1. Chapter 11 Legal and Ethical Responsibilities
Health Care Science Technology
Copyright © The McGraw-Hill Companies, Inc.

2. Objectives Describe the qualities of a successful health care worker.
Distinguish between laws, morals, and ethics.
Explain the purpose of professional codes of ethics.
Define standard of care.
Describe informed consent.
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3. Objectives (cont.)
Discuss the importance of confidentiality for health care professions.
Define the term advance directive and distinguish among living wills, durable powers of attorney, and health care proxies.
Describe clients’ rights and responsibilities.
Successfully complete 1 recording procedure.
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4. The Qualities of a Successful Health Care Worker 11-1
Qualities for Success
Understanding Laws, Morals, and Ethics
Licensure, Registration, and Certification
Standard of Care and Scope of Practice
Informed Consent
Confidentiality
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5. Qualities for Success Successful health care providers use the 3 Cs:
Courtesy
Compassion
Common sense
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6. Qualities for Success (cont.)
Other helpful qualities include:
A relaxed attitude when meeting new people.
A willingness to learn new skills and techniques.
An aptitude for working with the hands.
Empathy for others.
Good communication and listening skills.
Patience in dealing with others.
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7. Qualities for Success (cont.)
The ability to work as a member of a health care team.
Proficiency in English, science, and mathematics.
Tact.
The ability to keep information confidential.
The ability to leave private concerns at home.
Trustworthiness.
A sense of responsibility.
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8. Qualities for Success (cont.)
Responsibilities to Employers
Deal morally, ethically, and legally with your employer.
Report to work on time, properly dressed and groomed.
Stay current in your chosen field by attending seminars, continuing education courses, subscribing to professional journals, and obtaining in-house training.
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9. Qualities for Success (cont.)
The Health Care Team includes, but is not limited to:
Physicians
Registered nurses
Licensed practical or vocational nurses
Dietitians
Physical and occupational therapists
Respiratory therapists
Electrocardiography technicians
X-ray technicians
Medical transcriptionists
Nursing assistants
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10. Section 11-1 Apply Your Knowledge
List some members of the health care team.
Answer:
Physicians
Registered nurses
Licensed practical or vocational nurses
Dietitians
Physical and occupational therapists
Respiratory therapists
Electrocardiography technicians
X-ray technicians
Medical transcriptionists
Nursing assistants
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11. Legal, Moral, and Ethical Standards 11-2
Understanding Laws, Morals, and Ethics
Licensure, Registration, and Certification
Standard of Care and Scope of Practice
Informed Consent
Confidentiality
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12. Understanding Laws, Morals, and Ethics
Laws – a law, or statute, is a rule of conduct or action.
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13. Understanding Laws, Morals, and Ethics (cont.)
Criminal Laws – protect members of society from certain harmful acts of others. A criminal act may be one of:
Commission, if there is a law forbidding a certain act.
Omission, in violation of a law requiring a certain act.
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14. Understanding Laws, Morals, and Ethics (cont.)
Civil Laws – are concerned with private rights and remedies. Examples of the causes of civil disputes include:
Contract violation.
Slander or libel.
Trespassing.
Product liability.
Automobile accidents.
Family matters such as divorce, child support, and child custody.
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15. Understanding Laws, Morals, and Ethics (cont.)
Torts
A tort is broadly defined as a civil wrong committed against a person or property, excluding a breach of contract.
Torts may be intentional (willful) or unintentional (accidental) and, if intentional, may also be crimes.
Unintentional torts are acts that were not intended to cause harm. However, they are committed without regard for consequences.
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16. Understanding Laws, Morals, and Ethics (cont.)
An unintentional tort is caused by negligence. Negligence is also called medical malpractice.
Malpractice
The 3 Ds must be present for negligence to occur:
Duty – health care practitioner/client relationship exists.
Derelict – health care practitioner did not live up to the obligation of caring for a client.
Damage – the breach of duty results in damages to the client or plaintiff.
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17. Understanding Laws, Morals, and Ethics (cont.)
Physicians are most likely to be charged with negligence. However, other health care practitioners may be subject to such charges.
Medical practice acts are state statutes that govern medical practices. They do the following:
Cover requirements and methods for licensing health care providers.
Establish medical licensing boards.
List grounds for revoking licenses.
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18. Understanding Laws, Morals, and Ethics (cont.)
Morals are formed from your personal values – your concept of right and wrong.
Ethics are standards of behavior developed as a result of your moral values.
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19. Understanding Laws, Morals, and Ethics (cont.)
Noncompliance
Noncompliant health care workers may face fines or prison sentences and can lose their licenses to practice their profession.
Unethical conduct may result in expulsion or censure from your professional organization, but only the state can revoke a license.
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20. Licensure, Registration, and Certification
Licensure – is required for certain professions within a state.
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21. Licensure, Registration, and Certification (cont.)
Adding one’s name in an official registry or record as having satisfied the requirements for a certain health care occupation.
Fulfilling certain education requirements and/or paying a registration fee.
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22. Licensure, Registration, and Certification (cont.)
Certification – usually voluntary.
Reciprocity – when state licensing authorities accept a person’s valid license from another state.
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23. Standard of Care and Scope of Practice
Standard of care is the level of performance expected of a health care worker in carrying out his or her professional duties.
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24. Standard of Care and Scope of Practice (cont.)
Working outside your scope of practice can make you liable.
Working within your scope of practice ensures that you:
Do not injure clients or put them at risk by performing procedures that are beyond your ability.
Will not be held liable for a standard of care that is beyond your training, experience, and job description if a legal situation arises.
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25. Standard of Care and Scope of Practice (cont.)
The Law of Agency – an employer is legally liable for acts performed by employees.
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26. Standard of Care and Scope of Practice (cont.)
A SAMPLE CONSENT FORM
Informed Consent – in order for a client to make an informed decision regarding treatment, the client needs to be told the following:
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27. Standard of Care and Scope of Practice (cont.)
Informed Consent (cont.)
The proposed methods of treatment.
Why the treatment is necessary.
The risks involved in the proposed treatment.
All available alternative types of treatment.
The risks of any alternative methods of treatment.
The risks involved if treatment is refused.
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28. Standard of Care and Scope of Practice (cont.)
People who cannot give informed consent include:
Minors – individuals under 18 years of age (21 in some states). Exceptions include those deemed mature minors by the court.
Mentally incompetent individuals – persons judged by the court to be insane, senile, mentally retarded, or under the influence of drugs or alcohol.
Speakers of a foreign language who do not speak English.
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29. Standard of Care and Scope of Practice (cont.)
Confidentiality
It is illegal and unethical if a health care worker does not observe confidentiality.
Privileged communication refers to information held confidential within a protected relationship.
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30. Standard of Care and Scope of Practice (cont.)
Confidentiality (cont.)
Keeping client medical information confidential means:
Not informing any unauthorized person about the information contained in a client’s medical records.
Not showing written information to an unauthorized third party.
Taking proper precautions when communicating such information over a computer, telephone, or fax machine.
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31. Standard of Care and Scope of Practice (cont.)
Confidentiality (cont.)
Written consent must be obtained before releasing information to a third party.
CONSENT TO RELEASE INFORMATION
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32. Standard of Care and Scope of Practice (cont.)
Confidentiality (cont.)
Guidelines to follow if you have access to a client’s information:
Do not decide if information is confidential based on your approval or agreement.
Do not reveal financial information about a client.
Do not use the client’s name or other information if others in the room might overhear.
Use caution in giving the results of medical tests to clients over the telephone.
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33. Standard of Care and Scope of Practice (cont.)
Confidentiality (cont.)
Guidelines to follow if you have access to a client’s information: (cont.)
Do not leave medical charts or insurance reports where clients or others can see them.
If the client has not given written permission to release information, do not release it.
Do not discuss clients in public places where others may overhear, such as the cafeteria or elevator.
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34. Standard of Care and Scope of Practice (cont.)
Confidentiality (cont.)
Confidentiality for client medical records may be waived under the following circumstances:
When a third party requests a medical examination, such as a preemployment examination, and that third party pays the client’s bill.
When a client sues a physician or other health care practitioner for malpractice.
When the client signs a waiver allowing the release of information.
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35. Section 11-2 Apply Your Knowledge
When must written consent be obtained?
Answer:
Consent must be obtained for many procedures such as surgery and tests.
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36. Medical Records and Policies 11-3
Client Autonomy
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37. Medical Records
Facilities providing health care services are required by licensing authorities to keep and maintain health care records of clients.
Medical records provide:
A format for tracking, documenting, and maintaining a client’s health data.
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38. Medical Records (cont.)
Documentation of a client’s lifelong health care.
A basis for managing a client’s health care.
Background information in the event of a lawsuit.
Clinical data for education, research, statistical tracking, and assessing the quality of health care.
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39. Medical Records (cont.)
Medical records may be kept on paper, microfilm, or computer tapes or disks. They belong to the owners of the facility, even though the client owns the information contained in them.
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40. Medical Records (cont.)
Advance Directives – legal documents that make known a person’s wishes about life-support measures.
Living Will – provides instructions directly to physicians, hospitals, and other health care providers involved in a client’s medical treatment.
SAMPLE LIVING WILL
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41. Medical Records (cont.)
Advance Directives (cont.)
Durable Power of Attorney – not specifically a medical document, but it may serve that purpose. It gives a person, called a designee, the authority to make a variety of legal decisions on behalf of another person, called the grantor.
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42. Medical Records (cont.)
SAMPLE HEALTH CARE PROXY
Advance Directives (cont.)
Health Care Proxy – or health care power of attorney, is also an end-of-life document. With it, clients specify an agent to make medical decisions for them in the event that they lose the ability to reason or communicate.
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43. Medical Records (cont.)
Advance Directives (cont.)
Organ Donor Directives – a document that indicates client’s wish to donate organs for transplantation or medical research when client dies.
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44. Client Autonomy Clients’ Rights
The American Hospital Association’s Patient’s Bill of Rights is followed in most states. It guarantees the client’s right to:
Receive considerate and respectful care.
Receive complete and current information concerning his or her diagnosis, treatment, and prognosis.
Know the identity of physicians, nurses, and others involved with his or her care, as well as when those involved are students, residents, or trainees.
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45. Client Autonomy (cont.)
Clients’ Rights (cont.)
The American Hospital Association’s Patient’s Bill of Rights (cont.)
Know the immediate and long-term costs of treatment choices.
Receive information necessary to give informed consent prior to the start of any procedure or treatment.
Have an advance directive concerning treatment or be able to choose a representative to make decisions.
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46. Client Autonomy (cont.)
Clients’ Rights (cont.)
The American Hospital Association’s Patient’s Bill of Rights (cont.)
Refuse treatment to the extent permitted by law.
Receive every consideration of his or her privacy.
Be assured of confidentiality.
Obtain reasonable responses to requests for services.
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47. Client Autonomy (cont.)
Clients’ Rights (cont.)
The American Hospital Association’s Patient’s Bill of Rights (cont.)
Obtain information about his or her health care and be allowed to review his or her medical record and to have any information explained or interpreted.
Know whether treatment is experimental and be able to consent or decline to participate in proposed research studies or human experimentation.
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48. Client Autonomy (cont.)
Clients’ Rights (cont.)
The American Hospital Association’s Patient’s Bill of Rights (cont.)
Expect reasonable continuity of care.
Ask about and be informed of the existence of business relationships between the hospital and others that may influence the client’s treatment and care.
Know which hospital policies and practices relate to client care, treatment, and responsibilities.
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49. Client Autonomy (cont.)
Clients’ Rights (cont.)
The American Hospital Association’s Patient’s Bill of Rights (cont.)
Be informed of available resources for resolving disputes, grievances, and conflicts, such as ethics committees or patient representatives.
Examine his or her bill and have it explained and be informed of available payment methods.
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50. Client Autonomy (cont.)
Clients’ Responsibilities – clients are responsible for:
Providing information about past illnesses, hospitalizations, medications, and other matters related to their health status.
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51. Client Autonomy (cont.)
Clients’ Responsibilities (cont.)
Participating in decision making by asking for additional information about their health status or treatment.
Providing health care agencies with a copy of their written advance directive if they have one.
Informing physicians and other caregivers if they anticipate problems in following a prescribed treatment.
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52. Client Autonomy (cont.)
Clients’ Responsibilities (cont.)
Following a physician’s orders for treatment. The client has the right to refuse treatment to the extent permitted by law.
Providing health care agencies with necessary information for insurance claims and working with the health care facility to make arrangements to pay fees when necessary.
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53. Section 11-3 Apply Your Knowledge
Who owns the information in a client’s medical records?
Answer:
Clients own the information in their medical records.
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54. Procedures in Student Text
11A Recording Information on a Client’s Medical Record
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55. Chapter 11 Credits Slide 5 PhotoDisc
Slide 9 Will and Deni McIntyre/Photo Researchers
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