A talented and irreplaceable staff member is accepting bribes in order · Medical

J A talented and irreplaceable staff member is accepting bribes in order to prioritise patients for care. How might this be addressed?

Step 1 – IDENTIFY THE PROBLEM(S)

Briefly state the Scenario: A talented and irreplaceable staff member is accepting bribes in order to prioritise patients for care.

How might this be addressed?

List the Issues that arise from the scenario

• The possibility for a clinically competent individual to do more harm than good by their personal behaviour.

• Medical inequalities.

• Violation of Ethics and Professional Integrity (if allegations are true).

• Could this behaviour cause a loss of trust in/within the medical unit?

• Bribery is illegal in most jurisdictions, and both the staff member and potentially the organisation could face serious legal repercussions.

• Undermining Team Morale and Workplace Culture.

Identify Critical Information required and Assumptions to be made

• What is the evidence for this allegation?

• How might the allegation be proven?

• How should any investigation into the allegation be undertaken and who should do it?

• Who needs to know about the investigation? - chain of command, police, professional regulatory bodies, etc.

• What needs to be done regarding the practice of the staff member whilst the allegations are being investigated? - should they be suspended, should any other aspects of their practice be investigated?

• How should staff members be supported while they are under investigation?

• Could this behaviour be an indicator of something else?

Step 2 – ANALYSE

Patient: The principle of justice is central to this scenario, as it asserts that every individual is entitled to receive medical care, with prioritisation based solely on clinical needs rather than any other factors. Additionally, the principle of non-maleficence is at play, as the medical professional could be jeopardising patient care by making decisions based on financial gain, which may lead to harm or neglect of those who require immediate attention.

Clinical: Healthcare ethical principles do not change in armed conflict or emergencies and privileges or facilities used during said times should never be used for purposes outside healthcare needs. - WMA, ‘Ethical principles of health care in times of armed conflict and other emergencies’. At: https://www.wma.net/policies-post/ethical-principles-of-health-care-in-times-of-armed-conflict-and-other-emergencies/

Several key principles from the physician’s code of conduct are relevant to this scenario:

A physician shall:

- NOT allow their judgment to be influenced by personal profit or unfair discrimination.

- Deal honestly with patients and colleagues, and report to the appropriate authorities those who practice unethically or incompetently or who engage in fraud or deception.

- NOT receive any financial benefits or other incentives solely for referring patients or prescribing specific products.

WMA International Code of Medical Ethics, Revised: October 2022. At: https://www.wma.net/policies-post/wma-international-code-of-medical-ethics/

MSF Behavioral Standards, 2024. At: https://www.doctorswithoutborders.org/who-we-are/behavioral-commitments

Legal: In many jurisdictions, accepting bribes is classified as corruption, the UK specifically prohibits bribery in any form, including bribery within healthcare. - UK Government. ‘Bribery Act, Section 2. Offences Relating to Being Bribed’. 2010. At: https://www.legislation.gov.uk/ukpga/2010/23/contents

These laws are designed to prevent financial incentives from influencing medical decisions, which can lead to unethical practices such as overprescribing medications, unnecessary treatments, or biased referrals. This may result in legal liability for malpractice, and doctors may face lawsuits, loss of their medical license, and other legal penalties.

Societal/Military: Integrity is a key trait for maintaining trust and credibility in the medical profession. Maintaining trust involves upholding oneself and other professionals to the highest standard of professional conduct. This is also included in the UK Army’s Values and Standards, alongside the value of selfless commitment (putting the team ahead of your needs and trust) - British Army. ‘Values and Standards’. At: https://www.army.mod.uk/learn-and-explore/about-the-army/values-and-standards/

Both patients and the public place their trust in healthcare professionals to provide fair and unbiased care. The discovery of bribery can erode public trust in the healthcare system, causing patients to feel that their care is contingent on personal or financial circumstances, rather than medical needs

If the bribery practice becomes widespread/publicised, it could result in reputational damage, loss of funding, or legal settlements. Additionally, resource allocation may be skewed, affecting the overall efficiency and effectiveness of healthcare delivery..

Step 3 – FUSE

● Summarise conclusions

● Insert citations to key reference sources for your analysis

● Determine the exact Decision(s) to be made

While a clinically competent individual may possess valuable skills, their personal behaviour can significantly impact the overall functioning of the team and the care provided to patients.

It is clear that it would be ethically unacceptable to accept bribes to prioritise patients. It is highly likely that this behaviour would be subject to military law and criminal law. In crisis situations, there is considerable scope for unethical behaviour especially if individuals (e.g. healthcare workers) have control of a commodity in high demand.

Medical practitioners should report behaviour not keeping in line with the principles of the Code of Conduct to the appropriate authorities (whether that would be the military or the appropriate professional body). - WMA International Code of Medical Ethics, Revised: October 2022. At: https://www.wma.net/policies-post/wma-international-code-of-medical-ethics/

ICRC Code of Conduct, 2023. At: https://www.icrc.org/sites/default/files/document/file_list/code_of_conduct_2023.pdf

Step 4 – DECIDE

• What is your Decision?

• Why (can you justify it)?

• Residual uncertainly, need for review?

Addressing this situation requires a careful balance of protecting patient welfare, maintaining ethical standards, and holding the individual accountable. Through a thorough investigation, appropriate disciplinary action, and a commitment to transparency and ethics, the issue of bribery can be resolved in a way that safeguards the integrity of the healthcare system and restores public trust.

How might you ensure that your personnel are aware of their behavioural responsibilities? Education and training in healthcare ethics is crucial to provide the best standard of care. - ICRC. ‘Protecting Healthcare: Guidance For The Armed Forces’. 2021. At: https://healthcareindanger.org/wp-content/uploads/2021/03/4504_002-ebook.pdf

Reviewed and formatted by:

Adriana Salas Yeguez, MBBS Year 3 King’s College London

December 2024