Legal and Ethical Responsibilities

Legal and Ethical Responsibilities

Copy the following terms into your notes: • Restrain—to limit or restrict movement • Confidential—not to be shared or told; to be held in confidence or kept to oneself • Communicable Disease—disease that is transmitted from one individual to another • Morals—personal standards of right or wrong

Copy the following terms into your notes: • Patient’s Rights—the factors of care that patients can expect to receive • Prognosis—expected outcome • Long-Term Care—care given to the elderly, individuals with disabilities or handicaps, and with chronic or long-term illnesses

Copy the following terms into your notes: • Continuity of Care—concept that a person is to receive the same level of care throughout their hospitalization • Euthanasia—assisted death

Being aware of and following legal regulation is important for: • Your own protection • The protection of your employer • The safety and well-being of the patient

I. Legal Responsibilities: • Those responsibilities that are authorized based on law • Health care professionals/workers are required to know and follow state laws that regulate their respective licenses or registrations or set standards for their respective professions

Legal Responsibilities: • Civil Law—focuses on legal relationships between people and the protection of a person’s rights • Criminal Law—focuses on wrongs against a person, property, and society • Examples: • Practicing in a health profession without having the required license • Misuse of narcotics • Theft • murder

Legal Responsibilities: • Torts—wrongful acts that do not involve contracts • A civil wrong, other than a breach of contract • This occurs when a person is harmed or injured because a healthcare provider does not meet the established or expected standards of care

Common Torts: • Malpractice—commonly called “professional negligence” • defined as the failure of a professional to use the degree of skill and learning commonly expected in that individual’s profession • Examples: • A physician not administering a tetanus injection when a patient has a nail puncture wound • A nurse performing minor surgery without having any training

Common Torts: • Negligence—failure to give care that is normally expected of a person in a particular position, resulting in injury of another person • Examples: • Falls and injuries that occur when side rails are left down • Using or not reporting defective equipment • Infections caused by the use of non-sterile instruments and/or supplies

C. Assault and Battery: • Assault—includes the threat or attempt to injure • Battery—includes the unlawful touching of another person without consent • Examples: • performing a procedure after a patient has refused to give permission • Improper handling or rough treatment of a patient while providing care

Remember! • It is important to remember that patients must give consent for any care and that they have the right to refuse care • Some procedures or practices require written consent from the patient • Examples: • Surgery • Diagnostic tests • Experimental procedures

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 • Remember that a person has the right to withdraw consent at any time • All procedures must be explained to the patient • No procedure should be performed if the patient does not give consent

D. Invasion of Privacy: • Includes unnecessarily exposing an individual or revealing personal information about an individual without that person’s consent • Examples: • Improperly draping or covering a patient • Informing the news media of a patient’s condition without the patient’s permission

E. False Imprisonment: • Refers to the restraining an individual or restricting an individual’s freedom • Examples: • Keeping patients hospitalized against their will • Applying physical restraints without properly authorization or with no justification

F. Abuse: • Abuse includes any care that results in physical harm, pain, or mental anguish • Examples of Abuse: • Physical Abuse—hitting, forcing people against their will, restraining movement, depriving people of food or water, and/or not providing physical care.

Examples of Abuse: • Verbal Abuse—speaking harshly, swearing or shouting, using inappropriate words to describe a person’s race or nationality, and/or writing threats or abusive statements • Psychological Abuse—threatening harm; denying rights; belittling, intimidating, or ridiculing the person; and/or threatening to reveal information about the person • Sexual Abuse—any unwanted sexual touching or act, using sexual gestures, and/or suggesting sexual behavior

Health care providers must be alert to the signs and symptoms of abuse: • Unexplained bruises, fractures, burns, or injuries • Signs of neglect such as poor hygiene • Irrational fears or a change in personality • Aggressive or withdrawn behavior • Patient statements that indicate abuse or neglect

Health care workers are required by law to report any signs or symptoms of abuse to their immediate supervisor or to the individual in the facility responsible for reporting the suspicions to the proper authorities

Common Torts: • Defamation—occurs when false statements either cause a person to be ridiculed or damaged the person’s reputation • Slander occurs when the info is spoken • Libel occurs when the info is written • Examples: • Reporting that a patient has an infectious disease to a government agency when lab results are inaccurate • Telling others that a person has a drug problem when another medical condition actually exists

II. Privileged Communications: • Comprise all information given to health care personnel by a patient • By law this information must be kept confidential and shared only with other members of the patient’s health care team • It cannot be told to anyone else without the written consent of the patient

II. Privileged Communications: • The consent should state: • what information should be released • to whom the information should be given • any applicable time limits

II. Privileged Communications: • Some information is exempt by law and must be reported, such as: • births and deaths • injuries caused by violence • drug abuse • communicable diseases • sexually transmitted diseases

Health Care Records • Considered privileged communications • They contain information about the care provided to the patient • The record belongs to the healthcare facility, but the patient has a right to obtain a copy of any information

Health Care Records: • These records can be used as legal records in a court of law • Erasures are not allowed • Errors should be crossed out with a single line so material is still readable • Correct information should be inserted, initialed, and dated • If necessary an explanation for the correction should also be provided

Health Care Records: • Health care records should be properly maintained, kept confidential, and retained for the amount of time required by state law • When records are destroyed, they should be burned or shredded to maintain confidentiality

Ethics: • Defined as the study of the principles of right or wrong or a set of principles relating to what is morally right or wrong • Ethics provide a standard of conduct or a code of behavior • It allows a health care provider to analyze information and make decisions based on what people believe is right and good conduct

Rules for Healthcare Ethicist: • Free Agency: A patient has a right to make a decision about his or her own body without outside control • Difficult Questions Raised • Does a patient who desires to commit suicide have a moral obligation to minor children? • Does a mother seeking an abortion have an obligation to the father of the child?

Rules for Healthcare Ethicist: • Equality: The healthcare system has a duty to treat all patients fairly • Difficult Questions Raised: • In the real world resources are scarce. How do you treat 100 patients needing a heart transplant fairly, when there aren’t enough hearts to go around? How does one fairly allocate scarce resources?

Rules for Healthcare Ethicist: • Obligation To Do Good To Others: Healthcare workers are obligated to take action that will result in the best outcome for the patient. • Difficult Questions Raised: • If death is viewed as the ultimate evil, then saving a life, at any cost must be viewed as an ultimate good. Is that really true? • Who determines what is “good”? Are we justified in saving a life that will only prolong misery? • Are we obligated to save a life at any cost? • What if the patient doesn’t want to live? How does the obligation to do good interface with the patient’s free agency?

Rules for Healthcare Ethicist: • Obligation To Do No Harm: The first obligation of a healthcare practitioner is to avoid harming anyone. • Difficult Question Raised: • What about experimental procedures? Is it okay to risk an informed patient’s life to develop a surgical technique that may save patients in the future.

Rules for Healthcare Ethicist: • Loyalty: A healthcare worker should be loyal. • Difficult Questions Raised: • Loyal to who—the patient, the profession, the co-worker, the hospital? • What happens when the principle of loyalty comes into conflict with the principle of honesty? Is it better to be loyal to people, or to the principles?

Rules for Healthcare Ethicist: • Honesty: A health care worker should be honest. • Difficult Questions Raised: • Is it always good to tell the truth? What if you had the address of Anne Frank and the Nazi’s asked you if you knew where any Jews were hiding? • What if the truth destroys self-esteem? • Do we always know the truth? One philosopher said: “If it comes to being truthful or being kind, I choose to be kind. I know what kindness is.”

Ethical Codes: • 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. • Respect the patient’s choice to die peacefully and with dignity when all options have been discussed with the family and/or predetermined by advanced directives.

Ethical Codes: • 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.

Ethical Codes: • Stay informed and up to date and pursue continuing education as necessary. • Maintain confidentiality. A legal violation can occur if a patient suffers personal or financial damage when confidential information is shared with others, including family members. Information obtained from patients should not be repeated or used for personal gain. Gossiping about patients is ethically wrong.

Ethical Codes: • 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, coworkers, and employers. Avoid negative or derogatory statements and always express a positive attitudes. • Be sincere, honest, and caring. Treat others as you want to be treated. Show respect and concern for feelings, dignity, and the rights of others.

IV. Patients’ Rights: • Federal and state legislation requires health care agencies to have written policies concerning patient’s rights. • All states have adopted these patient and resident rights and some have added additional rights. • Health care workers can face job loss, fines, and even imprisonment if they do not follow and grant established rights.

Patient’s Bill Of Rights: • States that a patient has the right to: • Considerate and respectful care; • Obtain complete, current information concerning diagnosis, treatment, and prognosis; • Receive information necessary to give informed consent prior to the start of any procedure or treatment;

Patient’s Bill Of Rights: • Have advance directives for health care and/or refuse treatment to the extent permitted under the law; • Privacy concerning a medical care program; • Confidential treatment of all communications and records;

Patient’s Bill Of Rights: • Reasonable response to a request for services; • Obtain information regarding any relationship of the hospital to other health care and educational institutions; • Be advised of and have the right to refuse to participate in any research project;

Patient’s Bill Of Rights: • Expect reasonable continuity of care; • Review medical records and examine bills and receive an explanation of all care and charges; • Be informed of any hospital rules, regulations, and/or policies and the resources available to resolve disputes or grievances.

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

Resident’s Bill of Rights: • States that a resident has the right to : • Free choice regarding physician, treatment, care, and participation in research; • Freedom from abuse and chemical or physical restraints; • Privacy and confidentiality of personal and clinical records;

Resident’s Bill of Rights: • Accommodation of needs and choice regarding activities, schedules, and health care; • Voice grievances without fear of retaliation or discrimination; • Organize and participate in family/resident groups and in social, religious, and community activities;

Resident’s Bill of Rights: • Information on medical benefits, medical records, survey results, deficiencies of the facility, and the advocacy groups including the ombudsman program (state representative who checks on resident care and violation of rights); • Manage personal funds and use personal possessions;

Resident’s Bill of Rights: • Unlimited access to immediate family or relatives and to share a room with his/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.

Advance Directive for Health Care: • Defined as 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: • Living Wills—documents that allow individuals to state what measures should or should not be taken to prolong life when their conditions are terminal. • Must be signed when the individual is competent and witnessed by two adults who cannot benefit from the death

Do Not Resuscitate: • A living will frequently results in a do not resuscitate (DNR) order for terminally ill individuals • A DNR states that CPR will not be performed when the patient stops breathing and they are allowed to die with peace and dignity

Legal and Ethical Responsibilities