Civil law: a legal relationship between individuals. Criminal law: legal obligations between an individual and society or state. Felony: a more serious crime than a misdemeanor in which the punishment is imprisonment. Misdemeanor: a less serious offense than a felony; may be punishable by a fine or sentencing to a local prison for less than one year. Tort: a civil wrongful act causing harm or injury due to the healthcare worker not performing the standard of care.
Litigation: the determining of a person’s legal rights either by a lawsuit or some form of legal action. Licensure: legal permission to perform an occupation given by governmental agencies.
An example of civil law are torts or contracts. Examples of criminal law, commonly called a crime, are: practicing without a license, misuse of narcotics, theft and murder. Example of felony are murder, rape, arson, robbery, burglary, manslaughter. Example of misdemeanor: petty theft, disturbing the peace.
Legal implications in health care Malpractice: harmful, incorrect, or negligent practice or treatment of a patient by a health care provider. Negligence: failure of a health care provider to perform his/her duties in a responsible manner that results in injury to a patient.
Examples of malpractice include: physician not administering a tetanus injection when a patient has a puncture wound or a nurse performing minor surgery without training. Examples of negligence include: falls and injuries that occur when siderails are left down. Using or not reporting defective equipment. Infections caused by use of nonsterile instruments and/or supplies
Liable: to be legally responsible for failing to perform professional duties to meet the standards of care and/or causing harm or injury. Libel: a written statement that provides false information which can cause damage to a person’s reputation. Slander: spoken misrepresentations that are proven false and can damage another’s reputation.
An example of liable is: During her delivery, a patient suffers umbilical cord prolapse, which poses a serious threat to the life of the baby if a c-section is not performed immediately. The doctor fails to act in a timely manner, delaying the c-section. As a result of the delay, the baby suffers brain damage. If the doctor had acted in a timely fashion as is standard, the baby would not have been harmed. An example of libel is reporting a patient has an infectious disease to a government agency when lab results are inaccurate. Example of slander is stating a person has drug problems when another medical condition exists.
Conduct: the manner in which a person displays his/her behavior. Consent: the giving of one’s permission to another to perform a procedure or action. Can be consent to view medical records, consent to perform surgery. Breach of contract: the breaking of a promise, agreement, or contract in which parties have agreed upon.
A Contract can be Implied or Expressed: –Implied-obligations that are understood without verbally expressed terms; for example, qualified health worker prepares medication and patient takes medication; implied that patient accepts this treatment. –Expressed-stated in distinct and clear language, either orally or in writing; for example, surgery permit, promises must be kept and all risks associated with tx must be explained to patient.
Examples of Breach of Contract include failure to provide care and/or giving inproper care; patient refuses to pay for care; can lead to legal action. Reasonable care: the legal obligation of a health care worker to provide competent care according to the expected standards of practice.
Assault: the threatening or attempt to injure a person in an unlawful manner. Battery: the unlawful touching of another that results in injury.
Examples of assault and battery are: performing procedure after patient has refused to give permission or improper handling and rough treatment of patients. **Patients must give consent and have the right to refuse care at any time.
Illegal restraint: holding a person against his/her will by using a restrictive device or other means. Invasion of privacy: the giving out of information about an individual or patient without his/her consent; Unnecessary exposure of an individual or revealing personal information about an individual without consent.
Examples of illegal restraint include keeping a patient hospitalized against his or her will; application of physical restraints without proper authorization or with no justification. Examples of invasion of privacy improper draping or covering of a patient during a procedure that allows other patients or personnel to see patient exposed.
Continued examples of invasion of privacy include: Sending information to an insurance company without the patient’s written permission; informing news media about an individual’s condition without the individual’s permission.
Privileged communication: a patient’s personal information given to a health care worker that must be kept confidential. By law this information must be kept confidential and only shared with members of health care team.
Privileged Communications Certain information exempt by law and must be reported includes: –Births and deaths –Injuries caused by violence (assault and battery, abuse, stabbings) that may require police involvement. –Drug abuse –Communicable diseases –STD’s
Privileged Communications also include Health Care Records, or records containing information about the care that has been provided to the patient. These records belong to the health care provider, but the patient has right to obtain a copy of any information in record. Erasures not allowed; cross out errors with single line, insert correct info, initial and date.
Computerized records have created modern dilemmas on maintaining confidentiality. Safeguards have been created to maintain computer confidentiality such as: –Limiting personnel who have access –Using codes to prevent access to certain information –Requiring passwords to access specific information on records
Legal documents in healthcare Advanced directive: a written document that specifies if extraordinary measures are to be taken to prolong life if the patient can no longer make his/her own decision. Two main directives are a Living Will and a Durable Power of Attorney or POA.
Living will: a legal document prepared while a person is mentally competent that specifies what his/her wishes are regarding end-of life care. Durable power of attorney: a legal document that designates another person to make health care decisions in the event that the person is mentally or physically incapable of making their own.
In summary: Legal responsibilities are an important aspect of health care. All states have set rules and regulations Most health care agencies have specific rules, regulations, and standards that determine activities performed by individuals in different positions. Standards vary from state to state, and even agency to agency.
Application: Discuss the legal responsibilities in the following cases: –A geriatric assistant steals an elderly patient’s watch –A surgeon operates on the wrong leg –A dental assistant slaps a screaming child –A physical therapist fractures a patient’s leg while performing exercises
Continued Application; A medical assistant sends a copy of a patient’s record to an insurance company without the patient’s consent. A nurse working for a plastic surgeon tells a patient that a face lift will make the patient look 10 years younger.
Ethics Are a set of principles dealing with what is morally right or wrong Provide a standard of conduct or code of behavior Allow health care provider to analyze information and make decisions based on what people believe is right and of good conduct
Ethics Continued Modern health care advances have created many ethical dilemmas: –Is Euthansia (assisted death) justified in certain patients? –Should a patient be told that the health care provider has AIDS? –Should aborted fetuses be used for research? –When should life support be discontinued? –Do parents have a religious right to refuse life- saving blood transfusion for their child?
Ethics Continued –Can a health facility refuse expensive treatment, such as a bone marrow transplant, if a patient cannot pay for the treatment? –Who decides if a 75 year old patient or a 56 year old patient gets a single kidney available for transplant? –Should people be allowed to sell organs for transplants? –Should animals be used in medical research even if it results in the death of the animal?
Ethics Continued –Should genetic researchers be allowed to transplant specific genes to create the “perfect” human being? –Should human beings be cloned? –Should aborted embryos be used to obtain stem cells for research, especially as scientists may be able to use the stem cells to cure diseases such as diabetes, osteoporosis and Parkinson’s disease?
Basic Rules of Ethics Put saving a life and promotion of health above all else Make every effort to keep patient as comfortable as possible and to preserve life when possible. Respect the patient’s choice to die peacefully and with dignity when all options have been discussed with the patient and family and/or predetermined by advanced directives.
Basic Rules Continued… Treat all patient equally, regardless of race, religion, social or economical status, sex and nationality; avoid bias, prejudice, and discrimination. Provide care for all persons to best of your ability Maintain competent level of skill consistent with occupation; stay informed and up to date; pursue continuing education as necessary
Basic Rules Continued…. Maintain confidentiality –Information about patient must remain private and be shared only with others involved in care –Information obtained from patients should not be repeated or used for personal gain –Gossiping about patients is ethically wrong
Basic Rules Continued…. Refrain from immoral, unethical, and illegal practices –Report illegal action of others to proper authority –Avoid actions that are immoral or illegal Show loyalty to patients, co-workers and employer by avoiding negative comments and always express a positive attitude
Basic Rules Continued…. Be sincere, honest, and caring –Treat others as you want to be treated-”Golden Rule” –Show respect and concern for the feelings, dignity, and rights of others
In Summary: Study the code of ethics for occupation you enter Abide by the code Become a competent and ethical health care worker Earns you the respect and confidence of patients, co-workers, and employers.
Questions/Things to Think About Why do health occupations have an ethical code? Does a drug addict deserve the same care as the president of the United States? What should you do if you see a co-worker stealing drugs? A patient who is dying of cancer tells you he is saving sleeping pills to commit suicide. What should you do? Why?
Questions/Things to Think About “I hate this job” is a comment you hear in the staff conference room. What is wrong with this statement?
Crossword Puzzle ImprisonmentPractice Invasion of PrivacyNegligence Malpracticedefamation Libelpersonalbattery Living willslanderconsent Assaultwrittentort verbal
Critical Thinking After reviewing the Code of Ethics, answer the following: –Why do healthcare workers need a code of ethics? –How would life in school be different if high school students followed a code of ethics?
Who Should Get Custody? Josh Brown-father to Darcy since she was born Lawyer for the Howards Lawyer for Mary Brooks Jury members Judge (The judge will keep order in the court and throughout the proceedings)
Patient’s Rights Federal and State Legislation requires health care agencies to have written policies concerning patients’ rights, or the factors of care that patients can expect to receive The American Hospital Association has adopted a “Patient’s Bill of Rights” that is recognized and honored by many health care facilities. This bill of rights states, in part, that a patient has the right to…..
Patient’s Rights –Considerate and Respectful Care –Obtain complete, current information concerning diagnosis, treatment, and prognosis (expected outcome) –Receive information necessary to give informed consent prior to the start of any procedure or treatment –Have advance directive for health care and/or refuse treatment to the extent permitted under law
Patient’s Rights –Privacy concerning a medical care program –Confidential treatment of all communications and records –Reasonable response to a request for services –Obtain information regarding any relationship of the hospital to other health care and educational institutions –Be advised of and have the right to refuse to participate in any research project
Patient’s Rights –Expect reasonable continuity of care –Review medical records and examine bills and receive an explanation of all care and charges –Be informed of any hospital rules, regulations, and/or policies and the resources available to resolve disputes or grievances
Test Review Which of the following is an example of an ethical practice? –A. Practicing within the guidelines of the law –B. Following agency policies –C. Respecting cultural differences in clients
The principles and values that determine appropriate behavior are known as: –A. Slander –B. Malpractice –C. Libel –D. Ethics
Which of the following statements is true about ethical codes? –A. Nurses established the first code of ethics for a profession –B. What is ethical in one profession may not apply in another –C. They are legally binding –D. They are established by courts of public opinon