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Discuss the issue of cost to the insurer with your patient, pointing out that keeping his insurance company happy may make them more likely to cover additional treatments in the future
0%
0/118
Proceed with proton beam therapy as discussed at your patient's appointment
70%
83/118
Tell the patient that proton beam therapy will not be covered by his insurance company, so you will need to proceed with traditional radiation therapy
1%
1/118
Discuss the issue of cost to the insurer with your patient, relaying the company's request to him without making further commentary or recommendation
11%
13/118
Call your hospital's ethics committee for a formal consultation
8%
10/118
Select Answer to see Preferred Response
You should proceed with proton beam therapy. When making a decision between different treatments, patient medical need and preference should take precedence over cost of a procedure to an insurer. The ethical principles of autonomy and beneficence govern the tension between patient's medical need and insurer's desire to minimize costs. As a physician, you are obligated to respect your patient's autonomy by respecting his preferences in medical care, and to respect the core principle of beneficence by acting in his best interest. In this case, there is no conflict between autonomy and beneficence - you feel that proton beam therapy is best for his condition, and he desires it. Cost to the insurer should not enter the equation, and you as a physician should not ration care to patients based on the cost of treatment. As clinicians, our responsibility is to do whatever is in the best interest of our patient's welfare. Gillon discusses the practical application of the four ethical principles of autonomy, beneficence, non-maleficence, and justice to patients. He states that attention to these four principles, along with a focus on their scope of application, enables successful evaluation of most health care-related moral issues. Antiel et al. report the results of a survey of 1,032 physicians regarding the moral psychology of rationing care. They note that 67% of respondents supported cost-containment in general, but that 54% had a strong or moderate objection to the use of cost-effectiveness data in specific clinical decision. Illustration A shows the four core principles of medical ethics: autonomy, justice, beneficence, and non-maleficence. Incorrect Answer: Answers 1 & 4: You should not use cost to the insurer as a reason to sway your patient's decision. Answer 3: You should not lie to a patient about insurance coverage. Answer 5: A formal ethics consultation should not be necessary in this case - respect for autonomy and beneficence dictate that you should treat the patient with the proton beam therapy both you and he prefer.
4.2
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