Physicians in the double role of treatment provider and expert in light of principle-based social insurance medical ethics

Hans Magnus Solli,António Barbosa Da Silva

doi:10.5324/eip.v13i2.2911

Abstract

GPs serve in a double role of treatment provider and expert in certain social insurance systems, such as the Norwegian one. Some physicians assert that the ethical obligations of the two roles conflict with each other. The objective of this article is to show that social insurance medical ethics (SIME), which are based on recognised principles of medical ethics, unite the physicians’ obligations associated with these roles. The method applied is a medical ethics conceptual analysis. The material consists of literature on normative SIME. The study shows that SIME expands the role of the treatment provider to a wider societal context. Here, physicians should attempt to balance the perspectives of sympathy with empathy, as treatment providers, with the impartiality in their role as experts. Five principles of medical ethics are fundamental. Respect for human dignity is the overarching principle of medical ethics. The four others are nonmaleficence, beneficence (including soft paternalism), autonomy, and social justice. The article discusses two areas where it is asserted that the roles of treatment provider and expert conflict with each other: the application of beneficence and justice, and the duty of confidentiality versus the duty to provide information to the National Insurance service. The study concludes that there are no basic ethical conflicts between the two roles. The ethical problems that may arise when exercising this duality should be viewed in the same way as other ethical problems in medicine. Actual application and balancing of the principles may necessitate negotiations between patients and physicians.  Keywords: dual roles, professionalism, deliberation, impartiality, medical principle ethics, values of welfare state

Highlights

Research conducted in several welfare states, including Norway, documents how physicians often view medical certificates as problematic
Some physicians believe that conflicts may arise between the duality of the roles of patient treatment provider and expert when dealing with the National Insurance system (Wynne-Jones, Mallen, Main and Dunn 2010)
This study has argued in favour of a social insurance medical ethics (SIME) where the ethical duties that follow from the roles of treatment provider and expert can be understood and analysed within the frames of recognised principles of medical ethics

Summary

Introduction

Research conducted in several welfare states, including Norway, documents how physicians often view medical certificates as problematic. This is a matter of handling disagreements with patients about whether medical certificates are warranted or not, deciding the certificates’ correct duration, assessing the patient’s capacity for work, Solli H. Nord J Appl Ethics (2019), 13(2), 81-97 81 and collaborating with other parties like employers and the local National Insurance office. Some physicians believe that conflicts may arise between the duality of the roles of patient treatment provider and expert when dealing with the National Insurance system (Wynne-Jones, Mallen, Main and Dunn 2010)

Objectives

Methods

Conclusion