1. LEGAL AND ETHICAL RESPONSIBILITIES IN HEALTH CARE

2. 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.

3. 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

4. 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

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

6. 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

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

8. 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.

9. 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.

10. 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.

11. 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

12. 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

13. EMPLOYER
Principle
EMPLOYEE
Agent

14. 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.

15. 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

16. 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..

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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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.

24. 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

25. 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

26. 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

27. 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.

28. 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.

29. 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.