Ethics: Beneficence & Non-Malfeasance
Presented by: Dr. Dawn-Elise Snipes
Executive Director, AllCEUs
Objectives
~ Define beneficence and non-malfeasance
~ Explore common violations of this practice
Continuing Education (CE) credits can be earned for this presentation at https://allceus.com/member/cart/index/product/id/614/c/
Beneficence
~ Beneficence is PROACTIVE action that is done for the benefit of others.
~ Beneficent actions can be taken to
~ Prevent or remove harms
~ Improve the situation of others.
~ The goal of counseling is to promote the welfare of patients
~ Due to the nature of the relationship between clinicians and patients, clinicians have an obligation to:
~ Prevent and remove harms
~ Weigh and balance possible benefits against possible risks of an action.
Beneficence
~ Beneficence can also include:
~ Protecting and defending the rights of others (Advocacy)
~ Ensuring the use of a culturally sensitive, trauma informed approach
~ Ensuring the availability of effective referral sources to meet the needs and preferences of clients for whom you are not a good fit
~ Timely advocacy for them with their insurance company for additional session authorization
~ Advocate for patient with treating physician /be an effective member of a multidisciplinary team
Beneficence
~ Beneficence can also include:
~ Helping individuals struggling with mental health or addictive disorders find effective treatment based on their readiness for change
~ Increasing awareness of the problems of co-occurring disorders and their treatment
~ Getting continuing education to ensure awareness of current best practices for treatment
~ Providing patient educational videos or handouts in the waiting room or on your website to help them take charge of their health
~ Ensuring a signed release and provision of necessary information to referral sources BEFORE the patient arrives
Non-Malfeasance
~ Non-maleficence means to “do no harm.”
~ Refrain from providing ineffective treatments
~ Avoid acting with malice toward patients.
~ Assist patients in making the best treatment decision for them, not one that provides you the most benefit.
~ With all interventions, ensure benefits outweigh the risks.
~ Ensure the patient is provided with all treatment options and can make choose the least restrictive environment
~ Do not provide a treatment that has not been shown to be effective.
~ Do not make blind referrals when possible
~ Ensure referral sources are competent (i.e. licensed, certified etc.)
Non-Malfeasance
~ Non-maleficence means to “do no harm.”
~ Don’t encourage clients to collude in insurance fraud
~ Diagnosing them with a disorder they don’t have in order to get reimbursed
~ Changing diagnoses when benefits for one run out
~ Discharge clients when they have met maximal gains at that level of care
~ Do not bill for services under a therapist that were provided by an intern
~ Avoid, when possible, referring a patient back to the same treatment program they have already been through multiple times and relapsed
Non-Malfeasance
~ Making referrals to other providers who provide “rewards” for referrals
~ F.S. 491.009 (1) (j) Paying a kickback, rebate, bonus, or other remuneration for receiving a patient or client, or receiving a kickback, rebate, bonus, or other remuneration for referring a patient or client to another provider of mental health care services or to a provider of health care services or goods; or entering into a reciprocal referral agreement.
~ F.S. 456.054 ickbacks prohibited.—(1)As used in this section, the term “kickback” means a remuneration or payment, by or on behalf of a provider of health care services or items, to any person as an incentive or inducement to refer patients for past or future services or items, when the payment is not tax deductible as an ordinary and necessary expense.
Non-Malfeasance
~ Don’t encourage patients to opt for a higher level of care which would pay the company more
~ Don’t encourage patients to enroll in a treatment program with the insinuation that copays and deductibles will not be collected
~ Potential criminal charges against client
~ Potential that someone will try to collect if administration changes
Non-Malfeasance
~ Avoid using techniques in which the practitioner is not adequately trained, even if the state does not require a specialty certification
~ Hypnosis/EMDR
~ Sex Therapy
~ Child Therapy
~ Eating Disorders
~ Addiction
~ Do not provide prescriptive advice in an area in which the practitioner is not trained (Nutrition, medicine, exercise)
Summary
~ Beneficence means taking proactive action to improve client welfare
~ Non-Malfeasance means ensuring that above all you do no harm
~ Harm to clients is often incidental to a clinician’s actions to get more money
~ Insurance fraud
~ Referring to agencies with the best kickbacks
~ Failing to discharge a “reliable” client
~ Encouraging participation in an unnecessarily high level of care for a higher reimbursement level
Summary
~ Ethically clinicians should strive to:
~ Prevent people from becoming clients in the first place (Provide prevention activities or information)
~ Encourage people to seek help at the first sign of distress to prevent larger problems
~ Provide effective, efficient services to empower clients to take charge of their own mental and physical health
~ Ensure knowledge of a wide range of techniques and referral sources to meet the individualized needs of each client