1. Powell, Suzanne MBA, RN, CCM, CPHQ
  2. Fink-Samnick, Ellen MSW, ACSW, LCSW, CCM, CCTP, CMHIMP, CRP, DBH(c)


Case management's ethical tenets are timeless and remain a foundational pillar of case management practice. These tenets are independent of patient or situation context, even with the tremendous post/parapandemic times. Yet, the question beckons: Despite the times or their circumstances, how do health care professionals engage in ethical practice while still maintaining hope?


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Case management's ethical tenets are timeless despite the fluid nature of industry events. Advocacy is the trigger to activate each stalwart principle: autonomy, beneficence, fidelity, justice, and nonmalfeasance. The tenets are embraced across every health and behavioral health discipline and at the core of every practitioner's actions. Although these post-pandemic times have tested that premise, ethics remain a foundational pillar of (case management) practice, independent of patient or situation context.


Bioethical themes are embedded within health care's reality. Who has been pulled into patient and family discussions focused on efficacy of clinical treatments? What about clarification to best understand diagnosis and prognosis? It is an understatement to say case managers should be experts at "agreeing to disagree" with patients and the assorted stakeholders involved in their care. Yet, ensuring patient (and family) comprehension of details is at the hallmark of every communication; truth and transparency are intertwined with patient autonomy and beneficence.


The workforce has been met with a series of fresh ethical quandaries over this last year, from rationing services and treatments to the accompanying untenable choices of who lives and dies. Too many colleagues across disciplines and practice settings have faced more of these decisions in the past months than expected for their entire career (Fink-Samnick, 2020). Yet, the question beckons: Despite the times or their circumstances, how do health care professionals engage in ethical practice while still maintaining hope?


Hope and Ethics Are Intertwined

Hope is a powerful emotion. As health care workers, we see it frequently. We read the patient's documentation of health care challenges, but the patient is so motivated and hopeful, all expectations spin by and seemingly miracles occur. The definition of hope is operationalized though the patient experience: "to desire with expectation of obtainment or fulfillment, to want something to happen or be true" (Merriam-Webster, 2021). However, loss of hope may also have the opposite effect, as exemplified by this personal story.


My brother, his wife, and my husband went into the oncologist's office after the radiation therapy was completed and the postradiation scans were done. The oncologist stated, "Everything is looking good. At this time, we will hold off on more radiation and, in several months, we will see if any new treatments can be done in the coming year." We couldn't have gotten happier news after the recent deaths of our mother and stepfather, some 18 weeks apart.


Two days later, hospice called my sister-in-law, stating the oncologist ordered their services and for equipment to be brought to their house. The shock was enormous; this was the first time hospice was broached. The communication was via telephone from the hospice agency, and no indication of need was mentioned at the oncologist's appointment; themes of beneficence, fidelity, and nonmalfeasance by the provider ran through my mind. My brother called me while I was at work and conveyed what happened. When the hospice team arrived they were met with shock and confusion; they said that they were told "the patient had 3-6 months left." The delicacy of how this news should be conveyed can't be overstated; talk about patient autonomy!


I couldn't wrap my head around this sudden change and called my husband who witnessed the office visit 2 days earlier. Unfortunately, he also heard no mention of hospice, end-of-life choices, or progression of cancer. I never really saw this level of betrayal in the health care system lessen prior to my brother's death, which occurred 3 months later. One can only wonder, how did the provider's lack of attention to the ethical parameters of practice influence my brother's sense of hope? How did this lack of respect for patient autonomy and self-determination factor in? Where was shared discussion-making to reflect patient pain, suffering, as well as culturally inclusive practices? Did the provider lack the skill to convey hope or simply ethical adherence to attend to the human condition?


The intent of case management's ethical tenets is clear: to inform and guide the practice of every certified professional case manager. They protect the public by ensuring adherence to regulations, guidelines, and, most critically, minimum standards of competence for each requisite profession or practice specialty. A case manager's primary ethical obligation is to protect the public (Case Management Society of America, 2016). Professional and case management ethics and the concept of hope are clearly intertwined, each leveraging the other.




Case Management Society of America. (2016). Standards of practice for professional case management. Case Management Society of America. [Context Link]


Fink-Samnick E. (2020). Care across the pandemic. In End of life care for case management (Chapter 6). HCPro. [Context Link]


Merriam-Webster. (2021). Hope, definition.[Context Link]


end-of-life choices; ethics; hope; hospice