1. Ethical and Legal Responsibilities in Healthcare

2. The Purpose of Ethics
Ethics is a system of principles (fundamental truths) a society develops to guide decisions about what is right and wrong.
Ethics helps people deal with difficult and complex problems that lack easy answers.

3. Ethical Dilemma
When one ethical principle (truth) contradicts another.
Examples:
Murders should be sent to the electric chair vs. killing is wrong.
Freedom of speech should be protected by law vs. hate messages given on public grounds should be stopped.

4. Ethics and Health Care
Often ethical dilemmas involve life and death issues… like in healthcare
“Technology has progressed beyond society’s readiness to deal with the ethical and legal issues it presents.” (Flight, 2004)
When should life support be withdrawn for people in comas who have no chance of survival?
Should anencephalic babies (born with no brain only a brain stem) be kept alive?
Is healthcare a right or a privilege?

5. Personal Values
Are beliefs and ideals that provide the foundation for making decisions and guiding behavior.
They develop as people grow and mature.
They are influenced by family, religion, education and personal experience.
Not necessarily right or wrong
Regardless of your personal values,
*** you must support the practices of the healthcare facility where you work***

6. Ethics and the Law
Ethics often provide the general principles on which laws are based.
Example: If a society agrees that, ethically, life is precious, then it will pass a law that says murder is a crime.

7. Occupational Safety and Health Administration
Our society’s ethical principle that human life and health are precious led to the formation of OSHA.
OSHA: Created to protect the health and safety of all workers

8. When the Law and Ethics Collide
Marijuana can relieve nausea for chemotherapy patients, but also encourages inappropriate drug use. Should it be legalized? What do you think?
A law was passed requiring hospital ERs to accept all patients who required care even if they could not pay for it. Many hospitals could not afford to treat everyone who came, so they closed their ERs. Now the whole community has been denied health care. Who was right?

9. Guiding Principles of Health Care Ethics
Preserve life
Do good
Respect autonomy
Uphold justice
Be honest
Be discreet
Keep promises
Do no harm
How will you do these things when YOU are a healthcare professional?
Reflect on this question as we look at each one individually.

10. 1. Preserve Life
Basic guiding principle for health care professionals: Life is precious
What is “life”?
Should extreme technology be used to keep someone alive?
Should “quality” of life be considered?

11. Euthanasia
Performing an action that results in the death of a patient to alleviate suffering or when it is believed that there is no hope for recovery.
Dr. Jack Kevorkian: Michigan Dr. who assisted 100+ pts. to end their lives. He believed a painless death is the kindest thing a Dr. can do.
Spent 8 years in prison for doing this.
Should it be legalized? Would it be abused?
3 states allow PAD (physician aid-in-dying) where the pt. himself administers the lethal medication. Washington, Oregon, and Montana

12. Rationing Care and Resources
Health care costs are rising FAST!
Insurance limits which tests and treatments they will cover… so some rationing IS already taking place!
* Not enough organs for everyone who needs a transplant.
Who gets them?
*AMA (American Medical Association) says to consider
Likelihood of benefit
Impact of treatment in improving the quality of the patient’s life
Duration of the benefit
Urgency of the pts. Condition
Amount of resources required for successful treatment.

13. 2. Do Good Promote the welfare of others Listen carefully to the pt.
Make an effort to understand their ethnic and cultural backgrounds
Carefully assess the pts. needs
Be aware of their ethical beliefs.
Explain what you dare doing as you perform tests and treatments.
Provide education
Allow the pt. to ask questions
Answer all questions… go find the answer if you need to.

14. 3. Respect Autonomy Autonomy – Self-Determination
Pts. have the right to make their own health care decisions.
Even if you don’t agree with their decision, it’s still their decision!

15. Consent (permission)
Medical treatment cannot be carried out unless the pt. gives his/her consent.
Informed consent: When permission for treatment is given after the procedure and its possible consequences has been explained.
Implied consent – indicated by the pts. actions like showing up for a medical apt., opening the mouth for the dentist to give an injection.
Express consent – Given in writing. Especially needed for invasive procedures. (ones that puncture the skin, or insert objects into the body).

16. Informed Consent The patient must be informed about:
Procedure or treatment plan
Possible risks
Expected results
Alternative procedures with their benefits/risks
Consequences if the procedure is not performed
It’s not enough that they are just given this information, they must understand it too!
Can legally be signed by competent adults (over 18 or emancipated)
Usually minors (under 18) must have consent form signed by parent or guardian.

17. Assault and Battery Battery: Any unauthorized
touching of another person.
Performing a procedure without consent.
Assault: Any threatened or implied act, whether carried out or not.
Exception: emergency care given when the pt. is physically unable to give consent.
Being “too rough” with a patient, or “talking them into” signing a consent can result in assault &/or battery charges.

18. Advance Directives
Written instructions that outline individuals’ desires regarding care should they become unable (illness/injury) to make these decisions.
Designation of health care surrogate/representative… AKA Healthcare power of attorney
Pts. Designate specific people to make their healthcare decisions.
Anyone can be a surrogate, not just family.
Living Will
Outlines the pts. wishes regarding the type and extent of care to be given.
DNR = Do Not Resuscitate (no CPR)

19. Dilemmas…
Terri Schiavo: Was in a non-reversible vegetative state for 15 years. She had no advance directive. Husband wanted her feeding tube removed, parents wanted it kept in.
After years in court, the tube was removed and she died within 2 weeks.
Elderly who live alone and are no longer able to safely care for themselves… Can they be forced into assisted living facilities?

20. 4. Uphold Justice (Fairness)
All patients, regardless of race, economic status, religion, nationality, or personal characteristics, must receive the same level of care and consideration.

21. Reporting abuse Federal Child Abuse Prevention and Treatment Act
Requires the reporting of physical, sexual, and mental abuse of children AND protects those who do the reporting.
Pt. confidentiality does not exist in cases of suspected abuse.

22. Signs of Child Abuse
Bruises/welts/burns/lacerations (cuts)/abrasions (scrapes)
Skeletal injuries
Head injuries
Repeated injuries
Different explanations for the cause of an injury between child and parent.
Unusually compliant (agreeable), fearful, or aggressive behavior of the child.
***Report suspicious cases to supervisor or to authorities if necessary***

23. Abuse of Elderly
Estimated that 1-2 million people over age 65 are abused by their caregivers.
Neglect/lack of physical care
Financial abuse
Mental/emotional abuse
Abandonment
All states have reporting systems for elder abuse… generally through the Adult Protective Services, or the Area Agency on Aging, or the County department of social services.

24. Laws that Protect Occupational Safety and Health Administration(OSHA)
Employers must accept responsibility for the safety and health of their employees in the workplace.
Prevent contracting diseases
Waste management
Personal protection methods
Employee training programs

25. 5. Be Honest Increased trust = Increased well-being of the pt.
Should you tell pts. bad news if you think it will lead to depression and possibly even a suicide attempt?
Always admit your mistakes! They can have serious consequences!
Be on-time to work, don’t perform personal tasks on work time, don’t socialize and ignore your patients

26. Fraud Form of dishonesty that involves cheating or trickery
Submitting insurance claims for services not performed
Charging different rates for insured and uninsured pts.
Selling treatments, drugs, and devices that have not been proven effective.
Claiming to have a degree, experience or credentials that one does not have.

27. 6. Be Discreet
Be careful about what you say, preserve confidences, respect privacy.
Very important ethically, and it’s the law!
Confidentiality: Legal right to privacy concerning their medical affairs.
Violation of confidentiality, even if you think it’s for the best, can result in a lawsuit.

28. HIPAA
Health Insurance Portability and Accountability Act. Created in 2003
Pt. information cannot be released without written approval. Remember: The pt.’s medical information belongs to them and them alone!
Regulates the sharing of medical information
Medical records
Conversations between health care providers about pt. care
Insurance/billing information
Exempt (things that are reported by law)
Births/deaths, violent injuries (child abuse), drug abuse, certain communicable diseases.

29. Can patient confidentiality go too far?

30. Confidentiality continued
Breaking confidentiality can result in legal issues
Defamation of Character
Harming the reputation of another
Libel
Written
Slander
Spoken

31. Confidentiality Dilemmas
Firefighters assisted an injured woman and took her to the hospital. She was HIV+. Hospital knew but could not tell the firefighters without breaking confidentiality.
Genetic testing: Can help to identify problems and get them treated early, but insurance companies could drop pts. if they are deemed “expensive”.

32. 7. Keep Promises
Contract – formalized promises (agreements) that are enforceable by law.
Breech of Contract – When one of the parties fails to fulfill his/her part of the contract
Implied contracts
Actions create the contract.
Express contract
Specific terms and conditions are agreed upon.

33. Be responsible for employees who represent you
Agent: Someone who has the authority to represent another person.
Employers can be held liable (legally responsible) for the actions of their employees.
Examples:
Dr. held liable for a medical assistant giving the wrong medication
Physical therapist may be responsible for a patient fall that occurred while with the physical therapy assistant.

34. 8. Do No Harm
Work only within your scope of practice (What you are legally allowed to do in your profession)
Negligence: Failure to meet the standard of care that can be expected from a person with certain training and experience.
Action done wrong, or not done when it should have been

35. Malpractice Professional negligence
Many lawsuits could be prevented with good personal relationships with the healthcare provider
Most people understand that positive treatment results cannot be guaranteed.
Patients who feel ignored and disrespected (angry) are more likely to sue than those who feel positive about their care.

36. Reporting Unethical and Illegal Behavior
Any behavior that could affect the well-being of the patient must be reported!
If it is legal but ethically questionable (speaking poorly of coworkers) it may be best to first speak directly to this person.

37. Pt. Bill of Rights
Original from1973 adopted by the American Hospital Association (AHA)
Revised in 1992
Since then several other patient bill of rights have been written such as
Pregnant patient’s bill of rights
Psychiatric patient’s bill of rights
Hospice patient’s bill of rights
Etc.

38. The patient has the right to…
Considerate and respectful care
Information about their diagnosis, treatment and prognosis
Make decisions about his/her care
Have an advance directive (power of attorney or living will)
Privacy and confidentiality
Review his/her medical records and bills
Timely appropriate care even if he/she must be transferred to another facility
Voluntary participation in research studies

39. Patient responsibilities
Providing accurate health information
Requesting information when needed
Providing a copy of any advance directives
Be aware of the hospital’s obligation to efficient and equitable in providing care to other patients.
Recognize impact of life-style choices on their personal health