Ensuring Ethical Health Care Practice

1. Chapter 3 Ethical and Legal Responsibilities

2. Ethics • Ethics • 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

3. Ethics • Ethical dilemmas • Situations that have no clear answers or correct courses of action • E.g., gun control, capital punishment, freedom of speech

4. Ethics and Health Care • Many health care issues involve ethical decisions • Hippocrates was concerned with medical ethics • Hippocratic Oath

5. Ethics and Health Care • Impact of technological advances • Definition of life • Expense of care

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

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

8. Professional Codes of Ethics • Standards of professional conduct • Ensure high quality of care • Many professional organizations have codes • Codes provide guidelines for handling difficult issues

9. 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

10. Question • Which of the following is an example of a value? • Law that protects the welfare of patients • Professional code for behavior • Personal belief that education is necessary for a satisfying life

11. Answer • C. Personal belief that education is necessary for a satisfying life • Value • Belief on which decisions are based • Tends to be personal

12. 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

13. Question • True or False: • Some laws have harmful results.

14. Answer • True • Some laws, though meant to be fair, have unintended consequences that harm rather than help

15. Guiding Principles of Health Care Ethics • Preserve life • Do good • Respect autonomy • Uphold justice

16. Guiding Principles of Health Care Ethics • Be honest • Be discreet • Keep promises • Do no harm

17. 1. Preserve Life • Life is precious • 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

18. Question • True or False: • It is illegal in most states to withdraw artificial means of supporting life.

19. Answer • False • Not illegal to withdraw life support under certain conditions

20. 1. Preserve Life • Dilemmas: • Organ transplants • Stem-cell research • Rationing care and resources

21. Question • Research on stem cells is focused on finding ways they can be used to _____ . • Create drugs to cure cancer • Replace damaged cells in humans • Prevent abortion

22. Answer • B. Replace damaged cells in humans • Stem cells hold promise to replace cells damaged by disease or injury

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

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

25. Consent • Permission • Patient must give for treatment • Can be given by the following: • Mentally competent adults • Emancipated minors

26. Consent • Battery = 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

27. Consent • Informed consent • Procedure explained including possible consequences • Implied consent • Indicated by patient’s actions • Express consent • Given in writing

28. 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

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

30. 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

31. Advance Directives • 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

32. Question • True or False: • A patient admitted to a hospital is legally required to sign a living will.

33. Answer • False • Patients not legally required to prepare advance directives • However, health care facilities must advise patients of rights to do so

34. 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

35. 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

36. Reporting Abuse • Laws require reporting of abuse • Report suspected abuse to supervisor • Patient confidentiality does not apply

37. Laws that Protect • 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

38. 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

39. 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

40. 6. Be Discreet • Preserve confidence and respect privacy • Confidentiality • Patients’ information cannot be released without their written consent

41. 6. Be Discreet • Health Insurance Portability and Accountability Act (HIPAA) • National standards to protect patient privacy • Follow facility policies

42. Question • True or False: • Individual health care facilities must develop policies for protecting patient confidentiality.

43. Answer • True • Following federal guidelines, health care facilities must develop policies and procedures for maintaining patient confidentiality

44. 6. Be Discreet • Defamation of character • Disclosing unauthorized information that can harm reputation of another person • Libel • Disclosing information in writing • Slander • Disclosing information orally

45. 6. Be Discreet • Maintaining patient privacy • Close doors and curtains • Drape patients appropriately • Do not discuss patients in public areas • Discuss patients only with other authorized personnel

46. 6. Be Discreet • Dilemmas: • Public safety • Patient has contagious disease • Patient desire to harm self • Genetic testing

47. 7. Keep Promises • Promises are important part of relationships with others • Contracts • Formal promises enforceable by law

48. 7. Keep Promises • Contracts • Contain three components: • Offer • Acceptance • Consideration

49. 7. Keep Promises • Types of contracts: • Express • Discussion and agreement on specific terms and conditions • Implied • Actions of parties create and carry out contract

50. 7. Keep Promises • 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