A. Changes in the American health care delivery system, such as the increased complexity of financing health care costs, the need for authorizations for services prior to care provision, and the demands for cost-effectiveness, client 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 client advocate, will prevent ethical conflicts from occurring—or at least manage them when they arise—and especially reduce their impact on health care outcomes, the experience of the patient/family, the providers of care, and any others who may be involved.

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

D. Ethical principles are derived from ethical theories and constitute important values and moral beliefs that inform or serve as guidelines for ethical conduct.

E. There are five (5) common ethical principles case managers must be aware of and must incorporate into their practice. These include the following:

F. Ethical ambiguity or conflict occurs when an ethical principle that might inform behavior is absent, unclear, or controversial.

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 do the following:

I. Advocacy is a fundamental duty in the ethical case manager’s practice. It can be accomplished through a process that promotes a client’s selfdetermination, independence through education, resource and service facilitation, informed decision making, and elimination of disparities (CMSA, 2010).

A. Advocacy—A process that fosters clients’ independence by educating them about their rights, health care and human services, resources, and benefits. Advocacy entails securing informed consent and includes considerations of the client’s values, beliefs, and interests (CCMC, 2015).

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

C. Autonomy—A form of personal liberty whereby an individual possesses sufficient mental ability and an absence of external constraint to determine his or her behavior in accordance with a plan chosen and developed by himself or herself (CCMC, 2015).

D. Beneficence—Promoting the other’s good or taking steps that further the other’s legitimate interests (CCMC, 2015).

E. Client—The individual to whom, or on whose behalf, a case manager provides services (CCMC, 2015).

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, 2015).

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, & 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 or objects of value, that looks to a formal agreement among the principles where formal rules, principles, and procedures for settling disputes have been settled and adopted (Banja, 2003).

K. Deontologism—Popularized by Immanuel Kant (1724 to 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 performed from a sense of obligation (Beauchamp & Childress, 2008).

L. Dignity—A characteristic of human beings, largely deriving from their rational capacities to self-legislate their moral and legal rules and obligations, 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 & Childress, 2008).

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, and treating another fairly (Beauchamp & Childress, 2008).

Q. Moral character—A habituated response or repertoire of responses to situations bearing on human welfare (Beauchamp & Childress, 2008).

R. Morality—A term that refers to conduct that represents the customs, practices, or conventions that define and characterize people’s moral behavior. Unlike ethics, which tends to be critical, analytical, and inquiring toward beliefs, customs, and social conventions, morality is simply the compendium of a society’s or a community’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 & Childress, 2008).

T. Normative guidelines—Guidelines that are nationally accepted and considered or looked upon as recommendations or maxims that inform choices and justify action.

U. Privacy—Protecting or securing sensitive information from persons who have no need or right to it.

V. Publicity—The act of making decisions based on standards and rules that are not only available publicly but also accessible by those influenced by the decisions (Jansen, 2003).

W. Unprofessional behavior—Behavior that unreasonably deviates from norms, guidelines, standards, and ethical codes that inform professional behavior.

X. Utilitarianism—An ethical theory popularized by John Stuart Mill (1806 to 1873). It recommends right actions are the ones that produce the greatest amount of happiness for the greatest number of people (Beauchamp & Childress, 2008).

Y. Values—Ascriptions of worth, significance, or importance that inform the bases of standards, goals, or attitudes (Banja, 1997).