Respiratory Care Ethics and Legal Issues

What is Ethics?

  • Respiratory therapists (RTs) often face situations requiring ethical and legal choices.

  • Ethics, a branch of philosophy, addresses how we should act.

  • Ethics are moral principles supplementing the golden rule, emphasizing respect for others' humanity.

  • Ethics answers the question: "How do we act?"

The Force Behind Law

  • State statutes regulate behavior.

  • Professional boards and statutes regulate therapists, setting standards and education requirements.

  • Common law assigns compensation duties for injuries caused by negligence or intentional acts.

Ethical and Legal Issues Faced by RTs

  • RTs encounter growing ethical and legal challenges related to:

    • Patient expectations

    • Staffing

    • Quality of care

    • Rationing of care

    • Conflicts with third-party standards

    • Maintaining care standards amid cost constraints

    • Corporate influence

Code of Ethics

  • A code of ethics is vital for self-regulating professions.

  • It establishes rules and principles ensuring effective and caring public health services.

  • It can limit competition, set conduct rules, and restrict advertising.

  • Difficult ethical decisions often involve choosing between multiple right options.

  • AARC (American Association for Respiratory Care) Statement of Ethics and Professional Conduct should be reviewed.

Core Ethical Principles

  • Autonomy:

    • Respects patients' freedom and treatment decisions.

    • Forms the basis for informed consent, where patients must be informed about procedures, risks, and benefits, and can freely consent or refuse.

    • Deception or coercion to obtain consent is unethical.

  • Veracity:

    • Requires truthfulness between provider and patient.

    • Involves honestly disclosing all care-related choices.

    • Challenges arise with benevolent deception (withholding truth for the patient's perceived benefit), but truth is generally the best approach.

  • Nonmaleficence:

    • Requires avoiding patient harm.

    • Difficult to uphold due to side effects of treatments and procedures.

    • Procedures have potential side effects and complications.

  • Beneficence:

    • Goes beyond "do no harm" to actively contributing to patient well-being.

    • Dilemmas have spurred "advanced directives", addressing when to cease life-prolonging treatment when meaningful recovery is unlikely.

  • Confidentiality:

    • Requires respecting patient privacy and secrets, even after death.

    • It's a qualified principle; state laws may require breaches in certain cases (e.g., reporting gunshot wounds, child abuse) to prevent harm to others.

    • Social networking increases risks of unintentional PHI (protected health information) disclosure.

  • Justice:

    • Involves fair care distribution, balancing expenses and affordability.

    • Population trends and rising Medicare/Medicaid costs create challenges.

    • Distributive justice: deals with the rationing of health care services

    • Compensatory justice: seeks damages for harm caused by others, like medical malpractice (which represents <2% of healthcare costs).

Role of Duty

  • Allied health professions have defined practice areas based on tradition or law.

  • Practitioners must understand their role limits and act with integrity.

  • RTs might face ethical obligations to withhold critical information from a patient's family, leaving it to the physician.

  • Incident reports are essential for institutional protection, identifying system errors, and highlighting education/training needs.

Ethical Viewpoints and Decision Making

  • Formalism:

    • Relies on rules and principles.

    • Moral rightness is determined by an act's adherence to rules/principles.

    • An act is only justifiable if it upholds these rules.

  • Consequentialism:

    • Judges actions based on their consequences.

    • Uses the principle of utility—promoting the greatest good for the most people.

  • Virtue ethics:

    • Considers what a virtuous person would do.

    • Focuses on personal attributes and character rather than rules or consequences.

    • Asks: "How do I act to be a good RT practitioner?"

  • Intuitionism:

    • Holds that there are self-evident moral truths (e.g., "Treat others fairly").

Mixed Approaches

  • Combines strengths of different ethical perspectives.

  • Rule utilitarianism: concerned with which rule maximizes good, not which act.

  • Differences in values and education can lead to inconsistent decisions.

  • Variability among caregivers is a disadvantage.

Decision-Making Models

  • Ethical Decision-Making Model:

    1. Identify the problem/issue.

    2. Identify the individuals involved.

    3. Identify applicable ethical principles.

    4. Determine who should make the decision.

    5. Identify the practitioner's role.

    6. Consider alternatives (short-term and long-term consequences).

    7. Make a decision (including not acting).

    8. Observe the consequences of the decision.

Ethical Decision-Making Process

  1. Frame ethical statement

    • Conditions

    • Who

    • What

  2. List alternatives

  3. List consequences

    • Immediate

    • Long-range

  4. Make choice

    • For each consequence:

      • Scan list of personal values

      • Compare to consequences

        • CONSISTENT: Ethical statement is valid

        • INCONSISTENT: Reconsider and restate

  5. Ethical Decision

  6. Consider ALL consequences

Legal Issues Affecting Respiratory Care

  • Errors causing patient harm can result in professional liability.

  • Healthcare organizations implement quality review processes to reduce lawsuit risks.

  • Professional liability can increase healthcare costs.

  • Most cases do not go to court.

Public Law

  • Divided into criminal and administrative law.

  • Criminal law addresses acts against public welfare/safety.

  • Administrative law includes government agency regulations.

  • RTs must follow these rules.

System of Law

  • Civil law protects citizens/organizations from unfair/unlawful actions.

  • Civil courts determine wrongdoing and required reparations.

  • Tort law is most relevant to respiratory care.

Tort Law

  • Defintion: a civil wrong against an individual or property with a court-provided remedy.

  • Functions:

    • Maintain peace between individuals.

    • Replace vengeance with settlements.

  • Forms:

    • Negligent torts

    • Intentional torts

    • Torts with liability regardless of fault (e.g., defective product manufacturers).

Professional Negligence

  • Negligence: failure to use the expected skill and learning under similar circumstances.

  • Negligence consists of the failure to competently perform duties under licensure.

Malpractice

  • Malpractice: professional misconduct, lack of skill, or unethical conduct.

  • Classifications:

    • Criminal malpractice (e.g., assault and battery).

    • Civil malpractice (e.g., negligence).

    • Ethical malpractice (violations of ethics, potentially leading to disciplinary action).

  • Rules to prevent malpractice:

    • No intent to harm

    • Patient consent for procedure

Intentional Torts

  • Intentional tort: harm caused by deliberate action.

  • Examples:

    • Slander and Libel

    • Defamation of character

    • Assault and battery

    • Invasion of privacy

Other Torts

  • Strict Liability: liability without fault, even with reasonable care.

  • Breach of contract: patient injury due to incompetent service can lead to breach claims, although many states have high proof standards or disallow such actions.

  • RTs are responsible for their actions.

Helping Avoid Lawsuits

  • No guaranteed method exists, but providing excellent, well-documented care is effective.

  • Maintain an active RT license, stay informed through research/education, and adhere to institutional policies.

HIPPA

  • Health Insurance Portability and Accountability Act of 1996

  • Establishes standards for protecting individually identifiable health information.

  • Balances information protection with quality healthcare provision.

HIPPA Privacy –Protected Health Information

  • Definition: Information regarding an individual's past, present, or future physical or mental health, healthcare provision, or payment.

  • Steps to honor privacy:

    • Secure computers.

    • Avoid disclosing patient information to unauthorized individuals.

    • Refrain from discussing patient information in public areas.

Medical Supervision

  • RTs must work under competent medical supervision as per their "scope of practice."

  • Employers (physicians or hospitals) are liable for RT actions.

  • Supervising physicians may still be liable even if the hospital employs the therapist.

  • Legal theory of "failure to supervise".

  • Respondeat superior: (Latin: "that the master must answer")—the employer is responsible for the RT's actions.

Scope of Professional Practice

  • Includes:

    • Requirements and qualifications for licensure.

    • Exemptions

    • Grounds for administrative action.

    • Creation of examination board and processes.

    • Penalties and sanctions for unauthorized practice.

  • General guidelines/parameters for a clinician's practice.

National Labor Relations Act (NLRA)

  • Protects hospital workers, union members or not.

  • Protects actions benefiting all employees.

  • Example: requesting a shift differential increase for all RTs is a "protected concerted activity,