Ethical and Legal Responsibilities 

Ethics

• Ethics
  • System of principles for determining right and wrong
  • Guides decision making
  • Helps with difficult and complex problems
  • Varies among cultural groups
  • Influenced by religion, history, and collective experiences
• Ethical dilemmas
  • Situations that have no clear answers or correct courses of action
  • E.g., gun control, capital punishment, freedom of speech

Ethics and the Law

• Ethics provide general principles on which laws are based
• Sometimes laws conflict with individual ethics
• Laws can have negative, unintended consequences

Ethics and Health Care

• Many health care issues involve ethical decisions
• Hippocrates was concerned with medical ethics
  • Hippocratic Oath
  • Some topics relevant today
• Impact of technological advances
  • Definition of life
  • Expense of care
  • Birth control
  • Vaccinations

Professional Codes of Ethics

• Standards of professional conduct
  • Ensure high quality of care
• Many professional organizations have codes
• Codes provide guidelines for handling difficult issues

Personal Values

• Foundation for making decisions and guiding behavior
• Influenced by family, religion, education, and personal experience
• Establish priorities
• Values not necessarily right or wrong

Guiding Principles of Health Care Ethics

1. Preserve life
2. Do good
3. Respect autonomy
4. Uphold justice
5. Be honest
6. Be discreet
7. Keep promises
8. Do no harm

Preserve Life

• Life is precious
  • Take all possible means to preserve it
• No agreement on definition of life
  • Artificial means of supporting life
  • Euthanasia to relieve suffering
  • Illegal in most states
• Dilemmas
  • Organ transplantation
  • Euthanasia
  • Rationing care and resources

Do Good

• Promote welfare of others
  • Basic duty of health care professional
• Work in best interest of patients
• Perform one’s job without expectation of receiving anything extra

Respect Autonomy

• Self-determination
  • Patients have right to make own decisions
  • May choose type of treatment
  • May refuse treatment

Consent

• Permission
• Patient must give for treatment
• Can be given by the following:
  • Mentally competent adults
  • Emancipated minors
• Informed consent
  • Procedure explained including possible consequences
• Implied consent
  • Indicated by patient’s actions
• Express consent
  • Given in writing
• Battery = crime
  • Touching or treating patients without consent
• Assault = crime
• Threatening to touch or treat without permission
• False imprisonment
  • Holding mentally competent patients against their will

Advance Directives

• Written instructions containing patient’s desires regarding health care

1. Living will

   1. Contains written instructions regarding health care

2. Durable power of attorney for health

   1. Gives specific people authority to make health care decisions if an individual \n becomes unable to do so

• Patient Self-Determination Act of 1991
  • Health care facilities must provide adult patients with information about advance \n directives
  • Without instructions, care of incompetent patients can be difficult

Uphold Justice

• Justice refers to fairness
  • All patients must receive same level of care
  • Dilemmas:
  • Equitable distribution of health care resources
  • Ranking and rationing of health care services

Reporting abuse

• Protect others from harm
• Laws require reporting of abuse
  • Federal Child Abuse Prevention and Treatment Act
  • States have laws and reporting systems for elder and domestic violence and \n abuse
• Laws require reporting of abuse
  • Report suspected abuse to supervisor
  • Patient confidentiality does not apply
• Learn to recognize signs of abuse

Laws that Protect

• Occupational Safety and Health Act
  • Requires employers to be responsible for safety and health of employees
• Controlled Substances Act
  • Helps prevent abuse of addictive drugs
  • Provides guidelines for prescribing and handling

Be honest

• Good health care relies on honesty
• Patient’s trust important
• Dilemma:
  • How much to tell patients about their condition
• Honesty essential among coworkers and with supervisor

Fraud

• Dishonesty involving cheating or trickery
• Health care examples:
  • Insurance claims for services not performed
  • Selling ineffective treatments
  • Claiming education or credentials one does not have

Be Discreet

• Preserve confidence and respect privacy
• Confidentiality
  • Patients’ information cannot be released without their written consent
• Health Insurance Portability and Accountability Act (HIPAA)
  • National standards to protect patient privacy
  • Follow facility policies

Harming Reputation of Another

• Defamation of character
  • Disclosing unauthorized information that can harm reputation of another person
• Libel
  • Disclosing information in writing
• Slander
  • Disclosing information orally

Patient Privacy

• Maintaining patient privacy
  • Close doors and curtains
  • Drape patients appropriately
  • Do not discuss patients in public areas
  • Discuss patients only with other authorized personnel

Confidentiality Issues

• Dilemmas:
  • Public safety
  • Patient has contagious disease
  • Patient desire to harm self

Keep Promises

• Promises are important part of relationships with others
• Contracts
  • Formal promises enforceable by law

Formal Promises

• Contracts
  • Contain three components:

1. Offer
2. Acceptance
3. Consideration

Contracts

• Types of contracts:
  • Express
  • Discussion and agreement on specific terms and conditions
  • Implied
  • Actions of parties create and carry out contract

Contract Language

• Breach of contract
  • One party fails to carry out part of agreement
• Damages
  • Money to compensate for injury or loss
• Agent
  • Someone who represents another person when making contract

Agent

• Respondeat superior
  • Legal doctrine holding employer responsible for actions of employees

Do No Harm

• Essential responsibility of health care professionals
• Negligence
  • Failure to meet reasonable standard of care

Malpractice

• Professional negligence
  • May result in lawsuit against health care provider and/or facility
  • Perform all duties with care
  • Perform only duties for which you are trained
• Treat patients with kindness and respect
  • Communicate well
  • Listen to patients

Laws That Protect

• Good Samaritan laws
• Protect individuals who give care in emergency situations
• Best to stay within scope of training

Patient Rights

• Patient’s Bill of Rights (American Hospital Association)
• Affordable Care Act
  • Protect patients with health insurance issues
• Specialized patient rights
  • Mental health
  • Hospice

Handling Ethical Dilemmas

• Priority:
  • Well-being of patient
• Accept responsibility for making difficult decisions
  • Part of health care work
• Report illegal behavior
• Resources:
  • American Medical Association Council on Ethical and Judicial Affairs
  • Ethics committees at health care facilities
  • Clergy and counselors
  • Lawyers and risk management specialist