Bioethics

1. Bioethics Medical Therapeutics Ms. Bettag RN, BSN

2. Bell Work • Write out abbreviations.

3. Learning Objectives • Standard 3, Compare and contrast the specific laws and ethical issues that impact relationships among patients and the healthcare professional. • At the conclusion of class today I CAN: • Identify the structure of an ethical dilemma • Define key terms related to bioethics and use them in context • Describe the importance of understanding ethical issues in health care • https://www.youtube.com/watch?v=ghzHrO7Lm04

4. Greys Anatomy • Man in video is on death row and scheduled for execution in 5 days. The young boy needs a liver transplant and will die if he does not get a liver in the next 24 hours. The man is a match for the boy for a liver. • https://www.youtube.com/watch?v=cC_cCe7bgak • What is unethical? Is this legal, illegal, ethical, or/and unethical?

5. Ethics and Morals • Morals—personal beliefs of right and wrong behavior based on religious beliefs, cultural norms, family customs, and past experiences • Ethics—human behavior and its effect on society, more concerned with the big picture as well as the immediate situation

6. Laws and Ethics • Laws can be made to designate actions that are right and wrong even though the same action may not be viewed as unethical • Another action may be viewed by some as ethical but is considered illegal

7. Susan is a respiratory therapist at a large hospital. It was discovered that Susan had an affair with the chief of staff at the hospital. She was later fired by the board of the hospital. Were Susan’s actions illegal or unethical? • Illegal: go to the right side of the room by the window • Unethical: go to the left side of the room by the door • Both: go to the back of the room

8. Bell Work • Review for quiz

9. Learning Objectives • Standard 3, Compare and contrast the specific laws and ethical issues that impact relationships among patients and the healthcare professional. • At the conclusion of class today I CAN: • Identify the structure of an ethical dilemma • Define key terms related to bioethics and use them in context • Describe the importance of understanding ethical issues in health care

10. Bioethics • Specialized branch of ethics concerned with human behavior within the context of modern medicine • Medical research develops new technology and advances at a rapid rate • Human cloning, stem cell research, and euthanasia are examples

11. Ethical Principles • Ethical rules regarding people’s behavior • Ethical reasoning process • Seem simple and straightforward, may be complicated • Nonmaleficence • Beneficence • Autonomy • Distributive justice • Paternalism • Veracity • Fidelity

12. Nonmaleficence • Pertains to health-care workers • “Do no harm” • Hippocratic Oath, professional codes • In medicine there is always a potential to do harm

13. Beneficence • Health-care workers aim to provide benefit in addition to avoiding harm • Medications are proven to be safe before they are released • Medications and treatments should have a reasonable likelihood of being helpful • Risks should be made known to patients • https://youtu.be/EsvxAFvSgTI

14. Autonomy • Right of patients for self-determination • Freedom of choice • Patient’s right to refuse or accept medical treatment • Obtain informed consent before treatment or procedures • https://www.youtube.com/watch?v=LSeiur_-0IU

15. Distributive Justice • Includes concept of fairness • Fair allocation of scarce resources • People waiting for transplant organs • Who decides who receives the organ and who does not

16. Paternalism • “Father” role is taken on by health-care provider, judge, or other person or entity who makes the decision for a person based on his or her best interests • Right to autonomy is denied • Parent makes decisions for minor child

17. Veracity • Duty to be honest • Is there an appropriate time to withhold information from a patient? • Is there such a thing as the acceptable “little white lie”?

18. Fidelity • The duty to keep reasonable promises and to meet obligations • Clients have a right to expect health-care workers to keep their information private • Reasonable expectations and unreasonable expectations

19. Anatomy of an Ethical Dilemma • A decision must be made • The outcome will have profound consequences • There is a disagreement among involved parties about right course of action

20. Ethical Decision Making • Bias—response based on previous experience • Uses ethical reasoning process • Thoughtful decision making based on solid understanding of ethical principles and careful reasoning

21. Ethics Committees • Serve as resource to health-care organizations • Formulate institutional policies • Provide education for staff • Serve as consultant role between patients and providers

22. Would you want to serve on an ethics committee? • Yes: go the right side of the room by the window • No: go to the left side of the room by the door

23. Health care Ethical Behavior • Trust and loyalty • Confidentiality • Respect and dignity • Commitment to professional development

24. Discussion • Differentiate morals and ethics • Differentiate unethical and illegal • Define bioethics and identify if you have been exposed to a situation when bioethics was an issue

25. Learning Objectives Standard 3 Compare and contrast the specific laws and ethical issues that impact relationships among patients and the healthcare professional Standard 5 Explain characteristics of advanced directives, living wills, durable power of attorney, and other legal directives governing medical treatment. Explain, using domain-specific language and accurate definitions of legal concepts, how the content of these legal documents impacts patients’ rights for all aspects of care. At the conclusion of class today I CAN: Identify malpractice issues in healthcare and how they affect the every day operations of healthcare Define key terms that are used within medical law compare and contrast advanced directives, living wills, durable power of attorney and give examples of how they are used in healthcare

26. Medical Malpractice Act Statute or law regulating the practice of medicine Safeguards patient’s safety and privacy Responsibility of all personnel in health care

27. Licensure Regulation to ensure competence May vary from state to state Renew and pay every 2 years Continued education

28. Revoking a License Conviction of crime such as a felony or fraud Unprofessional conduct, such as, addiction, breach of confidentiality, false advertising, unethical behavior, inability to perform duties, or fee splitting

29. Respondent Superior “Let the master answer” Physicians are legally responsible for their employees Hospitals carry malpractice insurance for it’s employees Employees should have their own malpractice insurance Certification ensures competence

30. Scope of Practice The range of services a professional can offer based on education, training, ability, and licensure For example, medical assistants are trained to assist with minor surgery…medical assistants cannot perform surgery!

31. Standard of Care The minimum safe professional conduct under specific conditions as determined by professional peer organizations Failure to perform is negligence Omission: failure to use good judgment that results in harm to the patient Commission: performance of improper act that results in harm to patient Unintentional tort: negligence resulting in harm to a patient

32. Consent Implied consent— patient consents to treatment through actions What would be an example of implied consent? Informed consent— written form, signed by patient explaining procedure or treatment, who will perform, risks, and expected results When would informed consent be necessary?

33. Barriers to Informed Consent • Interpreters may be necessary if a patient is hearing impaired or speaks a different language • Good Samaritan law protects emergency personnel when a patient may not be able to speak or give consent • When might the Good Samaritan law be used?

34. Malpractice Medical form of negligence proven by four criteria, the 4 “D’s” Duty: must prove relationship existed (how?) Dereliction of duty: Must prove standard of care was not met (Use of expert witness) Direct cause: Damages suffered were a direct result of action in question Damage: must prove injury occured

35. The Lawsuit Process Subpoena—legal document requiring appearance in court or for a deposition Deposition—formal gathering of information Trial—information is gathered, date is set by court, expert witnesses, jury, verdict, and settlement Malpractice insurance—mandatory in most states

36. Intentional Torts: gross negligence, a form of negligence that involved an intentional act or failure to act that causes harm Assault—threat or perceived threat of bodily harm to another person Battery—touching inappropriately without permission Defamation—slander False imprisonment—holding a patient against his or her will Fraud—intentional misrepresentation of facts for financial gain Invasion of privacy—release of private information

37. Criminal Law Protects the safety and welfare of the public Determines what is legal and illegal The crime is considered to be against society or the state

38. Civil Law Private law Protects the rights of individuals Most commonly exercised type of law in ambulatory care

39. Patient Noncompliance Physician and patient enter into contract Physician responsible for diagnosing and treating patient, being available for patient care and communication, and arranging for different physician if absent Patient responsible for truthfully relating medical history, following treatment recommendations, and keeping appointments Patients who fail to comply with treatment recommendations cannot expect the treating physician to be responsible for the outcome of their care

40. Patient Noncompliance • Either party may end the physician–patient contract • Physician must send certified letter to patient • If physician does not follow proper procedure, abandonment may be charged

41. Statute of Limitations Determined by each state Determines length of time during which a lawsuit may be filed Medical records Accurate documentation

42. Risk Management Medical staff and physician can best defend against medical malpractice lawsuits by preventing lawsuits from occurring Accurate, complete documentation provides the best back up Proper documentation, presenting reasonable expectations, and being kind and empathetic toward patients all decrease the risk of a malpractice lawsuit.

43. Confidentiality Patient’s medical and personal information used for treatment, payment, and administrative operations “Need to know” Authorized release of information HIPAA

44. Exceptions to Disclosure Rules Court order such as workers’ compensation Impact on public safety such as reporting communicable diseases and abuse Organ donor Vital statistics such as births and deaths

45. Reporting Abuse Healthcare professionals are required by law to report all suspected abuse Procedures and forms vary from state to state Follow office policy and procedure manual

46. Child Abuse Neglect—child unattended, needs are not being met Emotional abuse—caregiver yells at child, fails to provide affection and attention Physical abuse—bruises, cigarette burns, and bites Sexual abuse—painful urination and unusual sexual knowledge for child’s age

47. Elder Abuse Neglect—unclean or unsafe living conditions, poor hygiene, and weight loss Physical abuse—frequent injuries, bruises, and patient’s fear of the caregiver

48. Think*Pair*Share • Using your phone or text book define the following: • Advance directive • Living Will • Durable Power of Attorney • With a partner discuss why these are important in healthcare

49. Durable Power of Attorney Legal document that is effective when a patient is unable to speak for himself or herself or make medical decisions Patient names another to make decisions States have standard forms What happens when someone has not appointed a durable power of attorney?

50. Living Will Document outlining type of care a patient requests in the event of severe injury Life support, feeding tubes, medications, kidney dialysis, ventilators, organ donation, etc. https://www.youtube.com/watch?v=1rmlGJxdpMk