Infant Mortality

Question True or False: A good system of ethics will provide answers to most health care decisions.

Answer False Many health care issues have no easy answers and present serious ethical dilemmas

Ethical and Legal Responsibilities Chapter 3 Ethical and Legal Responsibilities

Ethics Ethics Ethical dilemmas System of principles for determining right and wrong Guides decision making Helps with difficult and complex problems Varies among cultural groups Influenced by religion, history, and collective experiences Ethical dilemmas Situations that have no clear answers or correct courses of action E.g., gun control, capital punishment, freedom of speech

Ethics and Health Care Many health care issues involve ethical decisions Hippocrates was concerned with medical ethics Hippocratic Oath Impact of technological advances Definition of life Expense of care Professional Code of Ethics Standards of professional conduct Ensure high quality of care Many professional organizations have codes Codes provide guidelines for handling difficult issues

Personal Values Foundation for making decisions and guiding behavior Influenced by family, religion, education, and personal experience Establish priorities Values not necessarily right or wrong Belief on which decisions are based Tends to be personal

Ethics and the Law Ethics provide general principles on which laws are based Sometimes laws conflict with individual ethics Laws can have negative, unintended consequences

Guiding Principles of Health Care Ethics Preserve life Do good Respect autonomy Uphold justice Be honest Be discreet Keep promises Do no harm

1. Preserve Life Life is precious No agreement on definition of life Take all possible means to preserve it No agreement on definition of life Artificial means of supporting life Euthanasia to relieve suffering Illegal in almost all states Dilemmas: Organ transplants Stem-cell research Rationing care and resources

2. Do Good Promote welfare of others Work in best interest of patients Basic duty of health care professional Work in best interest of patients Perform one’s job without expectation of receiving anything extra

3. Respect Autonomy Self-determination Patients have right to make own decisions May choose type of treatment May refuse treatment

Consent Permission patient must give for treatment Can be given by the following: Mentally competent adults Emancipated minors Informed consent Procedure explained including possible consequences Implied consent Indicated by patient’s actions Express consent Given in writing

Violations of Consent Battery = crime Assault = crime Touching or treating patients without consent Assault = crime Threatening to touch or treat without permission False imprisonment Holding mentally competent patients against their will

Question If a patient schedules a root canal and shows up at the appointed time for the procedure, this is an example of _____ . Express consent Implied consent Informed consent

Answer B. Implied consent Implied consent Given by patient’s actions In this case, patient makes and keeps appointment for procedure

Advance Directives Written instructions containing patient’s desires regarding health care Designation of health care surrogate Also known as health care power of attorney Gives specific people authority to make health care decisions Living will Contains written instructions regarding health care Patient Self-Determination Act of 1991 Health care facilities must provide adult patients with information about advance directives Without instructions, care of incompetent patients can be difficult

4. Uphold Justice Justice refers to fairness All patients must receive same level of care Dilemma: Equitable distribution of health care resources Ranking and rationing of health care services

Reporting Abuse Protect others from harm Laws require reporting of abuse Federal Child Abuse Prevention and Treatment Act States have laws and reporting systems for elder abuse Report suspected abuse to supervisor Patient confidentiality does not apply Occupational Safety and Health Act Requires employers to be responsible for employees Controlled Substances Act Helps prevent abuse of addictive drugs Provides guidelines for prescribing and handling

5. Be Honest Good health care relies on honesty Patient’s trust important Dilemma: How much to tell patients about their condition Honesty essential among coworkers and with supervisor

Fraud Dishonesty involving cheating or trickery Health care examples: Insurance claims for services not performed Selling ineffective treatments Claiming education or credentials one does not have

Question True or False: Poor communication between the patient and the health care professional is a major cause of malpractice lawsuits.

Answer True Major contributors to malpractice lawsuits: Poor communication Resulting patient anger

6. Be Discreet Preserve confidence and respect privacy Confidentiality Patients’ information cannot be released without their written consent Health Insurance Portability and Accountability Act (HIPAA) National standards to protect patient privacy Follow facility policies Maintaining patient privacy Close doors and curtains Drape patients appropriately Do not discuss patients in public areas Discuss patients only with other authorized personnel Dilemmas: Public safety Patient has contagious disease Patient desire to harm self Genetic testing

Violations of Discretion Defamation of character Disclosing unauthorized information that can harm reputation of another person Libel Disclosing information in writing Slander Disclosing information orally

7. Keep Promises Promises are important part of relationships with others Contracts Formal promises enforceable by law Contain three components: Offer Acceptance Consideration Types of contracts: Express Discussion and agreement on specific terms and conditions Implied Actions of parties create and carry out contract Breach of contract One party fails to carry out part of agreement Damages Money to compensate for injury or loss Agent Someone who represents another person when making contract Respondeat superior Legal doctrine holding employer responsible for actions of employees

Question Which of the following is an example of a breach of contract? A patient refuses to pay for treatment because he is not happy with the results A physician refuses to perform a treatment based on information from lab tests A physical therapist cancels future appointments because the patient will not do the prescribed exercises

Answer A. A patient refuses to pay for treatment because he is not happy with the results Patient who refuses to pay physician for services given is not fulfilling his or her part of agreement Results in breach of contract

8. Do No Harm Essential responsibility of health care professionals Negligence Failure to meet reasonable standard of care Malpractice Professional negligence May result in lawsuit against health care provider and/or facility Good Samaritan laws Protect individuals who give care in emergency situations Best to stay within scope of training

Handling Ethical Dilemmas Priority: Well-being of patient Accept responsibility for making difficult decisions Part of health care work Report illegal behavior Resources: American Medical Association Council on Ethical and Judicial Affairs Ethics committees at health care facilities Clergy and counselors Lawyers and risk management specialists