- Email: [email protected]
Disability insurance for emergency physicians
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AMERICAN JOURNAL OF EMERGENCY MEDICINE • Volume 13, Number 2 • March 1995
cal analysis confuses beneficence (helping) with nonmaleficence (not doing harm). The incorporation of distributive justice into the protocol's defense seems somewhat tortured, and they also raise the question of futility unnecessarily. Why futility? Futility need only be mentioned in two contexts for EMS protocols. The first, physiological futility, exists in virtually all EMS systems. This concept allows medics to not resuscitate patients who have been decapitated, burned beyond recognition, have rigor or livor mortis, or have other injuries incompatible with life. The second context only comes into play when someone other than the patient (or the patient's designated surrogate) makes the resuscitation decision. A third-person rationale about whether a resuscitation is "worthwhile" need not exist if the patient has already made the decision. If patient autonomy exists, discussions of futility do not. Perhaps the authors could have saved themselves the mental anguish and simply allowed the patients to choose, in advance, whether to be resuscitated. As Hegel said, "What experience and history teach is this--that people and governments never have learned anything from history, or acted on principles deduced from it.' ,8 The best that can be said of Washington, DC's proposed prehospital DNAR protocol is that it has yet to be imple-
mented. Perhaps wiser and more generous minds will still prevail. KENNETH V. TSERSON,MD, MBA
Director, Arizona Bioethics Program, Professor of Surgery University of Arizona Health Sciences Center Tucson, AZ
REFERENCES 1. Sachs GA, Miles SH, Levin RA: Limiting resuscitation: Emerging policy in the emergency medical system. Ann Intern Med 1991 ;114:151-154 2. Iserson KV: Foregoing prehospital care: Should ambulance staff always resuscitate? J Med Ethics 1991 ;17:19-24 3. Iserson KV: A simplified prehospital advance directive law: Arizona's approach. Ann Emerg Med 1993;22:1703-1710 4. Iserson KV: Death to Dust: What Happens to Dead Bodies? Tucson, AZ, Galen Press, Ltd, 1994, p 20 5. A.R.S. 36-3201 et.seq. (Revised, 1994) 6. Fitzgerald DJ, Milzman DP, Sulmasy DP: Creating a dignified option: Ethical considerations in the formulation of prehospital DNR protocol. Am J Emerg Med 1995;13:000-000. 7. Beauchamp JF, Childress JE: Principles of Biomedical Ethics (2 ed). New York, NY, Oxford University Press, 1983 8. Hegel GWF: The Philosophy of History, 1832. In Hutchins RM (ed): Hegel: Great Books of the Western World, vol 46. Chicago, iL, Encyclopedia Britannica, 1952, p 155
Disability Insurance for Emergency Physicians Disability insurance for physicians can be tenuous and problematic, even for the HIV-negative physician. At least one major insurance carrier in the United States does not write disability insurance coverage for emergency physicians. Specifically, the insurance company in question does not write individual disability insurance policies for emergency physicians. The company contends that they have had a larger claims experience with emergency physicians and anesthesiologists than with other medical specialists (personal communication). When asked for the cause of this larger claims experience, the company responded that emergency physicians have a higher "burn-out" level than other specialists. However, they will write this type of insurance coverage for a group of physicians or a hospital that has emergency physicians as part of the group or staff. This attitude by an insurance company raises a number of questions for emergency physicians: (1) Does the insurance industry have data that they should be sharing with emergency physicians? (2) Are there other insurance companies that will not write disability insurance coverage for emer-
gency physicians? (3) Are there other types of coverage that insurance companies will not write for emergency physicians, such as medical insurance or life insurance? (4) Is the larger claims experience directly related to emergency physicians' increased exposure to HIV, violence, or other ills? (5) Should emergency medicine or the American College of Emergency Physicians (ACEP) fight for the rights of emergency physicians? Although ACEP has entered into an agreement enabling emergency physicians to purchase individual disability coverage, the important issue is that without this opportunity to purchase disability insurance from this source, we would be discriminated against and find ourselves with unduly expensive coverage, or no coverage at all. Isn't it discriminatory that insurance companies regard the emergency physician as "too high" a risk? LESLIE S. ZUN, MD, MBA
Chairman, Department of Emergency Medicine Mount Sinai Hospital Medical Center Chicago, IL
The Successful Emergency Physician in the Managed Care World Without question, we are entering a new era in the provision of medical care in the United States. Having to deal with health care costs that have been escalating at a rate far in excess of the rate of inflation, employers have been bur-
dened with medical benefit costs that contribute to their inability to compete in a global economy. Furthermore, federal and state legislators have been struggling with means to make their medical entitlement plans affordable. The
AMERICAN JOURNAL OF EMERGENCY MEDICINE • Volume 13, Number 2 • March 1995
cal analysis confuses beneficence (helping) with nonmaleficence (not doing harm). The incorporation of distributive justice into the protocol's defense seems somewhat tortured, and they also raise the question of futility unnecessarily. Why futility? Futility need only be mentioned in two contexts for EMS protocols. The first, physiological futility, exists in virtually all EMS systems. This concept allows medics to not resuscitate patients who have been decapitated, burned beyond recognition, have rigor or livor mortis, or have other injuries incompatible with life. The second context only comes into play when someone other than the patient (or the patient's designated surrogate) makes the resuscitation decision. A third-person rationale about whether a resuscitation is "worthwhile" need not exist if the patient has already made the decision. If patient autonomy exists, discussions of futility do not. Perhaps the authors could have saved themselves the mental anguish and simply allowed the patients to choose, in advance, whether to be resuscitated. As Hegel said, "What experience and history teach is this--that people and governments never have learned anything from history, or acted on principles deduced from it.' ,8 The best that can be said of Washington, DC's proposed prehospital DNAR protocol is that it has yet to be imple-
mented. Perhaps wiser and more generous minds will still prevail. KENNETH V. TSERSON,MD, MBA
Director, Arizona Bioethics Program, Professor of Surgery University of Arizona Health Sciences Center Tucson, AZ
REFERENCES 1. Sachs GA, Miles SH, Levin RA: Limiting resuscitation: Emerging policy in the emergency medical system. Ann Intern Med 1991 ;114:151-154 2. Iserson KV: Foregoing prehospital care: Should ambulance staff always resuscitate? J Med Ethics 1991 ;17:19-24 3. Iserson KV: A simplified prehospital advance directive law: Arizona's approach. Ann Emerg Med 1993;22:1703-1710 4. Iserson KV: Death to Dust: What Happens to Dead Bodies? Tucson, AZ, Galen Press, Ltd, 1994, p 20 5. A.R.S. 36-3201 et.seq. (Revised, 1994) 6. Fitzgerald DJ, Milzman DP, Sulmasy DP: Creating a dignified option: Ethical considerations in the formulation of prehospital DNR protocol. Am J Emerg Med 1995;13:000-000. 7. Beauchamp JF, Childress JE: Principles of Biomedical Ethics (2 ed). New York, NY, Oxford University Press, 1983 8. Hegel GWF: The Philosophy of History, 1832. In Hutchins RM (ed): Hegel: Great Books of the Western World, vol 46. Chicago, iL, Encyclopedia Britannica, 1952, p 155
Disability Insurance for Emergency Physicians Disability insurance for physicians can be tenuous and problematic, even for the HIV-negative physician. At least one major insurance carrier in the United States does not write disability insurance coverage for emergency physicians. Specifically, the insurance company in question does not write individual disability insurance policies for emergency physicians. The company contends that they have had a larger claims experience with emergency physicians and anesthesiologists than with other medical specialists (personal communication). When asked for the cause of this larger claims experience, the company responded that emergency physicians have a higher "burn-out" level than other specialists. However, they will write this type of insurance coverage for a group of physicians or a hospital that has emergency physicians as part of the group or staff. This attitude by an insurance company raises a number of questions for emergency physicians: (1) Does the insurance industry have data that they should be sharing with emergency physicians? (2) Are there other insurance companies that will not write disability insurance coverage for emer-
gency physicians? (3) Are there other types of coverage that insurance companies will not write for emergency physicians, such as medical insurance or life insurance? (4) Is the larger claims experience directly related to emergency physicians' increased exposure to HIV, violence, or other ills? (5) Should emergency medicine or the American College of Emergency Physicians (ACEP) fight for the rights of emergency physicians? Although ACEP has entered into an agreement enabling emergency physicians to purchase individual disability coverage, the important issue is that without this opportunity to purchase disability insurance from this source, we would be discriminated against and find ourselves with unduly expensive coverage, or no coverage at all. Isn't it discriminatory that insurance companies regard the emergency physician as "too high" a risk? LESLIE S. ZUN, MD, MBA
Chairman, Department of Emergency Medicine Mount Sinai Hospital Medical Center Chicago, IL
The Successful Emergency Physician in the Managed Care World Without question, we are entering a new era in the provision of medical care in the United States. Having to deal with health care costs that have been escalating at a rate far in excess of the rate of inflation, employers have been bur-
dened with medical benefit costs that contribute to their inability to compete in a global economy. Furthermore, federal and state legislators have been struggling with means to make their medical entitlement plans affordable. The