HAN 335: midterm

professional ethics

facing difficult human questions about right and wrong conduct, duties, rights, and fair treatment

what is ethics?

systematic study on and analysis of morality

morality

things ought or not ought to be done because of their deep social importance in the way they affect the interests of other people

(relationships between ppl)

includes: values, duty, character

goal of morality

protect a higher quality of life

values

intrinsic things a person, group, or society hold dear

not all values are "moral values"

uses moral judgements

duty

role each person plays in society (action)

moral duty

describes actions required of an individual, group or society if each is to play a part in preventing harm and building a foundation

character

traits, dispositions/attitudes that set groundwork for us to trust each other

pieces of morality

moral character = virtues

personal morality

collage of values, duties, character traits adopted and relevant to individuals life

stems from societal morality (can be influenced by culture, parents, etc)

moral integrity

sense of integrity felt when acting in accordance with your values that make up your personal morality

integration of character and conscience

societal morality

morality shared with others in society

contains values, duty, character that comes from deep cultural beliefs about humans relationship with God/Universe

group morality

subgroup found within society with their own set of belief

healthcare professionals - code of ethics

professional morality

embraces moral values, duty and character traits that do not apply equally or at all to others in society

ex: health professional required to help others no matter what

morality order

societal -> group -> personal

professional code of ethics

guides practice and promotes integrity

institution policies

group morality should be embedded in the policies, customs and practices or an institution

gold standard of ethics

maintain human dignity

"moral thing to do"

traditions, customs, laws are looked to for guidance

"ethical thing to do"

decisions being made have been reflected on and moral judgement has been used (may not align with moral thing)

ex: to be honest abt condition vs. continue helping patient get better

steps of ethical reasoning

1) recognize

2) analyze

3) seek resolution

4) act

law

-defined by government

-based on concepts of justice and equality

-formal rules for resolution of complex problems

-uniformity

-minimum standard of behavior

-rules of laws enforced by regulatory authorities and courts

"must"

ethics

-defined by individual and community

-based on how we define a good, worthy, meaningful life

-informal guidelines for resolution of complex problems

-some uniformity; respectful of diversity

-ideal or aspirational

-noncoercive

-standards and exhortations by custom, professional standards, discussion and persuasion

-should

moral agent

acts on your own moral authority, based on standard of behavior

moral repugnance

allows people to exempt themselves from doing specific things that may be against personal values

ex: doctors can refuse to do abortions

ethicists

analyzes and helps clarify values, duties, and other aspects of morality in specific situations

health

soundness of body or mind; free from disease or ailment

care

to protect, serious attention, to be concerned about, to look out for

Primum Non Nocere

First do no harm

goal of professional ethics

to arrive at a caring response

needed for patient-centered care

attention to detail

communication tools

nonmaleficence

do no harm (passive)

refrain from abuse

beneficence

minimize harm/maximize benefits (active)

remove harm when being inflicted, bring about positive good

autonomy

patients right to decide for themselves

must have liberty (freedom from controlling influences)

must have agency (capacity for intentional action)

paternalism

deciding for the patient

fidelity

duty to the patient; faithfulness

follow code of ethics, privacy, etc

(think of d in fidelity for duty)

veracity

must tell patients the truth

informed consent, diagnosis, prognosis, treatment options

therapeutic privilege

the withholding of relevant information from a patient when the physician believes disclosure would likely do harm

ethical problem prototypes

Moral distress

Locus of authority

Ethical dilemma

moral distress

occurs when the individual knows the right thing to do but organizational constraints make it difficult to take the right course of action

-lack of knowledge/uncomfortable

(ex: keeping patient on life support when it isnt best)

justice

make sure you are doing the right thing

no discrimination against any individuals

locus of authority problem

face a challenge of who should be primary decision maker

(ex: Nancy Cruzan, parents or state in charge)

ethical dilemma

face a challenge about the right thing to do, 2 or more courses of action but none feel completely right

deontological

ethical theory based on duty and obligation, regardless of the outcome

teleological (utilitarianism)

driven by the consequences of the actions and outcomes; driven to bring about the most good/least harm for the patient

step 1 of six step process of ethical decision making

1) gather as much relevant information as possible to get facts straight

what questions:

-what practices/research evidence

-what tests

-what might have happened

-what is recent history

step 2 of six step process of ethical decision making

2) determine precise nature of the ethical problem

-moral distress

-locus of authority

-ethical dilemma

step 3 of six step process of ethical decision making

3) decide on the ethics approach that will best get to heart of the problem

what are the approaches for step 3

narrative approach - keeps relevant details of story at center of deliberation

utilitarianism - consequence

deontology - duty

step 4 of six step process of ethical decision making

4) decide what should be done and how best it can be done (explore the widest range of options possible)

step 5 of six step process of ethical decision making

act

step 6 of six step process of ethical decision making

reflect on and evaluate the action

confidentiality

the practice of keeping harmful, shameful, or embarassing information within proper bounds

*an obligation*, ethical issue self-imposed by a profession

privacy

*a privilege*, legal issue invoked or relinquished by the patient that requires the professionals to not disclose information

**right to privacy gives legal standing to the ethical principle of confidentiality

violations of confidentiality

A RIGHT (focuses on provider)

disclosure of someone's private information that they voluntarily imparted in confidence and trust when there was an implicit promise not to divulge that information without their permission

violation of privacy

A DUTY

unauthorized disclosure of someone else's private information (unauthorized access, use of disclosure of protected health information)

modern difficulties with maintaining confidentiality

professional "need to know" - other health care professional

non-professional "need to know" - insurers, employers, office/hospital staff

communication hazards, and technology stuff

when can you share private patient information with other health professionals?

when it is directly related to the patients care

confidentiality is likely to be lost in return for

-insurance coverage

-employment opportunity

-your application for gov benefits

-investigation of health and safety at worksite

exceptions to obligation for confidentiality

-patient threatens to harm themselves, or others

-when required by law (suspected abuse, disease)

conflict

when the desire to benefit the patient and refrain from harming the patient is in conflict with the duty to prevent harm to others or society

HIPAA / privacy rule

health insurance portability and accountability act

a federal law protecting the privacy of patient-specific health care information and providing the patient with control over how this information is used and distributed

who is covered by hipaa privacy rule?

covered entities

what are covered entities

- health plan

- health care clearinghouse

- health care provider who transmits any health information in EMR

health plan

individual or group plan that provides or pays the cost of medical care

(insurance plan)

health care clearinghouse

public or private entity that processes or facilitates the processing nonstandard data elements of health information into standard data elements

middleman between health plan and health care provider

"medical claims"

health care providers

every healthcare provider, regardless of size, who electronically transmits health information

health information

info, either orally or written, created/received by a healthcare provider; includes past, present, and future information

examples of individually identifiable health information

name

address

SSN

phone number

protected health information

any individually identifiable health information

health info can be "de-identified" with either formal determination by qualified statistician, or removal of identifiable info

HIPAA excludes

- employment records that a covered entity maintains

- education and certain other records subject to FERPA (family educational rights and privacy act)

de-indentified health information

no basis to identify and individual

ways to de-identify:

1) a formal determination by qualified statistician

2) removal of specified identities of individual and individual's relatives, etc.

required disclosures

covered entity must disclose protected health information to individuals when

- they request access

- to DHHS (department of health and human services) when it is undertaking a compliance investigation

Permitted uses and disclosures of PHI

without individuals authorization:

- to individual

- treatment, payment, healthcare operations

-public interest and benefit activities

-limited data set for purpose of research, public health, or healthcare operations

facility directories

health care provider may rely on general condition patient name

notification

to notify relatives, family

12 national priority purposes (privacy rule permits use and disclosure of PHI)

1. Required by law

2. Public health activities

3. Victims of abuse / neglect/ domestic violence

4. Health oversight activities

5. Judicial and administrative proceedings

6. Law enforcement purposes

7. decedents

8. cadaver organ / eye / tissue donation

9. Research

10. Serious threat to health or safety

11. Essential government functions

12. Workers comp.

access

patients have right to review and obtain copy of PHI

amendment

gives individuals right to have covered entities amend their PHI (make changes if inaccurate or incomplete)

disclosure accounting

have right to an accounting of the disclosures of their PHI covered entity

HIPAA notice of privacy practice

individual has right to adequate notice of how covered entity may use and disclose PHI

compliance

DHHS, office for civil rights is responsible for administering and enforcing privacy rule

HITECH act of 2009

promote the use of EHR by covered entities

expanded requirements for:

- data breach notifications

- protection of electronic PHI

breach

impermissible use or disclosure of PHI that compromises the security or privacy of the data

strong paternalism

the overriding of a person's actions or choices even though he is substantially autonomous

weak paternalism

overriding the decision of someone who cannot currently make the decision for themselves

informed consent

explaining all aspects of care, including risks in noncoercive terms

disclosure

comprehensible to patient

capacity

ability to weigh medical information to make health decisions (MEDICAL TERM)

competence

a legal term for having the skills to do something; make decisions (LEGAL TERM)

implied consent

applies to patients who are unconscious, otherwise incapable of making informed decisions

expressed consent

consent given by adults who are of legal age and mentally competent to make a rational decision in regard to their medical well-being

involuntary consent

court makes decisions for the patient (mentally ill, behavior crisis, intellectual or developmental disabilities) this applies to the homeless population with no known family or known will or competency

advanced directive legislation

living will

health care proxy

a person the patient appoints to make medical decisions for them (donate organs, dying, etc)

Nancy Cruzan case ethical terms to know

Beneficence and Autonomy

Deontological - preserve Nancy's life

Utilitarianism - reduce Nancy's suffering

NC: start and end dates

jan 1983 - dec 1990

NC: State

missouri

NC: main players

nancy, joe joyce, state of missouri, william colby (lawyer)

persistent vegetative state

upper brain damage, but can still breathe independently, unconscious, reflexive responses

minimal conscious state

some responsiveness that is cognitively driven