The Joint Commission Sets Specific Ethical Expectations

The Joint Commission (TJC) accreditation requirements address ethical principles in several specific areas.

“First and foremost, leadership is expected to establish an ethical framework on which all operations, policies, procedures, and services are based, and in a manner that supports the delivery of safe, quality care, treatment, and services,” says Robert Campbell, PharmD, BCSCP, director of TJC’s Clinical Standards Interpretation Group.

These are some examples of ethical requirements in TJC’s leadership standards:

• To ensure the ethical framework is maintained, organizations are required to establish a process that allows staff, patients, and families to address ethical issues or issues prone to conflict (LD.04.02.03). “While establishing a formal ethics committee is an example of one way an organization may handle such issues, such a structure is not a requirement,” Campbell notes.

• Organizations are required to define, in writing, conflicts of interest that could affect safety and quality of care, treatment, and services (LD.02.02.01). “Conflicts of interest can challenge ethical principles,” Campbell says.

For example, such conflicts can occur between leadership, the governing body, and the medical staff. These could negatively affect patient care. Additionally, hospital policies must define the ongoing process for managing conflicts among leadership groups (LD.02.04.01).

• Care, treatment, and services must be provided based on patient needs, regardless of compensation or financial risk-sharing. “Ethical issues can also find their way into decisions regarding the delivery of care based on financial issues,” Campbell adds.

When such care, treatment, and services are denied because of payment limitations, the decision to continue providing care, treatment, and services or to discharge the patient should be based solely on the patient’s identified needs (LD.04.02.05). “There may be times when patients need to be informed before, or at the time of admission, of charges for services available that may not be covered by a third-party payor, such as Medicare,” Campbell explains.

• Medical staff are obligated to ensure privileged practitioners demonstrate behaviors that reflect a commitment to continuous professional development; ethical practice; an understanding of and sensitivity to diversity; and a responsible attitude toward patients, their profession, and society.

“Monitoring of such behaviors is often accomplished by establishing criteria that are evaluated as part of an ongoing professional practice evaluation process that is required by our standards,” Campbell says.