LEGAL AND ETHICALLEGAL AND ETHICAL

ETHICSETHICS

EthicsEthics

Set of principles relating to what is morally Set of principles relating to what is morally right or wrongright or wrong

Provide a standard of conduct or code of Provide a standard of conduct or code of behaviorbehavior

Allows a health care provider to analyze Allows a health care provider to analyze information and make decisions based on information and make decisions based on what people believe is right and good conductwhat people believe is right and good conduct

Modern health care advances have created Modern health care advances have created many ethical dilemmas for health care many ethical dilemmas for health care providersproviders

Some Dilemmas are….Some Dilemmas are….

Group activityGroup activity

Ethical CodesEthical Codes

Most of the national organizations Most of the national organizations representing the different health care representing the different health care occupations have established ethical occupations have established ethical codescodes

The codes differ slightly, but contain The codes differ slightly, but contain the same basic principles:the same basic principles: Put the saving of life and the promotion of Put the saving of life and the promotion of

health above all elsehealth above all else Make every effort to keep the patient as Make every effort to keep the patient as

comfortable as possible and to preserve life comfortable as possible and to preserve life whenever possiblewhenever possible

Ethical Code PrinciplesEthical Code Principles Respect the patient’s choice to die Respect the patient’s choice to die

peacefully and with dignity when all options peacefully and with dignity when all options have been discussed with the patient and have been discussed with the patient and family and/or predetermined by advance family and/or predetermined by advance directivesdirectives

Treat all patients equally, regardless of race, Treat all patients equally, regardless of race, religion, social or economic status, sex, or religion, social or economic status, sex, or nationality. Bias, prejudice, and nationality. Bias, prejudice, and discrimination have no place in health carediscrimination have no place in health care

Provide care for all individuals to the best of Provide care for all individuals to the best of your abilityyour ability

Maintain a competent level of skill Maintain a competent level of skill consistent with your particular occupationconsistent with your particular occupation

Principles continued…Principles continued…

Stay informed and up to date and pursue Stay informed and up to date and pursue continuing education as necessarycontinuing education as necessary

Maintain Maintain confidentialityconfidentiality. . Confidentiality means that information about the Confidentiality means that information about the

patient must remain private and can be shared patient must remain private and can be shared only with other members of the patient’s health only with other members of the patient’s health care team.care team.

A legal violation can occur if a patient suffers A legal violation can occur if a patient suffers personal or financial damage when confidential personal or financial damage when confidential info is shared with others, including family info is shared with others, including family members. members.

Info obtained from patients should not be Info obtained from patients should not be repeated or used for personal gain. repeated or used for personal gain.

Gossiping about patients is ethically wrong.Gossiping about patients is ethically wrong.

And moreAnd more Refrain from immoral, unethical, and Refrain from immoral, unethical, and

illegal practices. If you observe others illegal practices. If you observe others taking part in illegal actions, report such taking part in illegal actions, report such actions to the proper authoritiesactions to the proper authorities

Show loyalty to patients, co-workers, and Show loyalty to patients, co-workers, and employers. Avoid negative or derogatory employers. Avoid negative or derogatory statements and always express a positive statements and always express a positive attitudeattitude

Be sincere, honest, and caring. Treat Be sincere, honest, and caring. Treat others as you would want to be treated. others as you would want to be treated. Show respect and concern for the feelings, Show respect and concern for the feelings, dignity, and rights of othersdignity, and rights of others

Patients’ RightsPatients’ Rights

Federal and state legislation requires Federal and state legislation requires health care agencies to have written health care agencies to have written policies concerning patients’ rights, or policies concerning patients’ rights, or the factors of care that patients can the factors of care that patients can expect to receiveexpect to receive

Agencies expect all personnel to respect Agencies expect all personnel to respect and honor these rightsand honor these rights

The American Hospital Association has The American Hospital Association has adopted a “adopted a “Patient’s Bill of Rights” Patient’s Bill of Rights” that is recognized and honored by many that is recognized and honored by many health facilities.health facilities.

Patient’s Bill of RightsPatient’s Bill of Rights States, in part, that a patient has the right to:States, in part, that a patient has the right to: 1. considerate and respectful care1. considerate and respectful care 2. obtain complete, current info concerning 2. obtain complete, current info concerning

diagnosis, treatment, and prognosis diagnosis, treatment, and prognosis (expected outcome)(expected outcome)

3. receive info necessary to give informed 3. receive info necessary to give informed consent prior to the start of any procedure or consent prior to the start of any procedure or treatmenttreatment

4. have advance directives for health care 4. have advance directives for health care and/or refuse treatment to the extent and/or refuse treatment to the extent permitted under lawpermitted under law

5. privacy concerning a medical care program5. privacy concerning a medical care program

Bill of Rights continuedBill of Rights continued

6. confidential treatment of all 6. confidential treatment of all communications and recordscommunications and records

7. reasonable response to a request for 7. reasonable response to a request for serviceservice

8. obtain info regarding any relationship of 8. obtain info regarding any relationship of the hospital to other health care and the hospital to other health care and educational institutionseducational institutions

9. be advised of and have the right to refuse 9. be advised of and have the right to refuse to participate in any research projectto participate in any research project

10. expect reasonable continuity of care10. expect reasonable continuity of care

Bill of RightsBill of Rights

11. review medical records and 11. review medical records and examine bills and receive an examine bills and receive an explanation of all care and chargesexplanation of all care and charges

12. be informed of any hospital rules, 12. be informed of any hospital rules, regulations, and/or policies and the regulations, and/or policies and the resources available to resolve resources available to resolve disputes or grievancesdisputes or grievances

OBRAOBRA

Residents in a long-term care facilities are Residents in a long-term care facilities are guaranteed certain rights under the guaranteed certain rights under the Omnibus Budget Reconciliation Act of Omnibus Budget Reconciliation Act of 19871987

Every long-term care facility must inform Every long-term care facility must inform residents or their guardians of these residents or their guardians of these rights, and a copy must be posted in each rights, and a copy must be posted in each facility.facility.

Often called a Often called a “Resident’s Bill of “Resident’s Bill of Rights”Rights”

Resident’s Bill of RightsResident’s Bill of Rights

1.1. Free choice regarding physician, treatment, Free choice regarding physician, treatment, care, and participation in researchcare, and participation in research

2.2. Freedom from abuse and chemical or Freedom from abuse and chemical or physical restraintsphysical restraints

3.3. Privacy and confidentiality of personal and Privacy and confidentiality of personal and chemical recordschemical records

4.4. Accommodation of needs and choice Accommodation of needs and choice regarding activities, schedules, and health regarding activities, schedules, and health carecare

5.5. Voice grievances without fear of retaliation Voice grievances without fear of retaliation or discriminationor discrimination

Resident’s Bill of Rights continuedResident’s Bill of Rights continued

1.1. Organize and participate in family/resident groups Organize and participate in family/resident groups and in social, religious, and community activitiesand in social, religious, and community activities

2.2. Information on medical benefits, medical records, Information on medical benefits, medical records, survey results, deficiencies of the facility, and survey results, deficiencies of the facility, and advocacy groups including he ombudsman program advocacy groups including he ombudsman program (state representative who checks on resident care (state representative who checks on resident care and violation of rights)and violation of rights)

3.3. Manage personal funds and use personal possessionsManage personal funds and use personal possessions4.4. Unlimited access to immediate family or relatives Unlimited access to immediate family or relatives

and to share a room with his or her spouse, if both and to share a room with his or her spouse, if both are residentsare residents

5.5. Remain in the facility and not be transferred or Remain in the facility and not be transferred or discharged except for medical reasons, the welfare discharged except for medical reasons, the welfare of the resident or others, failure to pay, or if the of the resident or others, failure to pay, or if the facility either cannot meet the resident’s needs or facility either cannot meet the resident’s needs or ceases to operateceases to operate

OBRAOBRA

All states have adopted these rights, All states have adopted these rights, and some have added additional and some have added additional rightsrights

Health care workers can face job Health care workers can face job loss, fines, and even imprisonment if loss, fines, and even imprisonment if they do not follow and grand they do not follow and grand established patients’ or residents’ established patients’ or residents’ rightsrights

Advance Directives for Health CareAdvance Directives for Health Care

Also known as legal directivesAlso known as legal directives Legal documents that allow individuals Legal documents that allow individuals

to state what medical treatment they to state what medical treatment they want or do not want in the event that want or do not want in the event that they become incapacitated and are they become incapacitated and are unable to express their wishes unable to express their wishes regarding medical careregarding medical care

Two main directives are a living will Two main directives are a living will and a Durable Power of Attorney (POA) and a Durable Power of Attorney (POA) for Health Carefor Health Care

Living WillsLiving Wills

Documents that allow individuals to state Documents that allow individuals to state what measure should or should not be taken what measure should or should not be taken to prolong life when their conditions are to prolong life when their conditions are terminalterminal

Document must be signed when the Document must be signed when the individual is competent and witnessed by two individual is competent and witnessed by two adults who cannot benefit from the deathadults who cannot benefit from the death

Frequently results in a DNRFrequently results in a DNR Allows the patient to die in peace and keep Allows the patient to die in peace and keep

the belief that quality of life is more important the belief that quality of life is more important than quantitythan quantity

Durable Power of Attorney (POA)Durable Power of Attorney (POA)

Document that permits an individual Document that permits an individual (known as a principal) to appoint another (known as a principal) to appoint another person (agent) to make any decisions person (agent) to make any decisions regarding health care if the principal regarding health care if the principal should become unable to make decisionsshould become unable to make decisions

Includes providing or withholding specific Includes providing or withholding specific medical or surgical procedures, hiring or medical or surgical procedures, hiring or dismissing health care providers, spending dismissing health care providers, spending or withholding funds for health care, and or withholding funds for health care, and having access to medical recordshaving access to medical records

POA must be signed by the principal, POA must be signed by the principal, agent, and one or two adult witnessesagent, and one or two adult witnesses

Patient Self-Determination Act Patient Self-Determination Act (PSDA)(PSDA)

19901990 Mandates that all health care facilities Mandates that all health care facilities

receiving any type of federal aid receiving any type of federal aid comply with the following comply with the following requirements:requirements: Inform every adult, both orally and in Inform every adult, both orally and in

writing, of their right under state law to writing, of their right under state law to make decisions concerning medical care, make decisions concerning medical care, including the right to refuse treatment including the right to refuse treatment and right-to-die optionsand right-to-die options

Provide information and assistance in Provide information and assistance in preparing advance directivespreparing advance directives

PSDAPSDA

Document any advance directives on the Document any advance directives on the patient’s recordpatient’s record

Have written statements to implement the Have written statements to implement the patient’s rights in the decision-making patient’s rights in the decision-making processprocess

Affirm that there will be no discrimination Affirm that there will be no discrimination or effect on care because of advance or effect on care because of advance directivesdirectives

Educate the staff on the medical and legal Educate the staff on the medical and legal issues of advance directivesissues of advance directives

PSDAPSDA

PSDA ensures that patients are PSDA ensures that patients are informed of their right and have the informed of their right and have the opportunity to determine the care opportunity to determine the care they will receivethey will receive

All health care workers must be All health care workers must be aware of and honor advance or legal aware of and honor advance or legal directivesdirectives

Professional StandardsProfessional Standards

By following certain standards at all By following certain standards at all times, you can protect yourself, your times, you can protect yourself, your employer, and the patientemployer, and the patient

Here are some basic standards:Here are some basic standards:

1. Perform only those procedures for 1. Perform only those procedures for which you have been trained and are which you have been trained and are legally permitted to dolegally permitted to do Never perform a procedure unless you Never perform a procedure unless you

are qualifiedare qualified If you are not legally permitted to either If you are not legally permitted to either

perform a procedure or to sign perform a procedure or to sign documents, it is your responsibility to documents, it is your responsibility to refuse to do so because of legal refuse to do so because of legal limitationslimitations

2. Use approved, correct methods 2. Use approved, correct methods while performing any procedurewhile performing any procedure Follow specific methods taught to you Follow specific methods taught to you

by a qualified person or observe and by a qualified person or observe and learnlearn

Most health care agencies have an Most health care agencies have an approved procedure manual that approved procedure manual that explains the step-by-step methods for explains the step-by-step methods for performing tasksperforming tasks

3. Obtain proper authorization before 3. Obtain proper authorization before performing any procedureperforming any procedure Can be directly from Dr., therapist, or Can be directly from Dr., therapist, or

individual in charge of patient’s careindividual in charge of patient’s care Can be in written ordersCan be in written orders Immediate supervisor will interpret Immediate supervisor will interpret

orders and then direct you to perform orders and then direct you to perform procedures if you are unable to access procedures if you are unable to access patient’s recordspatient’s records

4. Identify the patient and obtain 4. Identify the patient and obtain patient’s consent before performing patient’s consent before performing any procedureany procedure Check the patient’s name bandCheck the patient’s name band If a patient refuses to allow you to If a patient refuses to allow you to

perform a procedure, check with you perform a procedure, check with you immediate supervisor b/c some require immediate supervisor b/c some require written consentwritten consent

5. Observe all safety precautions5. Observe all safety precautions Handle equipment carefullyHandle equipment carefully Be alert to all aspects of safetyBe alert to all aspects of safety Know and follow safety rules and Know and follow safety rules and

regulationsregulations Make an effort to eliminate any hazards Make an effort to eliminate any hazards

as quickly as possibleas quickly as possible

6. Keep all information confidential6. Keep all information confidential This includes oral and written informationThis includes oral and written information Do NOT place patient records in any area Do NOT place patient records in any area

where they can be seen by unauthorized where they can be seen by unauthorized individualsindividuals

If you are reporting specific information If you are reporting specific information about a patient to a supervisor, make sure about a patient to a supervisor, make sure no one can hear you conversationno one can hear you conversation

Avoid discussing patients with others at Avoid discussing patients with others at home, in social situations, in public places, home, in social situations, in public places, or anywhere outside the agencyor anywhere outside the agency

7. Think before you speak and 7. Think before you speak and carefully consider anything you saycarefully consider anything you say

8. Treat all patients equally 8. Treat all patients equally regardless or race, religion, social or regardless or race, religion, social or economic status, sex, or nationalityeconomic status, sex, or nationality Provide care for all individuals to the Provide care for all individuals to the

best of your abilitybest of your ability

9. Accept no tips or bribes for the 9. Accept no tips or bribes for the care you providecare you provide You receive a salary for your servicesYou receive a salary for your services The care you provide should not be The care you provide should not be

influenced by the amount of money a influenced by the amount of money a patient can afford to paypatient can afford to pay

A polite refusal is usually the best way A polite refusal is usually the best way to handle the situationto handle the situation

10. If any error occurs or you make a 10. If any error occurs or you make a mistake, report it immediately to mistake, report it immediately to your supervisoryour supervisor NEVER try to hide or ignore an errorNEVER try to hide or ignore an error Make every effort to correct the Make every effort to correct the

situation as soon as possiblesituation as soon as possible TAKE RESPONSIBILITY FOR YOU ACTIONSTAKE RESPONSIBILITY FOR YOU ACTIONS

11. Behave professionally in dress, 11. Behave professionally in dress, language, manners, and actionslanguage, manners, and actions Take pride in your occupation and in the Take pride in your occupation and in the

work you dowork you do Promote a positive attitude at all timesPromote a positive attitude at all times

Closing ThoughtsClosing Thoughts

Remember that it is your responsibility to Remember that it is your responsibility to understand the legal and ethical implications understand the legal and ethical implications of you particular health career!of you particular health career!

Never hesitate to ask specific questions or to Never hesitate to ask specific questions or to request written policies from your employerrequest written policies from your employer

Contact your state board of health or state Contact your state board of health or state board of education to obtain info regarding board of education to obtain info regarding regulations and guidelines for your occupationregulations and guidelines for your occupation

By obtaining this information and by following By obtaining this information and by following the basic standards listed, you will protect the basic standards listed, you will protect yourselfyourself