Virtual Mentor. April 2000, Volume 2, Number 4.
Cases in Law and Ethics
Intentional Misdiagnosis to Get Insurance Coverage
An ethical case explores what a physician should do when a patient's health insurance will not cover a screening test for cancer despite the fact that a family history puts the patient at increased risk of developing the disease.
Both ethics and law address norms that govern physicians' behavior. Many view the law as a baseline for articulating the limits placed on individuals living within society as well as an enabling device to facilitate social relationships. Encompassing as the law may be in some areas of human conduct, in many others it is silent. In the absence of legal norms or prohibitions, physicians often find guidance in the standards arrived at through ethical reasoning.
To guide students through the process of ethical reasoning and to acquaint them with case law, a new case study will appear every 2 to 4 weeks. Students will be given legal and/or ethical opinions to assist their decision-making.
April Case Scenario
A 32-year-old man presents with no significant past medical history. The patient's 38-year-old brother was recently diagnosed with colon cancer and recently underwent a subtotal colectomy. Given the young age of his brother, the patient is now concerned about getting (or already having) colon cancer. Although he has no abdominal symptoms, he insists on a screening colonoscopy. The physician shares the patient's concern and believes that given his family history such an intervention is warrented. However, the patient's health insurance plan will not pay for a colonscopy, but the physician knows that the plan will pay if the patient has had recent weight loss and change in bowel habits, although this diagnosis is inaccurate.
What should the physician do?
See what the AMA Code of Medical Ethics says about this topic in:
Opinion 8.12 Patient information. American Medical Association. Code of Medical Ethics 2008-2009 Edition. Chicago, IL: American Medical Association; 2008:263-265.
Opinion 8.13 Managed care. American Medical Association. Code of Medical Ethics 2008-2009 Edition. Chicago, IL: American Medical Association; 2008:266-274.
The viewpoints expressed on this site are those of the authors and do not necessarily reflect the views and policies of the AMA.
© 2000 American Medical Association. All Rights Reserved.