A. Changes in the American health care delivery system such as the increased number of managed care organizations, the need for authorizations for services prior to care provision, and the demands for cost effectiveness, patient safety, and quality of care, have resulted in a rising number of ethical concerns for health care professionals including case managers.

B. These changes have also resulted in the expectation that the case manager, as a patient advocate, will prevent ethical conflicts from occurring—or at least address them when they arise—and reduce their impact on health care outcomes, the experience of the patient/family, the providers of care, and others.

C. Ethical theories attempt to explain what it means to act ethically by defining:

D. Ethical principles derive from ethical theories and constitute important values that inform or serve as guidelines for ethical conduct.

E. There are six common ethical principles case managers must be aware of and must incorporate into their practice. These include:

F. Ethical ambiguity or ethical conflict occurs when an ethical guideline that might inform behavior is absent, unclear, or controversial. It also happens when guidelines or principles conflict with each other; that is, when satisfying one principle—such as honoring a client’s right to make his or her own decisions—collides with another principle—such as working to provide a benefit rather than a harm for the client (Banja, 1999).

G. Ethics and law share certain similarities and differences (Lo, 2000).

H. Codes of ethics, such as the Code of Professional Conduct for Case Managers advocated for by the Commission for Case Manager Certification (CCMC), attempt to:

I. Advocacy is essential in the ethical case manager’s practice. It can be accomplished through a process that promotes client’s rights and functional independence through education, resource and service facilitation, and informed decision making (CCMC, 2004).

A. Advocacy—Acting on behalf of those who are not able to speak for or represent themselves. It is also defending others and acting in their best interest (CCMC, 2005).

B. Advocate—The individual or groups involved in advocacy activities.

C. Autonomy—A form of personal liberty whereby an individual possesses sufficient mental ability to determine his or her behavior in accordance with a plan chosen and developed by himself or herself (CCMC, 2004).

D. Beneficence—Promoting the other’s good or taking steps that further the other’s legitimate interests (CCMC, 2004).

E. Client—The individual to whom, or on whose behalf, a case manager provides services (CCMC, 2004).

F. Code of Professional Conduct for Case Managers—A document consisting of principles, rules of conduct, and standards for professional conduct, as well as procedures for processing complaints, that the CCMC offers by way of providing ethical guidelines for case managers (CCMC, 2004).

G. Competence—The domain of skills, behaviors, practices, obligations, and responsibilities that are defined and bounded by the professional’s training and qualifications, licensure(s), or certification(s) (Banja, 2006).

H. Confidentiality—A nondisclosure responsibility that connotes refraining from divulging client information to individuals who have neither a need nor a right to know it (Jonsen, Siegler, and Winslade, 2002).

I. Conflict of interest—A set of conditions in which professional judgment concerning a primary interest, such as a patient’s welfare or the validity of research, tends to be unduly influenced by a secondary interest, such as financial gain (Thompson, 1993).

J. Contractualism—A model for resolving ethical dilemmas, usually bearing on the distribution of benefits, that looks to a formal agreement among the principles where the ethical rules and principles and procedures for settling disputes have been settled and adopted (Banja, 2003).

K. Deontologism—Popularized by Immanuel Kant (1724-1804), an ethical theory that is grounded in reason and bases decisions on the moral acceptability of the principles that are used to resolve a dilemma; the best principles are the ones that have the widest applicability (to similar cases) and that are done from a sense of obligation (Beauchamp and Childress, 2001).

L. Dignity—A characteristic of human beings that explains their inherent value and their enjoying fundamental rights.

M. Ethical dilemma—A situation wherein the ethically correct course of action is unclear; usually arises due to lack of clarity regarding which ethical principle is appropriate to apply, or because multiple ethical principles are in conflict (Banja, 1999).

N. Ethics—A word that can refer to the literature of moral philosophy; the development of a virtuous character; or the analysis of principles, rules, or language that characterize an action or judgment bearing on human welfare as right or good, or wrong, harmful, evil, beneficial, burdensome, etc. (Beauchamp and Childress, 2001).

O. Impartiality—Treating others similarly; making decisions that do not discriminate against individuals or groups on the basis of irrelevant differences such as ethnicity, race, age, gender, or lifestyle (Jansen, 2003).

P. Justice—Providing someone with his or her right or due; providing what a person is owed; treating another fairly (Beauchamp and Childress, 2001).

Q. Moral character—A habituated response or repertoire of responses to situations bearing on human welfare (Beauchamp and Childress, 2001).

R. Morality—A term that refers to conduct that represents the customs or conventions that define people’s moral behavior. Unlike ethics, which tends to be critical and analytical toward beliefs, customs, and social conventions, morality is simply the compendium of a society’s sensibilities bearing on acceptable versus unacceptable behavior (Lo, 2000).

S. Nonmaleficence—Refraining from harming; preventing harm from occurring; or, if only harm can occur from an inevitable act or decision, ensuring that the least amount of harm occurs (Beauchamp and Childress, 2001).

T. Normative guidelines—Guidelines that are nationally accepted and considered or looked upon as common standards. In relation to ethics, they inform ethical behavior.

U. Privacy—Protecting or securing sensitive information against persons who have no right to it (Lo, 2000).