LEGAL AND ETHICAL RESPONSIBILITIES IN HEALTH CARE

Legal and Ethical Issues Legal and ethical issues are issues and rights and choices that clients have. The mental health treatment system has an uneasy relationship with the legal system. Under certain circumstances people can be forced into mental health treatment. Here are resources concerning legal and ethical issues in mental health.

Legal Responsibilities Civil Law Legal relationships between people and the protection of a persons rights Torts- wrongful acts that do not involve contracts Health care mainly affected by civil law: both contracual and torts Criminal Law Wrongs against a person, property or society Examples of criminal law in health care- practicing without license, use of narcotics, theft, murder

Torts Malpractice- “bad practice” Negligence- failure to give care that is normally expected Assault-threat or attempt to injure Battery-unlawful touching of another person without their consent Invasion of Privacy- includes unneccessary exposure of an individual or revealing personal information

Torts (cont.) False imprisonment-Restraining an individual or restricting their freedom. Abuse-Any care that results in physical pain or mental anguish

Forms of Abuse Physical- hitting, restraining, depriving of food water or physical needs Verbal- can be spoken or written – swearing, shouting, ethnic slurs Psychological-threatening harm, denying rights, intimidating, belittling Sexual touching, gestures, or suggestions that are unwanted

Torts (cont.) Defammation- false statements which cause a person to be ridiculed or ruin their reputation 1) Slander-spoken 2) Libel-written

Informed Consent Permission granted voluntarily by a person who is sound of mind after the procedure and all risks involved have been explained in terms the person can understand. A health care provider must advise the patient about the potential benefits, risks, and possibilities involved in any procedure or treatment. The patients written consent to proceed.

Informed Consent A critical aspect of patient rights as well as for protection of the health care providers involved. Patients have the right to refuse any procedure and medication, even if others consider it in their best interest to receive the care Respecting this right of the patient is a very important aspect of medical ethics. Requiring written informed consent offers Evidence in a court of law that defends the actions of the doctors or nurses involved.

Implied Consent The doctrine that a rational person would want to be helped or taken care of even if they were unconscious and unable to give informed consent. This is another option for an overview slide.

Contracts Expressed Contracts Stated in distinct and clear language either orally or in writing. Ex. Surgical permit Implied Contracts Obligations understood without verbally expressed terms Ex. Giving medication to a patient

Legal Disability A person who does not have the legal capacity to form a contract. Minors Mentally incompetent individuals Someone under the influence of drugs Someone who does not understand the language

EMPLOYER Principle EMPLOYEE Agent

Privileged Communications All information given to health care personnel by a patient Must be kept confidential and shared only by members of patient’s health care team Must receive written release to give information to others (exceptions: births and deaths, injuries caused by violence, drug abuse, communicable diseases and sexually transmitted diseases.

Health Care Records An example of privileged communications Patient may obtain a copy Can be used as legal records Errors crossed out with a single line and initialed, and dated Must be kept for amount of time required by law then burned or shredded

Ethics Set of principals relating to what is morally right or wrong. Provide a standard of conduct or code of behavior. Issues: Euthansia, Stem Cell Research, marijuana legalization, animal in research, denying treatment on religious grounds etc..

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

Patients Rights Patient’s Bill of Rights by AHA Considerate respectful care Obtain complete current info about diagnosis etc… Receive info to give informed consent Have advanced directives- can refuse treatment

Patients’ Rights Privacy Confidentialty Reasonable response to a request for services Receive info about relationships between doctors and medical facilities etc… Be informed of right to refuse being involved in research

Patients’ Rights Reasonable continuity of care Right to review medical records and examine bills Be informed of hospital rules, regulations, and resources to settle greivances

Advanced 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 Durable Power of Attorney- Document which allows another individual to make their medical decisions for them if they become unable to

Advanced Directives Patient Self-Determination Act Inform every adult verbally and in writing of their right to make decisions about their care including right to refuse treatment and right to die Document advance directiveson patient’s record

Advances Directives A legal document that a patient signs defining the type of health treatment and care they would like to receive in various health situations that may arise Different health situations may warrant different directives from the patient A living will is a type of advanced directive. It is a legal document, freely signed by a competent individual, defining the type of medical treatment and care they would like to receive should their health stability decrease to the point that they are not longer capable of making important health decisions on their own behalf Without written documentation that expresses the patient’s wishes, confusion can occur, leading to errors in providing or withholding the care of the patient. This error may lead to ignoring of patient autonomy. Clients have the right to expect individualized, safe, competent, and beneficial care.

Professional Standards Only perform procedures you have been trained and are legally permitted to do. Use only approved, correct procedures Obtain proper authorization before performing any procedure Identify patient and receive their consent before performing procedure

Professional Standards Observe all Safety Precautions Keep all information confidential Think before you speak Treat all patients equally Accept no tips or bribes If any mistakes or errors occur report them immediately to your supervisor Behave professionally in dress, language, manners and actions

Health care workers are legally responsible for the care given to clients The scope of duties a health care worker may perform is defined by their level of training and education Health care workers must understand their limits and scope of practice. It is malpractice to perform skills past the level of the health care workers training and education. It is malpractice to neglect to do something that is considered common practice Errors may result from emotional, psychological, physical, and financial burdens being placed on all involved Prevention of errors is the best solution, but the proper handling of an error when it occurs may prevent legal action

Ethical guidelines to be followed at work Health science students are thought to know more about health care because of their work and training. People frequently ask questions about health problems and may rely on the answersgiven by the health science students. Students must answer such questions with greatest care. They should always suggest the patient ask the doctor. Students should be constantly aware of their limitations in such instances. Be accurate in following directions and in reporting. Report any error or accident to superior at once. Take proper care of equipment and supplies. Not only is medical equipment expensive, it is inconvenient and inefficient if it is not in working order at all times. Do not steal office or hospital supplies or equipment. Treat co-workers with respect and courtesy. Everyone is important to the smooth operation of the health care facility. Every person and every task deserves respect. Complete assigned tasks. Ask questions to be sure you understand an assignment before starting it. Consult supervisor when help is needed or when you’re unsure of what to do. Do not grant a patient’s request that is not mentioned on the chart without checking with the supervisor.

Ethical guidelines to be followed at work Do only those things for which training has been provided and is legally allowable. Accept no money or expensive gifts from patients. Respect the privacy of patients and their families. Know and follow the health care facility’s rules and policies. Do not discuss personal problems or affairs with patients. Avoid inappropriate, flippant, or unbecoming behavior. Treat all patients with kindness, compassion, and respect. Help patients to maintain their dignity and confidence. Respect the religious beliefs of patients.

End of Life Health care providers need to understand the patient’s wishes in order to provide the desired level of care during life threatening and end of life illnesses. This can be controversial in a situation where a health care professional has performed procedures or life extending care, when the patient has made it clear that only minimal or comfort measures of care are desired. What will the audience be able to do after this training is complete? Briefly describe each objective and how the audience will benefit from this presentation.