1. Infant Mortality

2. Question True or False:
A good system of ethics will provide answers to most health care decisions.

3. Answer
False
Many health care issues have no easy answers and present serious ethical dilemmas

4. Ethical and Legal Responsibilities
Chapter 3
Ethical and Legal Responsibilities

5. Ethics Ethics Ethical dilemmas
System of principles for determining right and wrong
Guides decision making
Helps with difficult and complex problems
Varies among cultural groups
Influenced by religion, history, and collective experiences
Ethical dilemmas
Situations that have no clear answers or correct courses of action
E.g., gun control, capital punishment, freedom of speech

6. Ethics and Health Care
Many health care issues involve ethical decisions
Hippocrates was concerned with medical ethics
Hippocratic Oath
Impact of technological advances
Definition of life
Expense of care
Professional Code of Ethics
Standards of professional conduct
Ensure high quality of care
Many professional organizations have codes
Codes provide guidelines for handling difficult issues

7. Personal Values Foundation for making decisions and guiding behavior
Influenced by family, religion, education, and personal experience
Establish priorities
Values not necessarily right or wrong
Belief on which decisions are based
Tends to be personal

8. Ethics and the Law
Ethics provide general principles on which laws are based
Sometimes laws conflict with individual ethics
Laws can have negative, unintended consequences

9. Guiding Principles of Health Care Ethics
Preserve life
Do good
Respect autonomy
Uphold justice
Be honest
Be discreet
Keep promises
Do no harm

10. 1. Preserve Life Life is precious No agreement on definition of life
Take all possible means to preserve it
No agreement on definition of life
Artificial means of supporting life
Euthanasia to relieve suffering
Illegal in almost all states
Dilemmas:
Organ transplants
Stem-cell research
Rationing care and resources

11. 2. Do Good Promote welfare of others Work in best interest of patients
Basic duty of health care professional
Work in best interest of patients
Perform one’s job without expectation of receiving anything extra

12. 3. Respect Autonomy Self-determination
Patients have right to make own decisions
May choose type of treatment
May refuse treatment

13. Consent Permission patient must give for treatment
Can be given by the following:
Mentally competent adults
Emancipated minors
Informed consent
Procedure explained including possible consequences
Implied consent
Indicated by patient’s actions
Express consent
Given in writing

14. Violations of Consent Battery = crime Assault = crime
Touching or treating patients without consent
Assault = crime
Threatening to touch or treat without permission
False imprisonment
Holding mentally competent patients against their will

15. Question
If a patient schedules a root canal and shows up at the appointed time for the procedure, this is an example of _____ .
Express consent
Implied consent
Informed consent

16. Answer B. Implied consent Implied consent Given by patient’s actions
In this case, patient makes and keeps appointment for procedure

17. Advance Directives
Written instructions containing patient’s desires regarding health care
Designation of health care surrogate
Also known as health care power of attorney
Gives specific people authority to make health care decisions
Living will
Contains written instructions regarding health care
Patient Self-Determination Act of 1991
Health care facilities must provide adult patients with information about advance directives
Without instructions, care of incompetent patients can be difficult

18. 4. Uphold Justice Justice refers to fairness
All patients must receive same level of care
Dilemma:
Equitable distribution of health care resources
Ranking and rationing of health care services

19. Reporting Abuse Protect others from harm
Laws require reporting of abuse
Federal Child Abuse Prevention and Treatment Act
States have laws and reporting systems for elder abuse
Report suspected abuse to supervisor
Patient confidentiality does not apply
Occupational Safety and Health Act
Requires employers to be responsible for employees
Controlled Substances Act
Helps prevent abuse of addictive drugs
Provides guidelines for prescribing and handling

20. 5. Be Honest Good health care relies on honesty
Patient’s trust important
Dilemma:
How much to tell patients about their condition
Honesty essential among coworkers and with supervisor

21. Fraud Dishonesty involving cheating or trickery Health care examples:
Insurance claims for services not performed
Selling ineffective treatments
Claiming education or credentials one does not have

22. Question True or False:
Poor communication between the patient and the health care professional is a major cause of malpractice lawsuits.

23. Answer True Major contributors to malpractice lawsuits:
Poor communication
Resulting patient anger

24. 6. Be Discreet Preserve confidence and respect privacy Confidentiality
Patients’ information cannot be released without their written consent
Health Insurance Portability and Accountability Act (HIPAA)
National standards to protect patient privacy
Follow facility policies
Maintaining patient privacy
Close doors and curtains
Drape patients appropriately
Do not discuss patients in public areas
Discuss patients only with other authorized personnel
Dilemmas:
Public safety
Patient has contagious disease
Patient desire to harm self
Genetic testing

25. Violations of Discretion
Defamation of character
Disclosing unauthorized information that can harm reputation of another person
Libel
Disclosing information in writing
Slander
Disclosing information orally

26. 7. Keep Promises
Promises are important part of relationships with others
Contracts
Formal promises enforceable by law
Contain three components:
Offer
Acceptance
Consideration
Types of contracts:
Express
Discussion and agreement on specific terms and conditions
Implied
Actions of parties create and carry out contract
Breach of contract
One party fails to carry out part of agreement
Damages
Money to compensate for injury or loss
Agent
Someone who represents another person when making contract
Respondeat superior
Legal doctrine holding employer responsible for actions of employees

27. Question Which of the following is an example of a breach of contract?
A patient refuses to pay for treatment because he is not happy with the results
A physician refuses to perform a treatment based on information from lab tests
A physical therapist cancels future appointments because the patient will not do the prescribed exercises

28. Answer
A. A patient refuses to pay for treatment because he is not happy with the results
Patient who refuses to pay physician for services given is not fulfilling his or her part of agreement
Results in breach of contract

29. 8. Do No Harm Essential responsibility of health care professionals
Negligence
Failure to meet reasonable standard of care
Malpractice
Professional negligence
May result in lawsuit against health care provider and/or facility
Good Samaritan laws
Protect individuals who give care in emergency situations
Best to stay within scope of training

30. Handling Ethical Dilemmas
Priority:
Well-being of patient
Accept responsibility for making difficult decisions
Part of health care work
Report illegal behavior
Resources:
American Medical Association Council on Ethical and Judicial Affairs
Ethics committees at health care facilities
Clergy and counselors
Lawyers and risk management specialists