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Ethics in Health CareEthics in Health Care
04/19/23 Ethics in Health Care 2
IntroductionIntroduction
• Ethics allows a health care worker to analyze information and make decisions based on what is right and good conduct
• Modern health care has created many ethical dilemmas for the health care worker
• This lesson will explore ethics, patients’ rights, advance directives and professional standards for the health care worker
• Ethics allows a health care worker to analyze information and make decisions based on what is right and good conduct
• Modern health care has created many ethical dilemmas for the health care worker
• This lesson will explore ethics, patients’ rights, advance directives and professional standards for the health care worker
04/19/23 Ethics in Health Care 3
ObjectivesObjectives
• Define ethics• List basic rules of ethics for the health care
worker• Discuss and debate varying ethical
dilemmas which have resulted from modern medicine
• List the rights of patients who are receiving health care
• Review long-term care Bill of Rights• Define advance directives
• Define ethics• List basic rules of ethics for the health care
worker• Discuss and debate varying ethical
dilemmas which have resulted from modern medicine
• List the rights of patients who are receiving health care
• Review long-term care Bill of Rights• Define advance directives
04/19/23 Ethics in Health Care 4
Objectives (continued)Objectives (continued)
• List the types of advanced directives and describe the role of the health care worker as it relates to advanced directives
• Discuss the terms of the Patient Self-Determination Act (PSDA)
• Explain how professional standards meet legal and ethical requirements in health care
• Discuss importance of malpractice insurance and compare costs for varying health care professions
• List the types of advanced directives and describe the role of the health care worker as it relates to advanced directives
• Discuss the terms of the Patient Self-Determination Act (PSDA)
• Explain how professional standards meet legal and ethical requirements in health care
• Discuss importance of malpractice insurance and compare costs for varying health care professions
04/19/23 Ethics in Health Care 5
EthicsEthics
• Ethics are a set of principles dealing with what is morally right or wrong
• Each profession has their own code of ethics developed by their national organizations
• Most contain the same basic principles however they may differ slightly
• Ethics are a set of principles dealing with what is morally right or wrong
• Each profession has their own code of ethics developed by their national organizations
• Most contain the same basic principles however they may differ slightly
04/19/23 Ethics in Health Care 6
ActivityActivity
• Have students research the code of ethics for the profession which they have an interest in pursuing
• Allow them to compare the code of ethics for the varying health care professions
• Compare/contrast
• Have students research the code of ethics for the profession which they have an interest in pursuing
• Allow them to compare the code of ethics for the varying health care professions
• Compare/contrast
04/19/23 Ethics in Health Care 7
Ethical DilemmasEthical Dilemmas
• Modern health care technology has created many ethical dilemmas
• Assisted suicide – is it justified in certain patients?
• Stem cell research- should aborted fetuses be used?
• Should a patient be permitted to smoke marijuana if it eases effects of chemotherapy?
• Modern health care technology has created many ethical dilemmas
• Assisted suicide – is it justified in certain patients?
• Stem cell research- should aborted fetuses be used?
• Should a patient be permitted to smoke marijuana if it eases effects of chemotherapy?
04/19/23 Ethics in Health Care 8
AssignmentAssignment
• Present prompt for writing folder entry (prompt and rubric attached)
• Researching an ethical dilemma• Set deadline for rough draft submission• For homework, have student do basic
research either on their writing topic or other topic of interest which would pose an ethical dilemma
• Be ready to present and debate their stand on that particular topic the next class meeting
• Present prompt for writing folder entry (prompt and rubric attached)
• Researching an ethical dilemma• Set deadline for rough draft submission• For homework, have student do basic
research either on their writing topic or other topic of interest which would pose an ethical dilemma
• Be ready to present and debate their stand on that particular topic the next class meeting
04/19/23 Ethics in Health Care 9
Basic Rules of EthicsBasic Rules of Ethics
• Put saving of life and promotion of health above all else
• Make every effort to keep patient as comfortable as possible and to preserve life when possible
• Respect patient’s choice to die peacefully and with dignity (advanced directive)
• Treat all patients equally (avoid bias, prejudice, and discrimination)
• Put saving of life and promotion of health above all else
• Make every effort to keep patient as comfortable as possible and to preserve life when possible
• Respect patient’s choice to die peacefully and with dignity (advanced directive)
• Treat all patients equally (avoid bias, prejudice, and discrimination)
04/19/23 Ethics in Health Care 10
Rules of Ethics (cont)Rules of Ethics (cont)
• Provide care for all persons to the best of your ability
• Maintain competent level of skill consistent with occupation
• Maintain confidentiality– Gossiping about patients is ethically wrong
• Avoid immoral, unethical, or illegal practice
• Provide care for all persons to the best of your ability
• Maintain competent level of skill consistent with occupation
• Maintain confidentiality– Gossiping about patients is ethically wrong
• Avoid immoral, unethical, or illegal practice
04/19/23 Ethics in Health Care 11
Rules of Ethics (cont)Rules of Ethics (cont)
• Show loyalty to patients, co-workers, and employer
• Be sincere, honest and caring
• Show loyalty to patients, co-workers, and employer
• Be sincere, honest and caring
04/19/23 Ethics in Health Care 12
Patients’ Bill of RightsPatients’ Bill of Rights
• Most of us have seen the sign in retail stores “The Customer is Always Right”
• Patient and customer satisfaction is essential to health care facilities just as pleasing the customer is for retail stores
• Most of us have seen the sign in retail stores “The Customer is Always Right”
• Patient and customer satisfaction is essential to health care facilities just as pleasing the customer is for retail stores
04/19/23 Ethics in Health Care 13
Patients’ RightsPatients’ Rights
• Patients’ rights are factors of care that patients can expect to receive
• Health care facilities have written policies concerning patients' rights
• All health care workers must honor these
• Patients’ rights are factors of care that patients can expect to receive
• Health care facilities have written policies concerning patients' rights
• All health care workers must honor these
04/19/23 Ethics in Health Care 14
ActivityActivity
• Obtain copy of specific clinical facility’s Patient Bill of Rights
• Discuss and compare to AHA affirmed Bill of Rights
• Obtain copy of specific clinical facility’s Patient Bill of Rights
• Discuss and compare to AHA affirmed Bill of Rights
04/19/23 Ethics in Health Care 15
“Patients’ Bill of Rights”“Patients’ Bill of Rights”
• According to the American Hospital Association, the patient has right to:
• Considerate and respectful care• Obtain complete current information
concerning diagnosis, treatment, and prognosis
• Receive information necessary to give informed consent
• Have advance directive and/or refuse treament to extent permitted under law
• According to the American Hospital Association, the patient has right to:
• Considerate and respectful care• Obtain complete current information
concerning diagnosis, treatment, and prognosis
• Receive information necessary to give informed consent
• Have advance directive and/or refuse treament to extent permitted under law
04/19/23 Ethics in Health Care 16
Rights (continued)Rights (continued)
• Privacy concerning medical care• Confidential treatment of all
communications and records• Reasonable response to request for
services• Obtain information regarding any
relationship of the hospital to other health care and educational institutions
• Privacy concerning medical care• Confidential treatment of all
communications and records• Reasonable response to request for
services• Obtain information regarding any
relationship of the hospital to other health care and educational institutions
04/19/23 Ethics in Health Care 17
Rights (cont)Rights (cont)
• Be advised of and have the right to refuse to participate in any research project
• Expect reasonable continuity of care• Review medical records and examine
bill with all charges explained• Be informed of any hospital rules or
regulations
• Be advised of and have the right to refuse to participate in any research project
• Expect reasonable continuity of care• Review medical records and examine
bill with all charges explained• Be informed of any hospital rules or
regulations
04/19/23 Ethics in Health Care 18
Long-Term Care Bill of RightsLong-Term Care Bill of Rights
• Residents of long-term care facilities are guaranteed rights under the Omnibus Budget Reconciliation Act (OBRA), established in 1987
• Residents of long-term care facilities are guaranteed rights under the Omnibus Budget Reconciliation Act (OBRA), established in 1987
04/19/23 Ethics in Health Care 19
“Residents’ Bill of Rights”“Residents’ 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 clinical records
• Accommodation of needs and choice regarding activities, schedules, and health care
• 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
• Accommodation of needs and choice regarding activities, schedules, and health care
04/19/23 Ethics in Health Care 20
Residents’ Bill of Rights (cont)
Residents’ Bill of Rights (cont)
• Voice grievances without fear of retaliation or discrimination
• Organize and participate in family/resident groups and in social, religious & community activities
• Information on medical benefits, medical records, survey results and deficiencies of the facility, and advocacy groups who check on resident care and violation of rights
• Voice grievances without fear of retaliation or discrimination
• Organize and participate in family/resident groups and in social, religious & community activities
• Information on medical benefits, medical records, survey results and deficiencies of the facility, and advocacy groups who check on resident care and violation of rights
04/19/23 Ethics in Health Care 21
Residents’ Bill of Rights (cont)
Residents’ Bill of Rights (cont)
• Manage personal funds and use personal possessions
• Unlimited access to immediate family or relatives and to share a room with spouse if both are residents
• Remain in the facility and not be transferred or discharged except for medical reasons, the welfare of resident or others, failure to pay, or if facility unable to meet resident’s needs, or ceases to operate
• Manage personal funds and use personal possessions
• Unlimited access to immediate family or relatives and to share a room with spouse if both are residents
• Remain in the facility and not be transferred or discharged except for medical reasons, the welfare of resident or others, failure to pay, or if facility unable to meet resident’s needs, or ceases to operate
04/19/23 Ethics in Health Care 22
Advance DirectivesAdvance Directives
• A patient’s instructions, usually relating to end-of-life issues regarding what medical treatment they want or do not want if they are unable to express their wishes
• Advance directives are legally binding documents
• http://www.youtube.com/watch?v=wlL4H8ecuAM
• A patient’s instructions, usually relating to end-of-life issues regarding what medical treatment they want or do not want if they are unable to express their wishes
• Advance directives are legally binding documents
• http://www.youtube.com/watch?v=wlL4H8ecuAM
• http://www.youtube.com/watch?v=VWL6t7-6VHA
• Alice’s Story and the need for Advance Directives
• http://www.youtube.com/watch?v=VWL6t7-6VHA
• Alice’s Story and the need for Advance Directives
04/19/23 Ethics in Health Care 23
04/19/23 Ethics in Health Care 24
Two Main TypesTwo Main Types
• Durable Power of Attorney (POA) for health care
• Living wills (obtain copy of one if possible or use samples in book, page 82)
• Durable Power of Attorney (POA) for health care
• Living wills (obtain copy of one if possible or use samples in book, page 82)
04/19/23 Ethics in Health Care 25
Advance DirectivesAdvance Directives
• Must be signed when the individual is competent and witnessed by two adults who will not benefit from the death
• Must be signed when the individual is competent and witnessed by two adults who will not benefit from the death
04/19/23 Ethics in Health Care 26
Living WillLiving Will
• Document allowing individuals to state what measures should or should not be used to prolong life if their condition is terminal
• Ex: CPR, ventilator, feeding tube, etc.• Frequently results in a “do not
resuscitate” (DNR) order
• Document allowing individuals to state what measures should or should not be used to prolong life if their condition is terminal
• Ex: CPR, ventilator, feeding tube, etc.• Frequently results in a “do not
resuscitate” (DNR) order
04/19/23 Ethics in Health Care 27
Durable Power of Attorney(POA)
Durable Power of Attorney(POA)
• Document permitting an individual (principal) to appoint another person (agent) to make any decisions regarding health care if the principal is unable to make those decisions
• Usually give POA’s to spouses or adult children
• May be given to any qualified adult however
• Must be signed by principal, agent, and two adult witnesses
• Document permitting an individual (principal) to appoint another person (agent) to make any decisions regarding health care if the principal is unable to make those decisions
• Usually give POA’s to spouses or adult children
• May be given to any qualified adult however
• Must be signed by principal, agent, and two adult witnesses
04/19/23 Ethics in Health Care 28
Patient Self-Determination Act (PDSA)
Patient Self-Determination Act (PDSA)
• Federal law that went into effect in 1990• Require all health care facilities 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 right to refuse treatment and right-to-die options
• Federal law that went into effect in 1990• Require all health care facilities 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 right to refuse treatment and right-to-die options
04/19/23 Ethics in Health Care 29
PDSA (continued)PDSA (continued)
• Provide information and assistance in preparing advance directives
• Document any advance directives on patient’s record
• Have written statements to implement the patient’s rights in the decision making process
• Affirm there will be no discrimination or affect on care due to advance directive
• Educate the staff on the medical and legal issues
• Provide information and assistance in preparing advance directives
• Document any advance directives on patient’s record
• Have written statements to implement the patient’s rights in the decision making process
• Affirm there will be no discrimination or affect on care due to advance directive
• Educate the staff on the medical and legal issues
04/19/23 Ethics in Health Care 30
Advance DirectivesAdvance Directives
• Health care workers must be aware of and honor advance directives regardless of their beliefs
• Patients will be asked if they have one upon admission to a health care facility
• Health care workers must be aware of and honor advance directives regardless of their beliefs
• Patients will be asked if they have one upon admission to a health care facility
04/19/23 Ethics in Health Care 31
ActivityActivity
• View advance directive video by Medcom Trainex
• Have students respond to the following scenario:
• A patient has asked you about advance directives. What information can you offer? Explain what one is, in your own words as if you were speaking to a patient
• View advance directive video by Medcom Trainex
• Have students respond to the following scenario:
• A patient has asked you about advance directives. What information can you offer? Explain what one is, in your own words as if you were speaking to a patient
04/19/23 Ethics in Health Care 32
AssignmentAssignment
• One of the purpose of educating the public about advance directives is to encourage them to write it well in advance of the onset of terminal illness. Have students write their own advance directive instructing their loved ones as to their wishes as they near the end of life.
• What would you include?• Would you want to live only on artificial
respiration and artificial feeding?• This is a highly personal exercise and may
be difficult for some. Be sensitive to their feelings and concerns.
• One of the purpose of educating the public about advance directives is to encourage them to write it well in advance of the onset of terminal illness. Have students write their own advance directive instructing their loved ones as to their wishes as they near the end of life.
• What would you include?• Would you want to live only on artificial
respiration and artificial feeding?• This is a highly personal exercise and may
be difficult for some. Be sensitive to their feelings and concerns.
04/19/23 Ethics in Health Care 33
Professional StandardsProfessional Standards
• Professional standards help meet legal responsibilities, ethics and patients’ rights
• By following certain standards at all times, the health care worker can protect themselves, their employer and the patient
• Some of the basic standards are as follows:
• Professional standards help meet legal responsibilities, ethics and patients’ rights
• By following certain standards at all times, the health care worker can protect themselves, their employer and the patient
• Some of the basic standards are as follows:
04/19/23 Ethics in Health Care 34
Professional StandardsProfessional Standards
• Perform only those procedures for which you have been trained and are legally permitted to do (scope of practice)– If asked to perform procedure for which you
are not qualified, refuse• Use approved, correct methods while
performing any procedure– Procedure manual
• Obtain correct authorization before performing any procedure
• Perform only those procedures for which you have been trained and are legally permitted to do (scope of practice)– If asked to perform procedure for which you
are not qualified, refuse• Use approved, correct methods while
performing any procedure– Procedure manual
• Obtain correct authorization before performing any procedure
04/19/23 Ethics in Health Care 35
Professional Standards (cont)Professional Standards (cont)
• Identify patient and obtain consent before performing any procedure– Check wrist band if available– State patient’s name clearly and repeat if
necessary– Ask patient their name and birth date– If patient refuses do not perform
procedure– Obtain written consent where needed
• Identify patient and obtain consent before performing any procedure– Check wrist band if available– State patient’s name clearly and repeat if
necessary– Ask patient their name and birth date– If patient refuses do not perform
procedure– Obtain written consent where needed
04/19/23 Ethics in Health Care 36
Professional Standards (cont)Professional Standards (cont)
• Observe all safety precautions• Keep all information confidential• Think before you speak and watch
everything you say• Treat all patients equally• Accept no tips or bribes for care • If error occurs or you make a mistake,
report it immediately to your supervisor
• Observe all safety precautions• Keep all information confidential• Think before you speak and watch
everything you say• Treat all patients equally• Accept no tips or bribes for care • If error occurs or you make a mistake,
report it immediately to your supervisor
04/19/23 Ethics in Health Care 37
Professional Standards (cont)Professional Standards (cont)
• Behave professionally in dress, language, manners and actions
• Liability– Errors can occur even with adhering to
standards– liability insurance is a form of protection– Agencies offer policies at reasonable cost
to health occupations workers and students
– Clinical students in this program maintain liability insurance
• Behave professionally in dress, language, manners and actions
• Liability– Errors can occur even with adhering to
standards– liability insurance is a form of protection– Agencies offer policies at reasonable cost
to health occupations workers and students
– Clinical students in this program maintain liability insurance
04/19/23 Ethics in Health Care 38
ActivityActivity
• Have student choose one standard of care and develop consequences which could occur if this standard is violated
• Have students use search engines to research sites to compare malpractice costs in the varying health care professions as well as state to state for physicians
• Have student choose one standard of care and develop consequences which could occur if this standard is violated
• Have students use search engines to research sites to compare malpractice costs in the varying health care professions as well as state to state for physicians
04/19/23 Ethics in Health Care 39
SummarySummary
• Always remember, it is your responsibility to understand the legal and ethical implications of your particular health career
• Never hesitate to ask questions or request written policies from your employer
• By following the basic standards, you will protect yourself, your employer, and the patient for whom you care for
• Always remember, it is your responsibility to understand the legal and ethical implications of your particular health career
• Never hesitate to ask questions or request written policies from your employer
• By following the basic standards, you will protect yourself, your employer, and the patient for whom you care for
