1. Chapter 13: Ethics and Law
Patricia Alt, PhD
Towson University

2. Overview Ethical and legal concepts overlap, but have different roots
Their interaction can be seen in patient & provider rights and responsibilities
Managed Care Organizations are also deeply affected by them
Ethical and legal concerns for healthcare managers include Beginning and End of Life issues

4. Sources of Ethics
Personal
Organizational
Theoretical
Bioethics

5. Some Basic Ethical Concepts
Respect for Persons
Beneficence
Nonmaleficence
Justice

6. Sources of American Law
Constitution
Legislatures
Executive Orders
Administrative Regulations
Courts

7. Some Basic Legal Concepts
Civil vs. criminal laws
Criminal law: a wrong against society as a whole, even if a particular individual is harmed
Civil law: wrongs against a person or organization, either by contract violations or by wrongful acts (torts)
Malpractice can be either civil or criminal

8. Elements of a Contract
In order to be binding must include all of these:
Between two or more parties
Both must be competent to consent
Agreement must be for something of value
Must be lawful

9. Types of Tort Negligence - generally unintentional
Intentional torts - deliberate acts
Infliction of mental distress

10. Negligence Must have the following four factors:
a duty toward the harmed party
breach of duty
injury or damages
causation

11. Intentional Torts Assault and battery False imprisonment
Defamation of character
Invasion of privacy

12. Malpractice
Defined as negligence or carelessness of a professional person
Under civil law = simple carelessness
Under criminal law = “reckless disregard for the safety of another”
Of concern for healthcare organizations, to protect patients and the organization itself

13. Provider Responsibilities
Healthcare organizations are affected by Federal and state laws, including EMTALA and ERISA
Individual providers are affected by licensure and malpractice laws
Professional standards and codes of ethics also apply

14. Patient Responsibilities
Patients must ask questions of their providers
They are also to provide accurate information to the provider
It is also expected that they will follow the care plan agreed upon with their provider

15. Provider Rights
Providers have the right to be treated with fairness and dignity by their employers
They are to be protected from sexual or other harassment
Generally able to excuse themselves from patient care with which they disagree (although this is under litigation at present)

16. Patient Rights Self-determination
Expect confidentiality of information
Informed consent or competent surrogate
Right to refuse care
Emergency treatment, even without ability to pay

17. Legal/Ethical Concerns in Managed Care
By definition, “managed” care imposes limits on patients and providers
Key concerns are maintenance of quality care and avoidance of unnecessary costs
Rationing of care is a potential issue
Physicians may find conflict between MCO rules and professional standards of care

18. Some Legal Issues for MCOs
Court cases establishing obligations of physicians to act as advocates for patients (Wickline v. California, 1986)
“Any Willing Provider” laws
ERISA (Employee Retirement Income Security Act of 1974) implications for state/federal regulation

19. Biomedical Concerns Resource allocation Consent Beginning of life care
End of life care
Research conducted in healthcare settings

20. Beginning of Life Care Issues
Provision and funding of contraception
Provision and funding of abortion
Court cases and state laws
Balancing parental, societal, and practitioner rights and responsibilities

21. End of Life Care Issues Advance Directives Surrogate Decision-makers
Care in the absence of clear directives
Decisions about life-sustaining treatment
Balancing familial, societal, and practitioner rights and responsibilities

22. Research in Healthcare Settings
Privately sponsored medical research in smaller organizations leads to concern about appropriate human subjects oversight in those settings
Institutional Review Boards are spreading beyond academic medical centers

23. Protections for Patients
Institutional Ethics Committees in most hospitals oversee a range of issues
Patient Advocate/Ombudsman Offices
Provider Codes of Ethics for each clinical profession
American College of Healthcare Executives Code of Ethics for administrators

24. Conclusion
Legal and ethical concerns continually evolve as medicine changes
Today’s solutions may be tomorrow’s problems
An area with immense potential for polarization and disagreement