Ethical Challenges in Addiction Treatment

1
Ethical Challenges in Addiction Treatment
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Definition ofWho is the Patient?
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Consent for Treatment Consent for Treatment
of Adolescents
4
Coerced Treatment
5
Treatment of the Incarcerated
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Imprisonment of Addicts

• Criminalization of intoxication
• Criminalization of fetal intoxication
• Criminalization of use/possession
• Criminalization of distribution
• Racial disparities in imprisonment

7
Withholding of Treatment/Termination of Treatment

• The non-compliant patient
• The recidivist patient
• The patient requesting detox who declines rehab
• The methadone maintenance patient who is using
  other substances

8

• The HIV or HBV patient
• The alcoholic patient requesting liver
  transplantation
• The injection drug patient requesting liver
  transplantation
• The HBV patient requesting liver transplantation

9
Confidentiality

• Notification of third parties
• Notification of parents of adolescent patients
• Notification of DMV
• Sharing of claims information with self-insured
  employers
• Sharing of information with case managers of
  utilization management firms

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Sexual Boundary Violations
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Practice While Under the Influence
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Physicians as Suppliers of Drugs/Diversion of
Controlled Substances
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Reporting of Colleagues
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Limitations on Insurance Benefits for Addiction
Treatment
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Ethical Challenges Due to Managed Care

• Conflicted Economic Incentives
• Conflicted Primary Loyalties
• the patient, the payor, the population under
  contract
• Disruptions in Continuity of Care Based on
  Managed Care
• Ethical Aspects of Carve-Outs
• Limitations on Provider Panel Access for
  Addiction Clinicians

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Economic Credentialing
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Expert Witness Testimony