Ethical Boundaries and Practices Ethical issues and their implications in healthcare.

What is ethics? Principles of right and wrong. Who should practice ethical behavior? Is there such a thing as ethical behavior among friends? When was the importance of ethics in health care first recognized? Teacher Notes: What is ethics? Have students suggest definitions. Who should practice ethical behavior? Help students consider a variety of careers and people who should behave ethically. Is there such a thing as ethical behavior among friends? Students should be able to come up with examples that deal with honestly, integrity, etc. First recognized…Many think of Hippocrates as the first, although the Code of Hammurabi is even older. (This PowerPoint doesn’t address the Code of Hammurabi, but if you want to challenge advanced students, ask them to find an example of medical ethics before Hippocrates, and see what they can find.)

Hippocrates What do you know about Hippocrates? Greek Physician Lived 2500 years ago Wrote Hippocratic Oath, which is still taken by physicians today. Teacher notes: Since students will likely think of Hippocrates, we’ll talk about him first. Let students tell you what they already know. Then reveal the bullets.

Codes of Ethics Professional associations write codes of ethics. Purpose: Set standards of professional conduct that promote the welfare of patients and assure high quality care. Is there a professional code of ethics for your future health profession? Teacher Notes: There is an activity related to Codes of Ethics in the supplement.

AAMA Code of Ethics Render service with full respect for the dignity of humanity. Respect confidential information obtained through employment. Uphold the honor and high principles of the profession. Seek to continually improve the knowledge and skills of medical assistants for the benefit of patients and colleagues. Teacher Notes: AAMA – American Association of Medical Assistants Remind students that respecting confidentiality is important, unless legally authorized or required to divulge such information. Ask students if they believe these ethical standards are unique to medical assisting, or do they relate to most health professions?

Ethics and the Law Laws are based on ethical principles. Most laws enforce ethical standards. Sometimes laws are in conflict with a person’s ethical principles. Healthcare workers should act in the best interest of patients and support legal standards for patient care. Teacher notes: Students should be able to differentiate between ethical standards and legal standards, at the same time, understand that most legal standards support ethical principles, and that there often is not a clear line that separates legal and ethical principles. Ask students if they can think of a legal standard that is also an ethical standard. For example, they might say that confidentiality is a legal standard, but patient confidentiality is also an ethical standard. It would be illegal and unethical to give out private patient information without consent. Sometimes laws are in conflict with a person’s ethical principles. For example, a healthcare worker who is a vegan might be opposed to feeding a patient who is eating meat. (Students may be able to cite additional examples.)

Ethics and the Law As a future healthcare professional, do you think you will ever be put in a position where your personal ethics are in conflict with the requirements of your profession? What will you do? As a healthcare professional, will you be able to disengage your emotions when dealing with ethical conflicts? Teacher notes: Have students work in pairs or small groups to discuss both of these questions. The goal is to help students understand that sometimes they will be placed in situations that make them uncomfortable. Legally and ethically, they must act professionally when dealing with all patients. At that point, you may share a personal example of a time where you had to control your personal feelings to calmly and professionally deal with a patient, or another healthcare worker.

Guiding Principles Ethical principles for healthcare workers and the corresponding laws that were created to support them. Teacher Notes: The next 8 slides show how healthcare workers apply ethical principles on the job.

Guiding Principles Preserve life Do good Respect autonomy Uphold justice Be honest Be discreet Keep promises Do no harm Teacher Notes: Divide the class into 8 pairs or small groups. Have each group number off from 1 to 8. Show all 8 principles. Have each group talk about their assigned guiding principle. They should discuss what they think it means and how it relates to the responsibilities of a healthcare worker, as well as to think about what legal standards protect the assigned guiding principle. Give each group 10 minutes to talk about the assignment. Then, have each group share their conclusion with the class. **Detailed information on the topic of guiding principles can be found in Introduction to Health Care, 2nd edition, chart 3-2 on page 67.

Healthcare Ethics: Euthanasia Results in death to alleviate suffering or when there is no hope for recovery. Many healthcare professionals feel euthanasia is contrary to their professional ethics. Regardless of their beliefs, healthcare workers should follow state laws. Teacher Notes: Lay term is mercy killing. Dr. Kevorkian is most noted physician who has assisted with suicide. Important to also talk about the importance of caring for terminally ill patients.

Healthcare Ethics: Organ Transplants Organ donations come at a time of crisis when somebody dies. Healthcare workers should ask about donation. Illegal to transplant organs without patient or family permission. Teacher Notes: Many people die each year, waiting for an organ transplant. It is important for healthcare workers to understand the laws involved and be sure patients and their families are well informed. Many states have donor cards or designation as an organ donor on their driver’s license.

Healthcare Ethics: Conception IVF – In vitro fertilization Egg and sperm donation Surrogates Fertility drugs What are the ethical considerations? Teacher Notes: Briefly explain each type of assisted fertility, and then ask the last question. Students may recall the 2009 case of Nadia Suleman, the Octomom. After briefing discussing the case, go to the next slide.

Should there be limits to IVF? Should obese people be allowed to have IVF? Should a couple be approved for IVF if they both smoke? Should a single person who is unemployed be a candidate for IVF? Teacher Notes: Allow students to react to the questions.

Codes of Conduct Ethical responsibilities include respecting the cultural, social and ethnic differences of patients and other healthcare workers. “Scope of practice” helps define the code of conduct for healthcare workers. Performing skills outside the scope of practice is illegal and unethical. Ethical codes of conduct are based on moral standards and society’s expectations.

Ethical Dilemmas Advances in health care have created ethical dilemmas for healthcare providers. There are no easy answers when addressing ethical dilemmas. The question is – what is the responsibility of healthcare providers when addressing ethical dilemmas? Teacher notes: What you are looking for in this slide is for student understanding about the separation of personal values and preferences from professional behavior. They, and their patients, will face ethical dilemmas. And of course, people are entitled to their beliefs. What is important here is helping students understand that they neither have to agree or disagree with ethical dilemmas, but rather need to follow ethical standards (codes) in the delivery of health care. The next slide shows examples of ethical dilemmas.

Ethical Dilemmas Should family members be allowed to discontinue life support? Do parents have a religious right to refuse life-saving blood transfusions for their child? Should people be allowed to sell organs for use in transplant? Should human beings be cloned? What should be done with fertilized frozen embryos when the parents no longer want them? Teacher notes: Allow students to raise their hands and react. Hopefully you will have differences of opinion on some of these dilemmas, and hopefully students can learn to discuss and disagree – respectfully.

Incident Reports To ensure prompt reporting and documentation of all incidents resulting in injury or having potential adverse affects to patients, employees, or visitors. To accurately document threats or actions of violence and environmental emergencies. To accurately document incidents of property damage. This slide explains the general purpose of incident reports in a healthcare setting.

Incident Reports Follow your agency’s policies in filling out and submitting incident reports. Focus on the facts. The purpose of the incident report is for legal record keeping – NOT punishment. Can you think of examples of when an incident report might be completed? Explain that different agencies have different policies for completing incident reports. Healthcare workers should know and follow their agencies requirements for completing and submitting incident reports. Tell students to think of the incident report as a collection of facts surrounding an unexpected incident. MOST of the time, incident reports are reviewed, filed, and never seen again. In many hospitals, a hospital legal representative reviews all incident reports. Help students understand that incident reports are necessary and important. Share some examples of incident reports with your students.

Electronic Incident Reports Some healthcare agencies are moving toward electronic incident reports.

Ethics Committee Most hospitals have ethics committees that examine ethical issues related to patient care. They can advise patients, families and healthcare providers. A hospital ethics committee might decide the best action to take for a terminally ill patient on a respirator. An ethics committee might also be asked to pass judgment on the actions of a healthcare provider. Teacher notes: Ethics committees have tremendous power in today’s healthcare environment. Patients are holding their doctors and hospitals to a higher standard of care. Committee meetings must respect patient confidentiality, examine facts, and support the ethical principles of the hospital (or other healthcare facility) and professions they represent. Ethics committees can serve different functions (as noted in this slide) and can have different roles/authority in different facilities.

Professional Practice Use the approved methods when performing procedures. Obtain proper authorization before performing any procedure. Identify the patient. Observe all safety precautions. Teacher Notes: As you present each standard of professional practice, ask students to describe and give examples of what it means. This forces students to think about the “why” of the practice.

Professional Practice Think before you speak and carefully consider everything you say. Accept no tips or personal gifts. Immediately tell your supervisor if you make a mistake. Act professionally in everything you say and do. Teacher Notes: As you present each standard of professional practice, ask students to describe and give examples of what it means. This forces students to think about the “why” of the practice.