RTT 215 Chapter 2: Ethics and Legal Considerations in Cancer Management

Vocabulary flashcards covering ethical concepts, distribution theories, biomedical principles, models of interaction, legal doctrines, and risk management based on the lecture notes.

Rules of Ethics

Enforceable rules governing professional behaviors, currently numbering 22, where violations include sanctions, reprimands, and revocation of certification.

ARRT Code of Ethics

An aspirational guide containing 10 guiding principles for Registered Technologists and Candidates to evaluate professional conduct.

Moral Ethics

A person's concept of right or wrong as it relates to conscience.

Legal Ethics

A sum of rules and regulations by which society is governed in a formal and legally binding manner.

Egalitarian Theory

A distribution theory based on the equal distribution of equal resources.

Entitlement Theory

A distribution theory based on a system of contracts where a person must be able to pay for the contract.

Fairness Theory

A distribution theory that tailors healthcare distribution to balance the dignity and equality of all persons with the inequality of their needs and circumstances.

Utilitarian Theory

A distribution theory calling for realizing the greatest good for the greatest number.

Autonomy

The bioethical principle of respect for the patient as a person, treating patients as individuals and informing them about procedures to facilitate appropriate decisions.

Beneficence

The bioethical principle referring to the performance of good acts.

Confidentiality

The ethical duty owed by healthcare providers to protect the privacy of patient information, binding all seven bioethical principles.

Justice

The ethical principle relating to fairness, moral rightness, and equal treatment for all patients regardless of background or illness.

Nonmaleficence

The bioethical principle centered on the avoidance of evil.

Role Fidelity

Faithfulness and loyalty; the principle that reminds healthcare professionals to be faithful to their role.

Veracity

The obligation to tell the truth and not to lie or deceive others.

Truthfulness

Conformance with fact or reality.

Secret

Knowledge a person has a right or obligation to conceal.

Statutory Duty to Report

The legal obligation to report specific medical conditions and incidents, including venereal diseases, contagious diseases, poisonings, and abuse.

Duty to Warn Third Parties

The obligation to disclose information to warn third parties of a risk of violence, contagious disease, or other risks.

Breach of Confidentiality

A tort involving the breach of fiduciary duty to maintain confidentiality and breach of contract between patient and provider or facility.

Defamation

The making of a false statement to a third party that is harmful to another's reputation.

Slander

Oral defamation.

Libel

Written defamation.

Patient Self-Determination Act

Federal law requiring healthcare institutions receiving Medicare or Medicaid funds to inform patients of their right to refuse care and initiate an advance directive.

Informed Consent

The process by which the treating healthcare provider discloses appropriate information to a competent patient so they may make a voluntary choice to accept or refuse treatment.

•Written consent of a patient to receive a proposed treatment

•Patient must be adequately informed

•Informed consent helps maintain patient autonomy

Competence

The ability to make choices.

Assault

A deliberate act wherein one person threatens to harm another person without consent, causing the victim to feel the threat can be carried out.

Battery

Physical touching of a victim when they have not consented.

False Imprisonment

Unlawful confinement of a person within a fixed area.

Teleology

Also known as consequentialism; an ethical theory that bases decisions on consequences and advocates providing the greatest good for the greatest number.

Deontology

Also known as nonconsequentialism; an ethical theory that bases decisions on individual motives and formal rules of right and wrong rather than consequences.

Virtue Ethics

An ethical theory focusing on practical wisdom and moral character for emotional and intellectual problem solving.

Engineering Model

An ethical decision-making model where the healthcare provider acts as a scientist concerned with facts and defines the patient as a condition or procedure.

Paternal or Priestly Model

An ethical decision-making model where the healthcare provider adopts an omniscient role and makes decisions for the patient.

Collegial Model

An ethical decision-making model involving sharing, trust, and a cooperative method for providing healthcare.

Contractual Model

An ethical decision-making model structured as a business relationship where both patient and provider have obligations, rights, and responsibilities.

Example:  Informed Consent

Covenantal Model

An ethical decision-making model grounded in traditional values and an agreement between patient and provider that is less business-like.

The covenant model recognizes areas of health care not always covered by a contract.  The covenant model is demonstrated by a patient trusting the caregiver to do what is right.

Critical Thinking

Purposeful, self-regulatory judgment resulting in interpretation, analysis, evaluation, and inference.

Tort Law

Civil law concerning civil wrongs filed to recover damages for personal injury or property damage resulting from negligent or intentional conduct.

•2 Categories

1.Intentional – done with the intent of causing another harm

2.Unintentional – wrongs

Advance Directives

A predetermined written choice made to inform others of how a patient wishes to be treated while incompetent.

•As part of the Patient Self-Determination Act:

•Documentation that patient has executed an Advance Directive

•Ensuring compliance with state laws regarding medical decisions and advance directives

•Education on ethical and legal issues concerning advance directives

Durable Power of Medical Attorney

A designated person chosen to make medical decisions on a patient's behalf.

Living Will

A written legal document executed by a competent patient directing that no artificial or heroic measures be used to preserve life and requesting pain relief.

Doctrine of Personal Liability

A legal doctrine stating that individuals are liable for their own negligent conduct.

Doctrine of Respondeat Superior

A legal doctrine meaning 'let the master answer', holding an employer liable for an employee's negligent acts committed while carrying out orders.

Doctrine of Res Ipsa Loquitur

A legal doctrine meaning 'the thing speaks for itself'.

Doctrine of Foreseeability

A principle of law holding an individual liable for all natural and proximate consequences of negligent acts to another to whom a duty is owed.

Risk Management

Links every quality improvement program with measurable outcomes necessary to determine overall effectiveness.

•Malpractice Insurance/Patient liability insurance

•Incident report

•The system for identifying, analyzing, and evaluating risks and selecting the most advantageous method for treating them

•Goal is to maintain high-quality patient care and conserve the facility’s financial resources

•Works closely with Quality Assurance

•Health Insurance Portability and Accountability Act (HIPAA),High-quality patient care

•(1) Standardize electronic patient administration, financial, and health data.

•(2) Create unique health identifies for employees, health care providers, and health plans

•(3) Ensure security standards that protect the confidentiality and integrity of individually identifiable health information past, present, and future

created in 1996

•Teleology (consequentalism)

§Utilitarianism – people should act to produce the greatest ratio of good to evil for everyone

•Bases decision on the consequences of an act

•Is immediate harm balanced with future benefit?

•Advocates providing the greatest good for the greatest number

Exceptions to Informed Consent

•Emergency situations where the informed consent process may have to be abandoned to save the patient’s life:

1.The patient is incapable of giving consent, and no lawful surrogate is available

2.Danger to life or risk of a serious impairment to health is apparent

3.Immediate treatment is necessary to avert these dangers

•The Patient Protection and Affordable Care Act of 2010 or “Obama Care”

•Prohibits health insurers from denying a patient coverage because of their medical histories

•Prevents health insurers from charging different premiums based on medical histories and gender

•Provides a subsidy to low- and middle-income Americans to help purchase insurance

•Expands Medicaid to include more low-income Americans

Obstacles of Informed Consent

•Physicians/healthcare providers

•Family

•Time constraints

•Attitude of Paternalism

•Communication

•Diversity of patient population

•Language barriers

•Cultural barriers

Elements of Full Informed Consent

•Nature of the treatment/procedure

•Reasonable alternatives to the treatment/procedure

•Relevant risks, benefits and uncertainties related to each alternative

•Assessment of patient understanding/competence

•Acceptance by the patient

Patient Confidentiality Guidelines

•Verbal communication

•Written information

•Computer information (need to make sure other patients don’t see other patient info on computer or if a patient is exposed on table that they do not see those screens)

•Reproduction and faxing of patient information

•Receipt of faxed information

•Sensitive information

•Employee conduct

Exception to Confidentiality:
Patient Authorization

•Patients consent to the release of their medical records

•Disclosure without consent include:

•Treatment

•Payment

•Health care operations

•Appointment reminders

•Treatment alternatives

•Health-related benefits

•Fundraising activities

•Facility directory

•Clergy

•Payment of care

•Research

Exceptions:  patients have been found to have waived their rights o confidentiality when they put their mental or physical state at issue in a lawsuit.  Release of patient information is also governed by state laws.

Exceptions to Confidentiality

•Wounds

•Abuse

•Communicable Diseases

•Accidents

•Birth Defects

•Addictions

•Family’s need to know

•Public’s need to know

•Third-party payers

Patient’s Bill of Rights

•High-quality patient care

•A clean and safe environment

•Patient’s involvement in his or her care

•Protection of the patient’s privacy

•Help when the patient leaves the hospital

•Help with the patient’s billing claim

Deontology (nonconsequentialism)

•don’t base decision on consequences: for example religion, uthanasia)

•Virtue Ethics

•Bases decision making on individual motives and morals rather than consequences

•Uses formal rules of right and wrong for reasoning and problem solving

Example:  some religious groups refuse blood products even if the consequences are negative (even fatal).

Virtue ethics

•Focuses on practical wisdom and moral character for emotional and intellectual problem solving.

•Incorporates parts of teleology and deontology in solving ethical dilemmas

This approach to problem solving serves the health care professional by integrating intellect, practical reasoning, and individual good.  Application of this theory to health care may be problematic, because instead of focusing on the acts or actions of individuals, this theory focuses on the individual performing the act or action.  Health care pofessionals work together as a team to provide patients with high-quality care.

Dying Patients and Their Families

•Role of Radiation Therapist

•Identify grief cycles and provide emotional support by discovering one’s own EI.

•Patient Grief Cycle

1. Shock: The initial reaction to hearing news of the bad event

2. Denial: Pretending that what is, isn’t

3. Anger: Outward demonstration of pent-up emotion and frustration

4. Bargaining: Trying to find a way out of the situation

5. Depression: Realization of the facts

6. Testing: Searching for realistic resolutions to the problem

7. Acceptance: Coping with the situation and finding a way forward

These are not linear, can happen in any order or at same time

Dying Patients and their fam

•Palliative Care

•Self-Determination

•Advanced Directive-written what wants to happen

•Durable Power of Medical Attorney- designated person to make desicions

•Living Will- patients state their wishes, the patient has to have competency when written(has been witnessed by 2 people that have no ties to finances or anything to patient)

•Living Will Criteria

1. Demonstrates competency at the time

2. Directs that no artificial or heroic measures be undertaken to preserve his or her life

3. Requests that medication be provided to relieve pain

4. Intends to relieve the hospital and physician of legal responsibility for complying with the directives in the living will

5. Has the signature witnessed by two disinterested individuals who are not related, are not mentioned in the last will, and have no claim on the estate

palliative care

not treating to cure, but to increases quality of life, reduce symptoms

Metastatic-

cancer is everywhere, no longer curable

Hospice-

end of life (usually within 6 months)

3 Goals of Risk Management

1.Elimination of the causes of loss experienced by the hospital, its patients, employees, and visitors

2.Reduction in the operational and financial effects of unavoidable losses

3.Coverage of inevitable losses at the lowest cost