Legal and Ethical Responsibilities

1. Legal and EthicalResponsibilities Chapter 5 (7th edition), Chapter 4 (6th edition) of DHO Text

2. 5:1 Legal Responsibilities • Professional integrity • is dependent on ethical behavior. • Health care workers • must understand ethical responsibilities, limitations, and the implications of actions taken. • A Code of Medical Ethics • a code of conduct that establishes standards that govern decisions and behavior of these entrusted with providing health care. • Many professions related to health care have adopted specific codes of ethics.

3. 5:1 Legal Responsibilities • Criminal law • Focuses on wrongs against a person, property, or society • Civil law • Focuses on legal relationships between people and the protection of a person’s rights

4. 5:1 Legal Responsibilities • Torts Occurs when a person is harmed or injured because a health care provider does not meet the established or expected standards of care • Malpractice • Means “bad practice” and is commonly called “professional negligence.” • Failure of a professional to use the degree of skill and learning commonly expected in a particular profession . Ex. A physician not administering a tetanus injection when a patient has a puncture wound • Negligence • Failure to give care that is normally expected of a person in a particular position. Ex. Falls and injuries that occur when side rails are left down

5. Legal Responsibilities • Torts (cont) • Assault and battery • Assault includes a threat or attempt to injure; battery includes the unlawful touching of another person without consent. Ex. Improper handling or threatening a patient • Informed Consent: permission granted voluntarily by a person who is of sound mind after the procedure and all risks involved have been explained in terms the person can understand • Invasion of privacy • Includes unnecessarily exposing an individual or revealing personal information about an individual without that person’s consent. Ex. Improperly draping or covering a patient

6. Legal Responsibilities • Torts (cont) • False imprisonment • Refers to restraining an individual or restricting an individual’s freedom. Ex. Applying physical restraints without proper authorization; keeping patient against his/her will • Abuse * • Any care resulting in physical harm, pain, or mental anguish. Ex. Physical abuse, verbal abuse, psychological abuse, and sexual abuse • Defamation • Occurs when false statements either cause a person to be ridiculed or damage the person’s reputation • a. Slander: spoken defamation • b. Libel: written defamation

7. Legal Responsibilities(continued) • Contract -an agreement between two or more parties • Components of a contract (3) • 1 - Offer (competent individual offers to be a patient) • 2 - Acceptance (provider gives an appointment, examines, or treats a patient • 3 - Consideration (payment made by patient for services provided) • Can be Implied or Expressed

8. Legal Responsibilities(continued) • Implied – Understood without verbally expressed terms • Ex. qualified HCW prepares medication and patient takes it – implied that patient accepts treatment • Expressed • Stated in clear language, orally or written • Ex. surgery permit • Promises of care must be kept • All risks completely explained to patient

9. Legal Responsibilities • Legal disability • Persons in contracts must be free of legal disability Ex. minors, mentally incompetent, under influence of drugs that alter mental state, semi- or unconscious people • Breach of contract • If contract not performed according to agreement, then contract is breached. Ex. failure to provide care or giving improper care; failure to pay accordingly • Non-English speaking party • Must have interpreter • Agent • Works under direction of another person

10. Legal Responsibilities • Privileged communications – • All information from a patient must be kept confidential • Shared only with other health team members • Exceptions: • 1 - Births and deaths • 2 - Injuries caused by violence (assault and battery, abuse, stabbings) that may require police involvement; • 3 - Drug abuse; • 4 - Communicable diseases and sexually transmitted diseases

11. Legal Responsibilities • Health care records • Information on care provided • Belong to provider, but patient has right to a copy • Can be a legal record in court of law • Erasures not allowed on record; cross out, date and initial; insert correct information • Retained for certain time required by law • When retention time is up - Must be burned or shredded to maintain confidentiality • Computer records - limit access, use of specific codes, password protection, constant monitoring and evaluation of computer use

12. Legal Responsibilities • Privacy Act: HIPAA • Standards established by Dept of Health & Human Services (in effect 2003) • Provide federal protection for privacy of health information • Patients must sign consent form • Must sign an “authorization for release of information” form

13. HIPAA • Authorization to Release Form contains: • Purpose of need for information • Extent of information that may be released • Any limits on the release of information • Date of authorization • Signature of person authorized to give consent • Exceptions to regulations: • Diseases or injuries that must be reported by law to protect the safety and welfare of the public • Exempt information – births, deaths, injuries by violence require police involvement, communicable diseases, sexually transmitted diseases

14. Summary • Legal responsibilities are an important part of health care • States have set rules and regulations • Most health care agencies have specific rules, regulations, and standards • Standards vary from state to state and agency to agency • Health care worker must know all legalities of what is expected of them

15. Group Activity – • Nightingale Pledge vs. Hippocratic Oath --- Compare • Present to class

16. 5:2 Ethics • A set principles dealing with what is morally right or wrong • Provide a standard of conduct or code of behavior • Help health care worker analyze information and make decisions based on what people believe is right

17. Ethical Dilemmas • Frequently created by modern medicine • Euthanasia (assisted death) • Confidentiality of AIDS diagnosis • Aborted fetuses and research • Continuing life support • Religious rights to refuse treatment for minors • Expensive treatments and payment

18. Ethical Dilemmas(continued) • Transplant decisions • Who gets the organ? • Should organs be sold? • Legal issues and marijuana • Animals and research • Genetic research • Cloning • Stem cell research

19. Basic Rules of Ethics 1. Save lives and promote health 2. Keep patient as comfortable as possible 3. Respect the patient’s right to die peacefully and with dignity 4. Treat all patients equally 5. Provide the best care you possibly can (continues)

20. Basic Rules of Ethics(continued) 6. Maintain competent skills and knowledge 7. Respect rules of confidentiality 8. Refrain from immoral, unethical, and illegal practices 9. Show loyalty to patients, co-workers, and employers • avoid negative statements and stay positive 10. Be sincere, honest, and caring

21. Summary • Study the code of ethics for the occupation you enter • Abide by the code • Become a competent and ethical health care worker • Earns you the respect and confidence of patients, co-workers, and employers

22. Group Activity • Read the Scenarios. Come up with, as a team, a decision based on the information given. • Present to final team decisions to the class.

23. 5:3 Patients’ Rights • Agencies must have written policies for patients’ rights • All personnel must respect and honor these rights • American Hospital Association has affirmed a Patient’s Bill of Rights • Long-term care facilities post Resident’s Bill of Rights

24. Patients Bill of Rights • Guarantees patient’s rights to the following: • Receive considerate and Respectful Care • Receive complete current information concerning his/her diagnosis, treatment and prognosis • Receive information necessary to give informed consent prior to the start of any procedure and or treatment • Refuse treatment to the extent permitted by law • Receive every consideration of his or her privacy

25. Patients Bill of Rights (cont.) • Be assured of confidentiality • Obtain reasonable responses to request for services • Obtain information about his or her health care. • Know whether treatment is experimental or involved in a research project • Expect reasonable continuity of care • Examine his/her bill and have it explained • Be informed of hospital rules and regulations, and resources available to resolve disputes or grievances

26. Activity • 1. Watch video clips regarding Patient Rights • http://abcnews.go.com/WNT/video/patients-bill-rights-14076222 • http://abcnews.go.com/WNT/video/patients-rights-clothes-clean-hands-14085088 • 2. Complete Ethical Dilemmas as a group. Present final team decisions to the class.

27. 5:4 Advance Directives for Health Care • Also known as legal directives • Legal document • Purpose – allows individual to state what medical treatment they want or do not want in the event they become incapacitated or unable to express their wishes • Two main directives • Living wills • Durable Power of Attorney (POA) for Health Care

28. Living Will • Documents that allow individuals to state what measures should or should not be taken to prolong life when their condition is terminal • Must be signed when individual is competent and witnessed by two adults who cannot benefit from the death • Most states now have laws that allow the withholding of life-sustaining procedures and honor living wills • Frequently results in a Do Not Resuscitate (DNR) order for a terminally ill individual

29. Durable Power of Attorney (POA) • Document that permits an individual (known as a principal) to appoint another person (known as an agent) to make any decisions regarding health care if the principal is unable to make decisions • Includes providing or withholding specific medical or surgical procedures, hiring or dismissing health care providers, spending or withholding funds for health care, and having access to medical records • Usually give POAs to spouses or adult children, but they can be given to any qualified adult • Must be signed by the principal, agent, and one or two adult witnesses

30. Advance Directives for Health Care (continued) • Patient Self-Determination Act (PSDA) • Federal Law in effect 1990 • Requires all health care facilities receiving any type of federal aid comply with the following:

31. Patient Self-Determination Act (PSDA) • Inform every adult of the right to make decisions concerning their medical care, including the right to refuse treatment and right-to-die options • Provide information and assistance in preparing advance directives • Document any advance directives on records • Provide written statements to implement the patients’ rights in the decision-making process • Affirm no discrimination or affect on care due to advance directives • Educate the staff on the medical and legal issues of advance directives

32. Patient Self-Determination Act (PSDA) • Patients are informed of their rights and have the opportunity to determine the care they will receive • Health care workers must be aware of the act and honor it • Health care workers should give serious consideration to preparing their own advance directives

33. Summary • Make patients aware of their rights • By observing patient rights, health care workers assure patient’s safety, privacy, and well-being, and provide quality care • Advance directives must be recognized and respected by health care workers

34. 5:5 Professional Standards • Perform only those procedures for which you have been trained and are legally permitted to do • Use approved, correct methods while performing any procedure • Obtain correct authorization before performing any procedure (continues)

35. Professional Standards(continued) • Identify the patient • Obtain patient’s consent • Observe safety precautions • Keep all information confidential • Think before you speak and watch everything you say • Treat all patients equally (continues)

36. Professional Standards(continued) • Accept no tips or bribes for care you provide • If an error or a mistake occurs, report it immediately to your supervisor • Behave professionally in dress, language, manners, and actions • Always carry liability insurance

37. Summary • Know the legal and ethical implications for your particular health care career • Ask questions • Request written policies • Contact your state board of health or education to obtain all the current regulations and guidelines (continues)

38. Summary(continued) • Follow basic standards listed • Protect yourself, your employer, and your patient for whom you provide all the necessary health care

39. Activity • Complete “Advance Directive Worksheet” individually.