Each day of National Health Ethics Week 2018, we will add a case and discussion questions, based on a different theme. The theme this year is:
Trust and Transparency: Conflict of Interest Throughout the Healthcare System
In broad terms, a conflict of interest occurs when an individual or organizations primary goal (caring for a particular patient or patients in general, for example) is or is perceived to be inappropriately influenced by secondary interests. We become particularly concerned when those secondary interests relate to personal gain.
Conflicts of interest arise frequently in health care practice and are often unavoidable, so much of the ethical work involves working out how to manage them appropriately. This means finding ways to balance the needs various parties, including current patients, future patients, health care providers, learners, and researchers in a context where resources of all kinds are limited.
Challenges can arise in determining the nature of an individual or organizational conflict of interest as well as in determining how to respond appropriately to a potential, perceived, or actual conflict of interest.
Some of the particular features of health care practice in Nova Scotia that can contribute to how we work through ethical questions about conflict of interest include:
- Multiple relationships between individuals in smaller communities (e.g., a patient’s nurse might also be their child’s soccer coach and also a neighbour)
- In smaller communities there can be fewer providers of services to choose from (or even no choice of provider)
- Resources in the health care system are limited, and so providers are often seeking innovative ways to meet needs
Specific resources are included with each case, and below is a list of general resources regarding conflict of interest:
- College of Physicians and Surgeons of Nova Scotia: Guidelines regarding conflict of interest. https://cpsns.ns.ca/wp-content/uploads/2017/11/Conflict-of-Interest.pdf
- College of Physicians and Surgeons of Nova Scotia: Guidelines on Physician interaction with Industry https://cpsns.ns.ca/wp-content/uploads/2017/10/Physician-Interaction-with-Industry.pdf
- Description and Examples of Conflicts of Interest. Partners’ Healthcare, Founded by Brigham and Women’s Hospital and Massachusetts General Hospital. https://www.partners.org/About/Ethics/Interactions-With-Industry/Description-of-COI.aspx
- Cristina Morciano , Vittorio Basevi, Carla Faralli, Michele Hilton Boon, Sabina Tonon, Domenica Taruscio:. 2016. Policies on Conflicts of Interest in Health Care Guideline Development: A Cross-Sectional Analysis. Plos one, November 15, 2016. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0166485
- Christopher C. Mutt. 2017. Conflict of Interest in Medicine. JAMA, 317(17): 1812. Published May 2, 2017. https://jamanetwork.com/journals/jama/fullarticle/2623608
- B Lo and MJ Field, editors. 2009. Institute of Medicine (US) Committee on Conflict of Interest in Medical Research, Education, and Practice; 6 Conflicts of Interest and Medical Practice. Washington (DC): National Academies Press (US); 2009. https://www.ncbi.nlm.nih.gov/books/NBK22944/
- Doctors, Money, and Conflicts of Interest. 2014. Health Care Triage. Produced by John Green and Stan Muller. https://www.youtube.com/watch?v=UJtLUaeEkbk
- NSHEN Bioethics book club: A Course in Deception by Jana Rieger. http://www.nshen.ca/wp-content/uploads/2018/02/A-course-in-deception-by-jana-riegerFINAL.pdf?x49227
- NSHEN Case Database: Case 35. Competing interests. https://nshencases.wordpress.com/2015/09/15/35-case-competing-interests/
- David B. Resnik. 2007. Conflict of Interest. When is Disclosure not enough? In Resnik DB; The price of Truth: How Money Affects the Norms of Science. Oxford Scholarship Online. http://www.oxfordscholarship.com/view/10.1093/acprof:oso/9780195309782.001.0001/acprof-9780195309782-chapter-5