LEGAL AND ETHICAL

1. LEGAL AND ETHICAL ETHICS

2. Ethics • Set of principles relating to what is morally right or wrong • Provide a standard of conduct or code of behavior • Allows a health care provider to analyze information and make decisions based on what people believe is right and good conduct • Modern health care advances have created many ethical dilemmas for health care providers

3. Some Dilemmas are…. • Group activity

4. Ethical Codes • Most of the national organizations representing the different health care occupations have established ethical codes • The codes differ slightly, but contain the same basic principles: • Put the saving of life and the promotion of health above all else • Make every effort to keep the patient as comfortable as possible and to preserve life whenever possible

5. Ethical Code Principles • Respect the patient’s choice to die peacefully and with dignity when all options have been discussed with the patient and family and/or predetermined by advance directives • Treat all patients equally, regardless of race, religion, social or economic status, sex, or nationality. Bias, prejudice, and discrimination have no place in health care • Provide care for all individuals to the best of your ability • Maintain a competent level of skill consistent with your particular occupation

6. Principles continued… • Stay informed and up to date and pursue continuing education as necessary • Maintain confidentiality. • Confidentiality means that information about the patient must remain private and can be shared only with other members of the patient’s health care team. • A legal violation can occur if a patient suffers personal or financial damage when confidential info is shared with others, including family members. • Info obtained from patients should not be repeated or used for personal gain. • Gossiping about patients is ethically wrong.

7. And more • Refrain from immoral, unethical, and illegal practices. If you observe others taking part in illegal actions, report such actions to the proper authorities • Show loyalty to patients, co-workers, and employers. Avoid negative or derogatory statements and always express a positive attitude • Be sincere, honest, and caring. Treat others as you would want to be treated. Show respect and concern for the feelings, dignity, and rights of others

8. Patients’ Rights • Federal and state legislation requires health care agencies to have written policies concerning patients’ rights, or the factors of care that patients can expect to receive • Agencies expect all personnel to respect and honor these rights • The American Hospital Association has adopted a “Patient’s Bill of Rights” that is recognized and honored by many health facilities.

9. Patient’s Bill of Rights • States, in part, that a patient has the right to: • 1. considerate and respectful care • 2. obtain complete, current info concerning diagnosis, treatment, and prognosis (expected outcome) • 3. receive info necessary to give informed consent prior to the start of any procedure or treatment • 4. have advance directives for health care and/or refuse treatment to the extent permitted under law • 5. privacy concerning a medical care program

10. Bill of Rights continued • 6. confidential treatment of all communications and records • 7. reasonable response to a request for service • 8. obtain info regarding any relationship of the hospital to other health care and educational institutions • 9. be advised of and have the right to refuse to participate in any research project • 10. expect reasonable continuity of care

11. Bill of Rights • 11. review medical records and examine bills and receive an explanation of all care and charges • 12. be informed of any hospital rules, regulations, and/or policies and the resources available to resolve disputes or grievances

12. OBRA • Residents in a long-term care facilities are guaranteed certain rights under the Omnibus Budget Reconciliation Act of 1987 • Every long-term care facility must inform residents or their guardians of these rights, and a copy must be posted in each facility. • Often called a “Resident’s Bill of Rights”

13. Resident’s Bill of Rights • Free choice regarding physician, treatment, care, and participation in research • Freedom from abuse and chemical or physical restraints • Privacy and confidentiality of personal and chemical records • Accommodation of needs and choice regarding activities, schedules, and health care • Voice grievances without fear of retaliation or discrimination

14. Resident’s Bill of Rights continued • Organize and participate in family/resident groups and in social, religious, and community activities • Information on medical benefits, medical records, survey results, deficiencies of the facility, and advocacy groups including he ombudsman program (state representative who checks on resident care and violation of rights) • Manage personal funds and use personal possessions • Unlimited access to immediate family or relatives and to share a room with his or her spouse, if both are residents • Remain in the facility and not be transferred or discharged except for medical reasons, the welfare of the resident or others, failure to pay, or if the facility either cannot meet the resident’s needs or ceases to operate

15. OBRA • All states have adopted these rights, and some have added additional rights • Health care workers can face job loss, fines, and even imprisonment if they do not follow and grand established patients’ or residents’ rights

16. Advance Directives for Health Care • Also known as legal directives • Legal documents that allow individuals to state what medical treatment they want or do not want in the event that they become incapacitated and are unable to express their wishes regarding medical care • Two main directives are a living will and a Durable Power of Attorney (POA) for Health Care

17. Living Wills • Documents that allow individuals to state what measure should or should not be taken to prolong life when their conditions are terminal • Document must be signed when the individual is competent and witnessed by two adults who cannot benefit from the death • Frequently results in a DNR • Allows the patient to die in peace and keep the belief that quality of life is more important than quantity

18. Durable Power of Attorney (POA) • Document that permits an individual (known as a principal) to appoint another person (agent) to make any decisions regarding health care if the principal should become 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 • POA must be signed by the principal, agent, and one or two adult witnesses

19. Patient Self-Determination Act (PSDA) • 1990 • Mandates that all health care facilities receiving any type of federal aid comply with the following requirements: • Inform every adult, both orally and in writing, of their right under state law to make decisions concerning medical care, including the right to refuse treatment and right-to-die options • Provide information and assistance in preparing advance directives

20. PSDA • Document any advance directives on the patient’s record • Have written statements to implement the patient’s rights in the decision-making process • Affirm that there will be no discrimination or effect on care because of advance directives • Educate the staff on the medical and legal issues of advance directives

21. PSDA • PSDA ensures that patients are informed of their right and have the opportunity to determine the care they will receive • All health care workers must be aware of and honor advance or legal directives

22. Professional Standards • By following certain standards at all times, you can protect yourself, your employer, and the patient • Here are some basic standards:

23. 1. Perform only those procedures for which you have been trained and are legally permitted to do • Never perform a procedure unless you are qualified • If you are not legally permitted to either perform a procedure or to sign documents, it is your responsibility to refuse to do so because of legal limitations

24. 2. Use approved, correct methods while performing any procedure • Follow specific methods taught to you by a qualified person or observe and learn • Most health care agencies have an approved procedure manual that explains the step-by-step methods for performing tasks

25. 3. Obtain proper authorization before performing any procedure • Can be directly from Dr., therapist, or individual in charge of patient’s care • Can be in written orders • Immediate supervisor will interpret orders and then direct you to perform procedures if you are unable to access patient’s records

26. 4. Identify the patient and obtain patient’s consent before performing any procedure • Check the patient’s name band • If a patient refuses to allow you to perform a procedure, check with you immediate supervisor b/c some require written consent

27. 5. Observe all safety precautions • Handle equipment carefully • Be alert to all aspects of safety • Know and follow safety rules and regulations • Make an effort to eliminate any hazards as quickly as possible

28. 6. Keep all information confidential • This includes oral and written information • Do NOT place patient records in any area where they can be seen by unauthorized individuals • If you are reporting specific information about a patient to a supervisor, make sure no one can hear you conversation • Avoid discussing patients with others at home, in social situations, in public places, or anywhere outside the agency

29. 7. Think before you speak and carefully consider anything you say • 8. Treat all patients equally regardless or race, religion, social or economic status, sex, or nationality • Provide care for all individuals to the best of your ability

30. 9. Accept no tips or bribes for the care you provide • You receive a salary for your services • The care you provide should not be influenced by the amount of money a patient can afford to pay • A polite refusal is usually the best way to handle the situation

31. 10. If any error occurs or you make a mistake, report it immediately to your supervisor • NEVER try to hide or ignore an error • Make every effort to correct the situation as soon as possible • TAKE RESPONSIBILITY FOR YOU ACTIONS

32. 11. Behave professionally in dress, language, manners, and actions • Take pride in your occupation and in the work you do • Promote a positive attitude at all times

33. Closing Thoughts • Remember that it is your responsibility to understand the legal and ethical implications of you particular health career! • Never hesitate to ask specific questions or to request written policies from your employer • Contact your state board of health or state board of education to obtain info regarding regulations and guidelines for your occupation • By obtaining this information and by following the basic standards listed, you will protect yourself