allow staff to raise concerns without fear of retaliation.
If I were a healthcare leader within this organization, it would be imperative to implement a comprehensive corrective action plan centered on protecting patients' rights, dignity, and safety. First, discharge protocols should require documented verification that each patient has access to safe transportation, an appropriate discharge destination, and the cognitive ability to comprehend discharge instructions. Second, mandatory staff education should be instituted, focusing on patient rights, ethical decision-making frameworks, and the protection of vulnerable populations. Third, an interdisciplinary ethics committee should be actively engaged in reviewing high-risk discharge cases and organizational practices to proactively identify systemic issues before patient harm occurs. Additionally, leadership must model ethical behavior and foster an environment that encourages open communication and ethical accountability. Employees should feel empowered to report unsafe practices without fear of reprisal. The ACHE Code of Ethics (2023) explicitly requires healthcare executives to prioritize the needs and welfare of patients above organizational interests, upholding principles of integrity, fairness, and respect for human dignity. Had these ethical standards been effectively embedded within the organizational culture, it is likely that this patient dumping incident would have been prevented.
Ultimately, healthcare organizations bear both a legal and moral responsibility to ensure all patients are treated with compassion, dignity, and respect, regardless of their socioeconomic status or mental health condition. This case serves as a critical reminder that ethical leadership and robust organizational safeguards are essential to preventing harm and maintaining public trust in healthcare systems.
References:
American College of Healthcare Executives. (2020, November 16). Creating an ethical culture within the healthcare organization.
[https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization\
Links to an external site.](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization)
American College of Healthcare Executives. (2023, December 5). Code of ethics.
[https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics\
Links to an external site.](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics)
Enck, G. (2014). Six-step framework for ethical decision making. Journal of Health Services Research & Policy, 19(1), 62–64.
[https://doi.org/10.1177/1355819613511599\
Links to an external site.](https://doi.org/10.1177/1355819613511599)
NBC News. (2018, January 12). Video shows Baltimore hospital's "patient dumping" [Video]. YouTube.
[https://youtu.be/HbuArN_wFlQ\
Links to an external site.](https://youtu.be/HbuArN_wFlQ)
Pozgar, G. D. (2023). Legal and ethical issues for health professionals (6th ed.). Jones & Bartlett Learning.
**Colleague 2**
Vazyria Brewster
Using the ethical framework of principlism, the patient-dumping incident demonstrates several serious violations of healthcare ethics. One of the most significant ethical principles breached was beneficence, which requires healthcare professionals and organizations to act in ways that promote the well-being of patients. Healthcare providers have a responsibility to ensure that patients are discharged to safe environments and have access to the resources necessary to support their continued care. In this case, leaving a vulnerable patient outside in cold weather without adequate clothing, shelter, or support did not serve her best interests and failed to protect her welfare. Instead of providing care that improved the patient's situation, the actions taken exposed her to additional risks and hardships.
The principle of nonmaleficence, commonly referred to as the obligation to "do no harm," was also violated. Healthcare organizations must avoid actions that could reasonably be expected to cause injury, suffering, or unnecessary risk. Discharging a patient who appeared unable to adequately care for herself created a foreseeable risk of physical harm due to exposure to harsh weather conditions as well as emotional distress and psychological trauma. The circumstances suggest that insufficient consideration was given to the patient's safety after discharge, resulting in a situation that could have had severe consequences for her health and well-being.
Another ethical concern involves the principle of justice, which emphasizes fairness, equality, and equitable access to care. Justice requires healthcare organizations to treat all patients with the same level of respect and consideration, regardless of their mental health status, financial situation, or social circumstances. By releasing a vulnerable patient into an unsafe environment without ensuring appropriate support services were available, the hospital failed to provide equitable treatment. This raise concerns that the patient's mental health challenges and apparent lack of resources may have influenced the discharge process and the level of care she received (Beauchamp & Childress, 2019).
Several organizational factors likely contributed to this incident. These may have included inadequate discharge planning procedures, insufficient staff training regarding ethical and legal responsibilities, poor communication among healthcare team members, and a lack of accountability within the organization. In addition, an organizational culture focused heavily on operational demands rather than patient-centered care may have influenced decision-making. The patient's vulnerability and need for additional social and mental health support services appear not to have been adequately addressed.
From an organizational culture perspective, preventing similar incidents requires a strong commitment to patient safety, dignity, and ethical care. The hospital could have strengthened discharge policies, required social work consultations for high-risk patients, and provided ongoing education regarding patient rights and ethical obligations. As a healthcare leader, I would ensure that discharge decisions consider not only a patient's medical condition but also their social, environmental, and psychological needs. I would encourage a culture of accountability where employees feel empowered to report concerns without fear of retaliation. Regular reviews of discharge practices, staff training, and compliance monitoring would also help ensure that every patient's legal rights, dignity, safety, and overall well-being are protected throughout the continuum of care.
**References:**
Beauchamp, T. L., & Childress, J. F. (2019). *Principles of biomedical ethics* (8th ed.). Oxford University Press.
Görgens, S. (2023).
[Turfing USALinks to an external site.\
Links to an external site.](https://go.openathens.net/redirector/waldenu.edu?url=https%3A%2F%2Fdoi.org%2F10.1001/amajethics.2023.857).
_AMA Journal of Ethics_,
_25_(12), E857–E860. https://doi.org/10.1001/amajethics.2023.857
NBC News. (2018, January 12).
[_Video shows Baltimore hospital’s ‘patient dumping’ | NBC Nightly NewsLinks to an external site._ Links to an external site.](https://youtu.be/HbuArN_wFlQ)[Video]. YouTube.
[https://youtu.be/HbuArN_wFlQ\
Links to an external site.](https://youtu.be/HbuArN_wFlQ) [Minimize Video](https://waldenu.instructure.com/courses/227012/discussion_topics/3490417?module_item_id=9837228)
[Links to an external site.](https://youtu.be/HbuArN_wFlQ) [Minimize Video](https://waldenu.instructure.com/courses/227012/discussion_topics/3490417?module_item_id=9837228) Pozgar, G. D. (2023).
_Legal and ethical issues for health professionals_ (6th ed.). Jones & Bartlett Learning
## image1.png
**## LawandEthicinHealthcare-Week2DicussionExplanation.docx**
**Law and Ethics in Healthcare**
**Week 2 Discussion**
**Conflicts Between Ethics and Financial Incentives**
Patient dumping or turfing is a systemic problem in our healthcare system. Usually associated with hospitals or providers refusing to treat certain patients, this frequently results from inadequate insurance, complex diseases and diagnoses, complex mental health issues without bed space, or inadequate social safety nets for those not fully fit to care for themselves. Patient dumping can occur within diverse healthcare settings, including emergency departments and long-term care health or rehabilitation facilities.
Healthcare organizations are often under immense financial pressure and commonly operate on narrow margins. When a hospital closes in a community it can have widespread negative impacts for that community’s access to care and population health. While policies should be in place for proper discharge of patients, there have been numerous cases of inappropriate patient discharge that do not support patients’ rights or sound ethical decision making. This has resulted in stories that run in the media and, ultimately, devastating financial penalties for hospitals and high-risk negative outcomes for patients.
**To prepare for this Discussion:**
· Watch the NBC News video
_Hospital Outrage, Patient Dumping in a Baltimore Hospital_ and reflect on the Learning Resources this week.
· As a healthcare administrator, consider how policies, organizational culture, and other factors can lead to patient dumping. How does the professional code of ethics apply to this situation?
**Post** your Discussion, to include the following:
· Explain the factors that contributed to the case of patient dumping presented in the video resource. Be sure to use an ethical framework for your analysis.
· From an organizational culture perspective, what could have been done to prevent this incident from happening again? As a healthcare leader at this facility, what would you have done to ensure patient’s individual and legal rights, dignity, and safety were preserved?
**Support your response by identifying and explaining key points and/or examples presented in the Learning Resources.**
**## Week2Discussion11.docx**
**Week 2 Discussion: Law and Ethics in Healthcare**
The NBC News video depicted a patient-dumping incident that stemmed from issues in ethical decision-making, patient advocacy, and discharge planning. Hospital staff left a mentally ill and disoriented woman outside in freezing temperatures while she wore only a hospital gown and socks. Using the ethical principles of beneficence, nonmaleficence, justice, and respect for persons, the hospital’s actions were clearly unethical. Beneficence calls for the best outcome to a patient, and nonmaleficence calls for avoiding harm to a patient. Leaving a vulnerable patient without proper support exposed her to physical and emotional harm. Justice was also breached since we are being dealt unfair and inappropriate treatment when we do not require it based on our level of mental health or financial status. To ensure ethically sound healthcare choices, the patient's welfare and safety must be given priority (Pozgar, 2023).
At an organizational level, this incident is illustrative of an absence of an ethical and patient-centered culture. The American College of Healthcare Executives (2020) says that healthcare organizations should encourage accountability, compassion and dignity toward human beings. With better discharge protocols, education on the ethical standards of staff members and clearer procedures for treating patients who fall into a more precarious condition, the hospital could have avoided this incident. As ethicist Pozgar (2023) discusses, ethics committees may have assisted in making challenging choices relating to patients with mental health needs. A culture that allows staff to talk about and point out wrong conduct might have prevented this from happening.
As a healthcare leader, I would ensure that every decision for a patient to be discharged also had a documented assessment on patient safety, mental status, need for housing and support services available. Before releasing high-risk patients, I would need every physician, nurse, social worker and case manager to come together. I would also periodically review discharge processes and give periodic ethics training based on the AACHE Code of Ethics (2023). Such actions would be intended to safeguard the legal rights, dignity, and safety of patients and uphold ethical accountability across the organization. The objective would be to make sure no patient is released into situations that could endanger their health or welfare.
**References**
American College of Healthcare Executives. (2020, November 16).
_Creating an ethical culture within the healthcare organization_.
[https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization)
American College of Healthcare Executives. (2023, December 5).
_Code of ethics_.
[https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics)
NBC News. (2018, January 12).
_Video shows Baltimore hospital’s “patient dumping” | NBC Nightly News_ [Video]. YouTube.
[https://www.youtube.com/watch?v=HbuArN_wFlQ](https://www.youtube.com/watch?v=HbuArN_wFlQ)
Pozgar, G. D. (2023).
_Legal and ethical issues for health professionals_ (6th ed.). Jones & Bartlett Learning
**## LawandEthicsinHealthcare-Week2LearningResources.docx**
**Law and Ethics in Healthcare**
**Week 2 Learning Resources**
**Required Readings**
· Pozgar, G. D. (2023).
_Legal and ethical issues for health professionals_ (6th ed.). Jones & Bartlett Learning.
· Chapter 3, “End-of-Life Dilemmas” (pp. 103–133)
· Chapter 4, “Health Care Ethics Committee” (pp. 135–147)
· Chapter 8, “Organizational Ethics and the Law” (pp. 221–263)
· American College of Healthcare Executives. (n.d.).
[_Ethics toolkitLinks to an external site._](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization/ethics-toolkit) _._ https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization/ethics-toolkit
· American College of Healthcare Executives. (2023, December 5).
[_Code of ethicsLinks to an external site._](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics) _._ https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics
· American College of Healthcare Executives. (2020, November 16).
[_Creating an ethical culture within the healthcare organizationLinks to an external site._](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization) _._ https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization
· Enck, G. (2014).
[Six-step framework for ethical decision makingLinks to an external site.](https://search.ebscohost.com/login.aspx?direct=true&AuthType=shib&db=mnh&AN=24326675&site=eds-live&scope=site&custid=s6527200).
_Journal of Health_ _Services Research & Policy_,
_19_(1), 62–64. https://doi.org/10.1177/1355819613511599
· Görgens, S. (2023).
[Turfing USALinks to an external site.](https://go.openathens.net/redirector/waldenu.edu?url=https%3A%2F%2Fdoi.org%2F10.1001/amajethics.2023.857).
_AMA Journal of Ethics_,
_25_(12), E857–E860. https://doi.org/10.1001/amajethics.2023.857
· Krishnamurthy, K. B. (2023).
[Should physicians be able to refuse to care for patients insured by Medicare?Links to an external site.](https://go.openathens.net/redirector/waldenu.edu?url=https%3A%2F%2Fdoi.org%2F10.1001/amajethics.2023.861) _AMA Journal of Ethics_,
_25_(12), E861–E863. https://doi.org/10.1001/amajethics.2023.861
· Roytman, M. (2023).
[AMA Code of Medical Ethics’ opinions related to “turfing.”Links to an external site.](https://go.openathens.net/redirector/waldenu.edu?url=https%3A%2F%2Fdoi.org%2F10.1001/amajethics.2023.898) _AMA Journal of Ethics_,
_25_(12), E898–E900.
[https://doi.org/10.1001/amajethics.2023.898](https://doi.org/10.1001/amajethics.2023.898)
**Required Media**
· NBC News. (2018, January 12).
[_Video shows Baltimore hospital’s ‘patient dumping’ | NBC Nightly NewsLinks to an external site._](https://youtu.be/HbuArN_wFlQ)[Video]. YouTube.
[https://youtu.be/HbuArN_wFlQ](https://youtu.be/HbuArN_wFlQ)
**Optional Resources**
· Ethics & Compliance Initiative. (n.d.).
[_ECI recent research_ Links to an external site.](https://www.ethics.org/knowledge-center/eci-recent-research/). https://www.ethics.org/knowledge-center/eci-recent-research/
**## Week2DiscussionResponse-LawandEthicsinHealihcare.docx**
**Law and Ethics in Healthcare**
**Week 2 Discussion Response**
**Colleague 1**
Marie Reed
Hello,
The patient dumping incident presented in the NBC News (2018) report illustrates a profound failure in organizational ethics, patient advocacy, and professional accountability within a healthcare setting. In the Video, a hospital employee is observed leaving a disoriented patient unattended at a bus stop, clothed only in a hospital gown and socks. This incident underscores how deficiencies in organizational policy, inadequate oversight, and a compromised ethical culture can culminate in actions that violate both legal mandates and fundamental ethical obligations.
From an ethical standpoint, Enck's (2014) six-step framework for ethical decision-making offers a valuable structure for examining this case. First, the ethical dilemma centers on the tension between organizational pressures, such as patient throughput, resource allocation, and operational efficiency, and the fundamental obligation to safeguard vulnerable individuals. Second, the range of stakeholders includes not only the patient but also healthcare providers, organizational leadership, and the broader community. Third, core ethical principles, such as beneficence, nonmaleficence, justice, and respect for people, were clearly compromised. The patient's unsafe discharge demonstrates a failure to ensure the patient's well-being, thereby violating the duty to do no harm and to protect individuals who lack the capacity to care for themselves. This outcome reflects a broader breakdown in both professional responsibility and organizational ethical standards.
In reviewing this case, several organizational factors likely contributed to this failure. Pozgar (2023) emphasizes that organizational ethics in healthcare requires the development and enforcement of policies that prioritize patient welfare while simultaneously ensuring compliance with legal and professional standards. When healthcare institutions prioritize efficiency, financial performance, or bed turnover at the expense of patient-centered care, there is a risk that staff may become desensitized to ethical responsibilities. In such environments, patients may be perceived as operational burdens rather than individuals entitled to dignity, compassion, and respect. Furthermore, the American College of Healthcare Executives (ACHE, 2020) asserts that ethical organizational cultures are cultivated through strong leadership commitment, transparency, accountability, and continuous ethics education. The circumstances of this case suggest the absence of these foundational elements, including insufficient reporting mechanisms and a lack of psychological safety that would allow staff to raise concerns without fear of retaliation.
If I were a healthcare leader within this organization, it would be imperative to implement a comprehensive corrective action plan centered on protecting patients' rights, dignity, and safety. First, discharge protocols should require documented verification that each patient has access to safe transportation, an appropriate discharge destination, and the cognitive ability to comprehend discharge instructions. Second, mandatory staff education should be instituted, focusing on patient rights, ethical decision-making frameworks, and the protection of vulnerable populations. Third, an interdisciplinary ethics committee should be actively engaged in reviewing high-risk discharge cases and organizational practices to proactively identify systemic issues before patient harm occurs. Additionally, leadership must model ethical behavior and foster an environment that encourages open communication and ethical accountability. Employees should feel empowered to report unsafe practices without fear of reprisal. The ACHE Code of Ethics (2023) explicitly requires healthcare executives to prioritize the needs and welfare of patients above organizational interests, upholding principles of integrity, fairness, and respect for human dignity. Had these ethical standards been effectively embedded within the organizational culture, it is likely that this patient dumping incident would have been prevented.
Ultimately, healthcare organizations bear both a legal and moral responsibility to ensure all patients are treated with compassion, dignity, and respect, regardless of their socioeconomic status or mental health condition. This case serves as a critical reminder that ethical leadership and robust organizational safeguards are essential to preventing harm and maintaining public trust in healthcare systems.
References:
American College of Healthcare Executives. (2020, November 16). Creating an ethical culture within the healthcare organization.
[https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization\
Links to an external site.](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization)
American College of Healthcare Executives. (2023, December 5). Code of ethics.
[https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics\
Links to an external site.](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics)
Enck, G. (2014). Six-step framework for ethical decision making. Journal of Health Services Research & Policy, 19(1), 62–64.
[https://doi.org/10.1177/1355819613511599\
Links to an external site.](https://doi.org/10.1177/1355819613511599)
NBC News. (2018, January 12). Video shows Baltimore hospital's "patient dumping" [Video]. YouTube.
[https://youtu.be/HbuArN_wFlQ\
Links to an external site.](https://youtu.be/HbuArN_wFlQ)
Pozgar, G. D. (2023). Legal and ethical issues for health professionals (6th ed.). Jones & Bartlett Learning.
**Colleague 2**
Vazyria Brewster
Using the ethical framework of principlism, the patient-dumping incident demonstrates several serious violations of healthcare ethics. One of the most significant ethical principles breached was beneficence, which requires healthcare professionals and organizations to act in ways that promote the well-being of patients. Healthcare providers have a responsibility to ensure that patients are discharged to safe environments and have access to the resources necessary to support their continued care. In this case, leaving a vulnerable patient outside in cold weather without adequate clothing, shelter, or support did not serve her best interests and failed to protect her welfare. Instead of providing care that improved the patient's situation, the actions taken exposed her to additional risks and hardships.
The principle of nonmaleficence, commonly referred to as the obligation to "do no harm," was also violated. Healthcare organizations must avoid actions that could reasonably be expected to cause injury, suffering, or unnecessary risk. Discharging a patient who appeared unable to adequately care for herself created a foreseeable risk of physical harm due to exposure to harsh weather conditions as well as emotional distress and psychological trauma. The circumstances suggest that insufficient consideration was given to the patient's safety after discharge, resulting in a situation that could have had severe consequences for her health and well-being.
Another ethical concern involves the principle of justice, which emphasizes fairness, equality, and equitable access to care. Justice requires healthcare organizations to treat all patients with the same level of respect and consideration, regardless of their mental health status, financial situation, or social circumstances. By releasing a vulnerable patient into an unsafe environment without ensuring appropriate support services were available, the hospital failed to provide equitable treatment. This raise concerns that the patient's mental health challenges and apparent lack of resources may have influenced the discharge process and the level of care she received (Beauchamp & Childress, 2019).
Several organizational factors likely contributed to this incident. These may have included inadequate discharge planning procedures, insufficient staff training regarding ethical and legal responsibilities, poor communication among healthcare team members, and a lack of accountability within the organization. In addition, an organizational culture focused heavily on operational demands rather than patient-centered care may have influenced decision-making. The patient's vulnerability and need for additional social and mental health support services appear not to have been adequately addressed.
From an organizational culture perspective, preventing similar incidents requires a strong commitment to patient safety, dignity, and ethical care. The hospital could have strengthened discharge policies, required social work consultations for high-risk patients, and provided ongoing education regarding patient rights and ethical obligations. As a healthcare leader, I would ensure that discharge decisions consider not only a patient's medical condition but also their social, environmental, and psychological needs. I would encourage a culture of accountability where employees feel empowered to report concerns without fear of retaliation. Regular reviews of discharge practices, staff training, and compliance monitoring would also help ensure that every patient's legal rights, dignity, safety, and overall well-being are protected throughout the continuum of care.
**References:**
Beauchamp, T. L., & Childress, J. F. (2019). *Principles of biomedical ethics* (8th ed.). Oxford University Press.
Görgens, S. (2023).
[Turfing USALinks to an external site.\
Links to an external site.](https://go.openathens.net/redirector/waldenu.edu?url=https%3A%2F%2Fdoi.org%2F10.1001/amajethics.2023.857).
_AMA Journal of Ethics_,
_25_(12), E857–E860. https://doi.org/10.1001/amajethics.2023.857
NBC News. (2018, January 12).
[_Video shows Baltimore hospital’s ‘patient dumping’ | NBC Nightly NewsLinks to an external site._ Links to an external site.](https://youtu.be/HbuArN_wFlQ)[Video]. YouTube.
[https://youtu.be/HbuArN_wFlQ\
Links to an external site.](https://youtu.be/HbuArN_wFlQ) [Minimize Video](https://waldenu.instructure.com/courses/227012/discussion_topics/3490417?module_item_id=9837228)
[Links to an external site.](https://youtu.be/HbuArN_wFlQ) [Minimize Video](https://waldenu.instructure.com/courses/227012/discussion_topics/3490417?module_item_id=9837228) Pozgar, G. D. (2023).
_Legal and ethical issues for health professionals_ (6th ed.). Jones & Bartlett Learning
## image1.png
**## LawandEthicinHealthcare-Week2DicussionExplanation.docx**
**Law and Ethics in Healthcare**
**Week 2 Discussion**
**Conflicts Between Ethics and Financial Incentives**
Patient dumping or turfing is a systemic problem in our healthcare system. Usually associated with hospitals or providers refusing to treat certain patients, this frequently results from inadequate insurance, complex diseases and diagnoses, complex mental health issues without bed space, or inadequate social safety nets for those not fully fit to care for themselves. Patient dumping can occur within diverse healthcare settings, including emergency departments and long-term care health or rehabilitation facilities.
Healthcare organizations are often under immense financial pressure and commonly operate on narrow margins. When a hospital closes in a community it can have widespread negative impacts for that community’s access to care and population health. While policies should be in place for proper discharge of patients, there have been numerous cases of inappropriate patient discharge that do not support patients’ rights or sound ethical decision making. This has resulted in stories that run in the media and, ultimately, devastating financial penalties for hospitals and high-risk negative outcomes for patients.
**To prepare for this Discussion:**
· Watch the NBC News video
_Hospital Outrage, Patient Dumping in a Baltimore Hospital_ and reflect on the Learning Resources this week.
· As a healthcare administrator, consider how policies, organizational culture, and other factors can lead to patient dumping. How does the professional code of ethics apply to this situation?
**Post** your Discussion, to include the following:
· Explain the factors that contributed to the case of patient dumping presented in the video resource. Be sure to use an ethical framework for your analysis.
· From an organizational culture perspective, what could have been done to prevent this incident from happening again? As a healthcare leader at this facility, what would you have done to ensure patient’s individual and legal rights, dignity, and safety were preserved?
**Support your response by identifying and explaining key points and/or examples presented in the Learning Resources.**
**## Week2Discussion11.docx**
**Week 2 Discussion: Law and Ethics in Healthcare**
The NBC News video depicted a patient-dumping incident that stemmed from issues in ethical decision-making, patient advocacy, and discharge planning. Hospital staff left a mentally ill and disoriented woman outside in freezing temperatures while she wore only a hospital gown and socks. Using the ethical principles of beneficence, nonmaleficence, justice, and respect for persons, the hospital’s actions were clearly unethical. Beneficence calls for the best outcome to a patient, and nonmaleficence calls for avoiding harm to a patient. Leaving a vulnerable patient without proper support exposed her to physical and emotional harm. Justice was also breached since we are being dealt unfair and inappropriate treatment when we do not require it based on our level of mental health or financial status. To ensure ethically sound healthcare choices, the patient's welfare and safety must be given priority (Pozgar, 2023).
At an organizational level, this incident is illustrative of an absence of an ethical and patient-centered culture. The American College of Healthcare Executives (2020) says that healthcare organizations should encourage accountability, compassion and dignity toward human beings. With better discharge protocols, education on the ethical standards of staff members and clearer procedures for treating patients who fall into a more precarious condition, the hospital could have avoided this incident. As ethicist Pozgar (2023) discusses, ethics committees may have assisted in making challenging choices relating to patients with mental health needs. A culture that allows staff to talk about and point out wrong conduct might have prevented this from happening.
As a healthcare leader, I would ensure that every decision for a patient to be discharged also had a documented assessment on patient safety, mental status, need for housing and support services available. Before releasing high-risk patients, I would need every physician, nurse, social worker and case manager to come together. I would also periodically review discharge processes and give periodic ethics training based on the AACHE Code of Ethics (2023). Such actions would be intended to safeguard the legal rights, dignity, and safety of patients and uphold ethical accountability across the organization. The objective would be to make sure no patient is released into situations that could endanger their health or welfare.
**References**
American College of Healthcare Executives. (2020, November 16).
_Creating an ethical culture within the healthcare organization_.
[https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization)
American College of Healthcare Executives. (2023, December 5).
_Code of ethics_.
[https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics)
NBC News. (2018, January 12).
_Video shows Baltimore hospital’s “patient dumping” | NBC Nightly News_ [Video]. YouTube.
[https://www.youtube.com/watch?v=HbuArN_wFlQ](https://www.youtube.com/watch?v=HbuArN_wFlQ)
Pozgar, G. D. (2023).
_Legal and ethical issues for health professionals_ (6th ed.). Jones & Bartlett Learning
**## LawandEthicsinHealthcare-Week2LearningResources.docx**
**Law and Ethics in Healthcare**
**Week 2 Learning Resources**
**Required Readings**
· Pozgar, G. D. (2023).
_Legal and ethical issues for health professionals_ (6th ed.). Jones & Bartlett Learning.
· Chapter 3, “End-of-Life Dilemmas” (pp. 103–133)
· Chapter 4, “Health Care Ethics Committee” (pp. 135–147)
· Chapter 8, “Organizational Ethics and the Law” (pp. 221–263)
· American College of Healthcare Executives. (n.d.).
[_Ethics toolkitLinks to an external site._](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization/ethics-toolkit) _._ https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization/ethics-toolkit
· American College of Healthcare Executives. (2023, December 5).
[_Code of ethicsLinks to an external site._](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics) _._ https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics
· American College of Healthcare Executives. (2020, November 16).
[_Creating an ethical culture within the healthcare organizationLinks to an external site._](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization) _._ https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization
· Enck, G. (2014).
[Six-step framework for ethical decision makingLinks to an external site.](https://search.ebscohost.com/login.aspx?direct=true&AuthType=shib&db=mnh&AN=24326675&site=eds-live&scope=site&custid=s6527200).
_Journal of Health_ _Services Research & Policy_,
_19_(1), 62–64. https://doi.org/10.1177/1355819613511599
· Görgens, S. (2023).
[Turfing USALinks to an external site.](https://go.openathens.net/redirector/waldenu.edu?url=https%3A%2F%2Fdoi.org%2F10.1001/amajethics.2023.857).
_AMA Journal of Ethics_,
_25_(12), E857–E860. https://doi.org/10.1001/amajethics.2023.857
· Krishnamurthy, K. B. (2023).
[Should physicians be able to refuse to care for patients insured by Medicare?Links to an external site.](https://go.openathens.net/redirector/waldenu.edu?url=https%3A%2F%2Fdoi.org%2F10.1001/amajethics.2023.861) _AMA Journal of Ethics_,
_25_(12), E861–E863. https://doi.org/10.1001/amajethics.2023.861
· Roytman, M. (2023).
[AMA Code of Medical Ethics’ opinions related to “turfing.”Links to an external site.](https://go.openathens.net/redirector/waldenu.edu?url=https%3A%2F%2Fdoi.org%2F10.1001/amajethics.2023.898) _AMA Journal of Ethics_,
_25_(12), E898–E900.
[https://doi.org/10.1001/amajethics.2023.898](https://doi.org/10.1001/amajethics.2023.898)
**Required Media**
· NBC News. (2018, January 12).
[_Video shows Baltimore hospital’s ‘patient dumping’ | NBC Nightly NewsLinks to an external site._](https://youtu.be/HbuArN_wFlQ)[Video]. YouTube.
[https://youtu.be/HbuArN_wFlQ](https://youtu.be/HbuArN_wFlQ)
**Optional Resources**
· Ethics & Compliance Initiative. (n.d.).
[_ECI recent research_ Links to an external site.](https://www.ethics.org/knowledge-center/eci-recent-research/). https://www.ethics.org/knowledge-center/eci-recent-research/
**## Week2DiscussionResponse-LawandEthicsinHealihcare.docx**
**Law and Ethics in Healthcare**
**Week 2 Discussion Response**
**Colleague 1**
Marie Reed
Hello,
The patient dumping incident presented in the NBC News (2018) report illustrates a profound failure in organizational ethics, patient advocacy, and professional accountability within a healthcare setting. In the Video, a hospital employee is observed leaving a disoriented patient unattended at a bus stop, clothed only in a hospital gown and socks. This incident underscores how deficiencies in organizational policy, inadequate oversight, and a compromised ethical culture can culminate in actions that violate both legal mandates and fundamental ethical obligations.
From an ethical standpoint, Enck's (2014) six-step framework for ethical decision-making offers a valuable structure for examining this case. First, the ethical dilemma centers on the tension between organizational pressures, such as patient throughput, resource allocation, and operational efficiency, and the fundamental obligation to safeguard vulnerable individuals. Second, the range of stakeholders includes not only the patient but also healthcare providers, organizational leadership, and the broader community. Third, core ethical principles, such as beneficence, nonmaleficence, justice, and respect for people, were clearly compromised. The patient's unsafe discharge demonstrates a failure to ensure the patient's well-being, thereby violating the duty to do no harm and to protect individuals who lack the capacity to care for themselves. This outcome reflects a broader breakdown in both professional responsibility and organizational ethical standards.
In reviewing this case, several organizational factors likely contributed to this failure. Pozgar (2023) emphasizes that organizational ethics in healthcare requires the development and enforcement of policies that prioritize patient welfare while simultaneously ensuring compliance with legal and professional standards. When healthcare institutions prioritize efficiency, financial performance, or bed turnover at the expense of patient-centered care, there is a risk that staff may become desensitized to ethical responsibilities. In such environments, patients may be perceived as operational burdens rather than individuals entitled to dignity, compassion, and respect. Furthermore, the American College of Healthcare Executives (ACHE, 2020) asserts that ethical organizational cultures are cultivated through strong leadership commitment, transparency, accountability, and continuous ethics education. The circumstances of this case suggest the absence of these foundational elements, including insufficient reporting mechanisms and a lack of psychological safety that would allow staff to raise concerns without fear of retaliation.
If I were a healthcare leader within this organization, it would be imperative to implement a comprehensive corrective action plan centered on protecting patients' rights, dignity, and safety. First, discharge protocols should require documented verification that each patient has access to safe transportation, an appropriate discharge destination, and the cognitive ability to comprehend discharge instructions. Second, mandatory staff education should be instituted, focusing on patient rights, ethical decision-making frameworks, and the protection of vulnerable populations. Third, an interdisciplinary ethics committee should be actively engaged in reviewing high-risk discharge cases and organizational practices to proactively identify systemic issues before patient harm occurs. Additionally, leadership must model ethical behavior and foster an environment that encourages open communication and ethical accountability. Employees should feel empowered to report unsafe practices without fear of reprisal. The ACHE Code of Ethics (2023) explicitly requires healthcare executives to prioritize the needs and welfare of patients above organizational interests, upholding principles of integrity, fairness, and respect for human dignity. Had these ethical standards been effectively embedded within the organizational culture, it is likely that this patient dumping incident would have been prevented.
Ultimately, healthcare organizations bear both a legal and moral responsibility to ensure all patients are treated with compassion, dignity, and respect, regardless of their socioeconomic status or mental health condition. This case serves as a critical reminder that ethical leadership and robust organizational safeguards are essential to preventing harm and maintaining public trust in healthcare systems.
References:
American College of Healthcare Executives. (2020, November 16). Creating an ethical culture within the healthcare organization.
[https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization\
Links to an external site.](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization)
American College of Healthcare Executives. (2023, December 5). Code of ethics.
[https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics\
Links to an external site.](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics)
Enck, G. (2014). Six-step framework for ethical decision making. Journal of Health Services Research & Policy, 19(1), 62–64.
[https://doi.org/10.1177/1355819613511599\
Links to an external site.](https://doi.org/10.1177/1355819613511599)
NBC News. (2018, January 12). Video shows Baltimore hospital's "patient dumping" [Video]. YouTube.
[https://youtu.be/HbuArN_wFlQ\
Links to an external site.](https://youtu.be/HbuArN_wFlQ)
Pozgar, G. D. (2023). Legal and ethical issues for health professionals (6th ed.). Jones & Bartlett Learning.
**Colleague 2**
Vazyria Brewster
Using the ethical framework of principlism, the patient-dumping incident demonstrates several serious violations of healthcare ethics. One of the most significant ethical principles breached was beneficence, which requires healthcare professionals and organizations to act in ways that promote the well-being of patients. Healthcare providers have a responsibility to ensure that patients are discharged to safe environments and have access to the resources necessary to support their continued care. In this case, leaving a vulnerable patient outside in cold weather without adequate clothing, shelter, or support did not serve her best interests and failed to protect her welfare. Instead of providing care that improved the patient's situation, the actions taken exposed her to additional risks and hardships.
The principle of nonmaleficence, commonly referred to as the obligation to "do no harm," was also violated. Healthcare organizations must avoid actions that could reasonably be expected to cause injury, suffering, or unnecessary risk. Discharging a patient who appeared unable to adequately care for herself created a foreseeable risk of physical harm due to exposure to harsh weather conditions as well as emotional distress and psychological trauma. The circumstances suggest that insufficient consideration was given to the patient's safety after discharge, resulting in a situation that could have had severe consequences for her health and well-being.
Another ethical concern involves the principle of justice, which emphasizes fairness, equality, and equitable access to care. Justice requires healthcare organizations to treat all patients with the same level of respect and consideration, regardless of their mental health status, financial situation, or social circumstances. By releasing a vulnerable patient into an unsafe environment without ensuring appropriate support services were available, the hospital failed to provide equitable treatment. This raise concerns that the patient's mental health challenges and apparent lack of resources may have influenced the discharge process and the level of care she received (Beauchamp & Childress, 2019).
Several organizational factors likely contributed to this incident. These may have included inadequate discharge planning procedures, insufficient staff training regarding ethical and legal responsibilities, poor communication among healthcare team members, and a lack of accountability within the organization. In addition, an organizational culture focused heavily on operational demands rather than patient-centered care may have influenced decision-making. The patient's vulnerability and need for additional social and mental health support services appear not to have been adequately addressed.
From an organizational culture perspective, preventing similar incidents requires a strong commitment to patient safety, dignity, and ethical care. The hospital could have strengthened discharge policies, required social work consultations for high-risk patients, and provided ongoing education regarding patient rights and ethical obligations. As a healthcare leader, I would ensure that discharge decisions consider not only a patient's medical condition but also their social, environmental, and psychological needs. I would encourage a culture of accountability where employees feel empowered to report concerns without fear of retaliation. Regular reviews of discharge practices, staff training, and compliance monitoring would also help ensure that every patient's legal rights, dignity, safety, and overall well-being are protected throughout the continuum of care.
**References:**
Beauchamp, T. L., & Childress, J. F. (2019). *Principles of biomedical ethics* (8th ed.). Oxford University Press.
Görgens, S. (2023).
[Turfing USALinks to an external site.\
Links to an external site.](https://go.openathens.net/redirector/waldenu.edu?url=https%3A%2F%2Fdoi.org%2F10.1001/amajethics.2023.857).
_AMA Journal of Ethics_,
_25_(12), E857–E860. https://doi.org/10.1001/amajethics.2023.857
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