CHAPTER 4 LEGAL AND ETHICAL PRINCIPLES Copyright 2003 by Mosby, Inc. All rights reserved.

Chapter 4 Legal and Ethical Principles Objectives: Define terms relating to legal and ethical principles. Describe examples of ethical behavior for the health care worker. Identify situations that show improper ethical or legal behavior. Explain the importance of confidentiality in health care including privacy issues resulting from advanced technology. Describe examples of rights of the health care patient. Describe the role of the health care worker regarding current legal issues including advance directives and telemedicine. Copyright 2003 by Mosby, Inc. All rights reserved.

Professional Codes of Conduct Health care workers must stay within a “scope of practice” Illegal and unethical to perform skills or tasks that are outside scope of practice Limits of practice are established by each state Nurse Practice Acts Laws that determine which tasks nurses may legally perform Copyright 2003 by Mosby, Inc. All rights reserved.

Table 4-1 Sample Scope of Practice Copyright 2003 by Mosby, Inc. All rights reserved.

Professional Codes of Conduct Ethics are the principles and values that determine appropriate behavior – Respect for cultural, social, and ethical differences of the clients and other workers – Practicing within the guidelines of laws, policies, and regulations established for each type of employment Morals are based on the experience, religion, and philosophy of the individual and the society Legal responsibilities – practicing within the guidelines of laws, policies, and regulations established for each type of employment. Ethical codes – guidelines for the actions of people in a profession. - Established by the professionals to whom they apply - May not be legally binding Ethical standards apply to relationships with fellow workers, patients, and the community. - Based upon individual morals and society’s expectations. - Following slide displays a Code Of Ethics which is a standard for all health occupations. P. 47 in text also shows Nightingale Pledge (Box 4-2). This is an example of an oath or pledge that each profession has which states the basic beliefs and goals of the group. Copyright 2003 by Mosby, Inc. All rights reserved.

Copyright 2003 by Mosby, Inc. All rights reserved. Box 4-1 Code of Ethics Copyright 2003 by Mosby, Inc. All rights reserved.

Health Careers and the Law Health care provider is legally responsible (liable) for his or her behavior and the care given Employer may also be liable for the actions of a health care provider that are not reasonably prudent (negligent) or that reflect bad practice (malpractice) Torrance Memorial fined for leaving bottle inside patient during surgery http://www.dailybreeze.com/lifeandculture/ci_18846187 Copyright 2003 by Mosby, Inc. All rights reserved.

Malpractice and Liability • It is considered malpractice when the health care worker is: – Performing skills that are beyond the level of the health care worker’s education and training – Neglecting to do something that is considered to be common practice such as leaving the client in an unsafe situation Copyright 2003 by Mosby, Inc. All rights reserved.

Copyright 2003 by Mosby, Inc. All rights reserved. Box 4-3 The Health Insurance Portability and Accountability Act Patient Protections Copyright 2003 by Mosby, Inc. All rights reserved.

Copyright 2003 by Mosby, Inc. All rights reserved. Confidentiality A patient’s health care is considered confidential, or private The health care worker is ethically responsible to maintain the patient’s privacy “Privacy of Individually Identifiable Health Information.” The rule applies to all agencies sharing personal health information (paper, oral, and electronic) for people who are insured privately, by public programs, or uninsured. Protects medical records and personal health information. 1996 HIPAA – Health Insurance Portability and Accountability Act – protect individually identifiable health information that might be accessible through use of electronic technology 2001 – standards for “Privacy of Individually Identifiable Health Information” were established by the Department of Health and Human Services. Life insurance and workers compensation programs are not covered by these regulations. These provides presently are allowed to use and reuse patient information without prior consent. Exception to the right of the patient to privacy – when there is imminent danger to another individual that can be foreseen by the practitioner. This “duty to warn” requires the health care practitioner to disclose the patient's relevant personal health information when such a threat exists. Copyright 2003 by Mosby, Inc. All rights reserved.

Copyright 2003 by Mosby, Inc. All rights reserved. Patient’s Rights Advisory Commission on Consumer Protection and Quality in the Health Care Industry Issued report designed to protect consumers Listed specific rights and responsibilities for the patient Right and responsibility to participate or have a representative in making treatment decisions Responsibility to communicate honestly and show respect for health care providers Responsible for making a “good-faith” effort to pay for care Responsible for following the procedures of the health care plan Copyright 2003 by Mosby, Inc. All rights reserved.

Copyright 2003 by Mosby, Inc. All rights reserved.

Copyright 2003 by Mosby, Inc. All rights reserved. Patient’s Rights • The patient has these rights – Confidentiality – Personal privacy – Quality care without mistreatment, neglect, or abuse – To voice grievances without fear of retaliation – Assurance that personal possessions will be cared for and secured while care is being given Copyright 2003 by Mosby, Inc. All rights reserved.

Copyright 2003 by Mosby, Inc. All rights reserved. Legal Directives Legal documents that allow patients to express their wishes about their health care and treatment Two types of Advance Directives: Living will allows a person to state in advance whether to receive life support and what life-support procedures to withhold if the person is terminally ill and permanently unconscious Durable power of attorney allows a second person or agent to make decisions if the first person is unable to make them Advanced directives take effect only when a patient loses ability to make his or her own decisions. Copyright 2003 by Mosby, Inc. All rights reserved.

Box 4-5 Elements of Advance Care Directives Copyright 2003 by Mosby, Inc. All rights reserved.

Health Care and the Internet • Patients can: – Access health care information – Join chat groups – Purchase drugs and other medical items – Consult a health care practitioner online JCAHO – Joint Commission on Accreditation of Health care Organizations – 2000 – adopted new credentialing standards for hospitals that are using telemedicine Copyright 2003 by Mosby, Inc. All rights reserved.

Copyright 2003 by Mosby, Inc. All rights reserved. Documentation A chart is the written documentation that serves as the legal record of the care given to the client. A chart must be precise, clear, and concise to show the activities of care. Main technique used for health care workers to communicate about the patient’s care. 2 General guidelines for good charting: Charting only for oneself and not for another person Keeping any information contained in the chart confidential ***Additional information in text for charting P. 30 Box 2-14 Guidelines for Charting Health Care Records and P. 406 Box 33-3 Guidelines for Charting Copyright 2003 by Mosby, Inc. All rights reserved.