1. Legal and Ethical Responsibilities
Chapter 5
Legal and Ethical Responsibilities

2. 5:1 Legal Responsibilities
Legal: Allowed by law: consists of ethics and morally right decisions.
Criminal Law: based on crimes/police: jail. something against government
Civil Law: peoples rights/people: pay a lot of money and can lose license. Protection against the abuse of a victim.

3. Tort Tort: illegal acts not involving contracts.
A tort occurs when a person is harmed or injured because the health care provider does NOT meet the established or expected standards of care.
Malpractice: practice not done correctly
Ex. Accidental puncture to patient
Negligence: fail to give care
Ex. Patient ignored

4. Tort Malpractice: practice not done correctly “Bad Practice”
Failure to use the skill & learning commonly expected in that profession, resulting in injury or harm.
Ex. Doing a surgical procedure incorrectly
Or A nurse ordering an exam only a doctor can order
Negligence: fail to give care normally expected of a person in that job, which results in injury
Ex. If a patient falls if the side rails were left down, not reporting defective equipment

5. TORT
Assault
Ex: threat or attempt to injure (“If you don’t take this medication, I’m going to shove it down your throat.”)
Battery: any inappropriate physical contact
Ex: touching without permission, performing a procedure after pat refusal or rough handling
Patients MUST give consent for any care
And They have the right to refuse care

6. Informed Consent
Permission granted voluntarily by a person who is of sound mind and all the risks have been explained in terms the person can understand.
Some procedures require written consent
Surgery, some diagnostic tests, experimental care, treatment of minors
Verbal consent required in all other cases
Ex. May I take your blood pressure, and patient nods head
Or I’m going to draw some blood, and pat raises arm

7. Was permission granted voluntarily? Who can say who is of sound mind?
Or are people forced into treatment or Dropped off at the hospital
Who can say who is of sound mind?
Mental patients, drugs, head trauma, mother caring her child
Have all the risks been explained?
No risks explained, some left out
Has the procedure & risks been explained in terms the patient can understand?
Medical jargon, Language barrier

8. Tort False Imprisonment-being restrained against your will
Keeping patients hospitalized against their will or applying physical or chemical restraints without justification or an order. An Order comes from a Doctor or a Court of Law
The patient has the right to leave the hospital or health facility at any time without the doctor’s permission (Unless quarantined)
AMA-Against Medical Advice, when a patient leaves the hospital against the doctors advice

9. Torts Abuse: a harm done to an individual
Physical: not providing physical care
Verbal: harm done with words
Psychological: mental harm
Sexual: unwanted touching

10. Torts Defamation - False information to ruin a persons reputation
Lies, Rumors or Gossip spread to discrete an individual, group or facility.
Slander - information that is spoken
Libel - information that is written

11. Legal Responsibilities
Contract; an agreement between two or more parties
A Doctor Patient relationship is established and made legal thru a contract
Components of contract
Offer-being offered the service
Acceptance-accepting the service
Consideration-paying for the service
Implied-understood without paperwork
Expressed-clearly stated or written

12. Legal Responsibilities
Legal Disability - a person who doesn’t have legal capacity to form a contract
Examples)
Underage, semiconscious, influence of drugs, mentally incompetent
Non-English speaking party
Agent-a person that makes the medical decisions for another
Health care Proxy

13. TORT
Invasion of privacy: spilling the beans, when the nurse shares information about a patient to a 3rd party individual without consent

14. Privileged Communications
All information given to health care personnel from the patient which must be kept confidential and shared only with people who are privileged to know such info (other members of the health care team).
Written consent given by the patient is needed to release the information to anyone else
Certain info is except by law and must be reported:
Births, Deaths, Injuries caused by violence, Drug Abuse, Reportable Diseases (Communicable & Sexually transmitted)

15. Health Records Considered Privileged Information
They belong to the Health Care Provider
But the patient may obtain copies
Can be used as legal records in court
Erasures are NOT allowed
Errors should be crossed out with a single line and left readable
Corrections inserted, initialed & dated
Sometimes corrections may be explained
Retained for an amount of time required by state law
Destroyed burned or shredded
Computer Records, limit access, using codes, use passwords, monitor use

16. Privacy Act Health Insurance Portability & Accountability Act (HIPAA)
Establish Standards to Protect Health Information
Privacy Standards:
Able to see and obtain copies of medical records
Given information on how their medical information will be used
Allowed to set limits on how personal health information is used
Request that reasonable care to keep information confidential

17. Ethics Set principles dealing with what is morally right or wrong
Provide a standard of conduct or code of behavior
Help health care worker analyze information and make decisions

18. Ethical Dilemmas Frequently created by modern medicine
Euthanasia Confidentiality of AIDS diagnosis
Aborted fetuses and research Continuing life support
Expensive treatments and payment Transplant decisions
Legal issues and marijuana Animals and research
Genetic research Cloning
Stem cell research

19. Basic Rules of Ethics Save lives and promote health Patient comfort
Respect the patient’s right to die peacefully and with dignity
Treat all patients equally
Provide the best care possible
Maintain competent skills and knowledge
Respect rules of confidentiality
Refrain from immoral, unethical, and illegal practices
Show loyalty to patients, co-workers, and employers
Be sincere, honest, and caring

20. Patient Bill of Rights The Patient Has the Right To:
Considerate & Respectful Care
Obtain complete & current Information
Have Advance Directives
Confidentiality
Reasonable response to a request for services
Refuse participation in any research project
Expect reasonable continuity of care
Review medical records, examine bills, explanation of all Care & Charges
Be informed of how to resolve disputes or grievances

21. 5:4 Advance Directives for Health Care
Also known as legal directives
- Allow individuals to state what medical treatment they want or do not want in the event they become incapacitated and unable to express there wishes
Legal document
Two main directives
Living wills – What measures should or should not be taken to prolong life.
Durable Power of Attorney (POA) – Permits the principal (Patient) to appoint an agent to make any decisions regarding healthcare if unable to

22. PSDA Health care workers must be aware of the act and honor it
Patient Self-Determination Act
Right to make decisions on medical care including to refuse treatment & right–to-die
Give info & assist in making Advance Directives
Document Adv. Directives in the Patient Record
Document how the patient was involved in decisions
No discrimination because of advance directives
Educate staff on legal issues of advance directives
Health care workers must be aware of the act and honor it
Health care workers should give serious consideration to preparing their own advance directives

23. Summary
By observing patient rights, health care workers assure patient’s safety, privacy, and well-being, and provide quality care
Advance directives must be recognized and respected by health care workers

24. Professional Standards
1. Perform only those procedures for which you have been trained and are legally permitted to do 2. Use approved, correct methods while performing any procedure 3. Obtain correct authorization before performing any procedure 4. Identify the patient 5. Obtain patient’s consent 6. Observe safety precautions 7. Keep all information confidential

25. Professional Standards (continued)
8. Think before you speak and watch everything you say 9. Treat all patients equally 10. Accept no tips or bribes for care you provide 11. If an error or a mistake occurs, report it immediately to your supervisor 12. Behave professionally in dress, language, manners, and actions 13. Always carry liability insurance