Download - Legal and Ethical Responsibilities Objective 64.01: Analyze legal roles and ethical behaviors
Legal and Ethical Responsibilities
Objective 64.01:Analyze legal roles and ethical behaviors
Legal Legal responsibilities: those that are
based on law
Law: a rule that must be followed
Health care workers must know and follow the state laws that regulate their licenses or registrations or set standards for their profession
Criminal Law:
Commonly known as a crimeFocuses on wrongs against person, property, or
societyExamples:
practicing without a licenseMisuse of narcoticsTheftMurder
Civil Law:
Focuses on legal relationships between people and protection of a person’s rights
Deals with torts and contracts
Tort:
Wrongful act that does not involve a contract
Called a civil wrong not a crimeMany types of tortsHappens when a person is injured
because a health care provider does not meet the established or expected standards of care
Malpractice
“Bad practice” or “professional negligenceDefined as the failure of a professional to use
the degree of skill and learning commonly expected in that individual’s profession
Causes injury, loss, damage to the person receiving care
Examples: physician not giving tetanus injection when a patient has a puncture wound or nurse performing minor surgery without having any training
Negligence
Failure to give care that is normally expected of a person in that particular profession
Results in injury to another personExamples: falls and injuries that occur when
side rails are left down; using or not reporting defective equipment, infections caused by the use of nonsterile instruments and/or supplies and burns caused by improper heat or radiation treatments
Assault and BatteryThreat or attempt to injureIncludes unlawful touching of another without
consentWritten consent required for some procedures
such as surgery, diagnostic tests, experimental procedures, treatment of minors, and side rail releases
Verbal consent is permitted for only some procedures but must be informed consent
Patients must five consent for care and have right to refuse
Informed ConsentPermission granted voluntarily by a person that
is of sound mind after the procedure and all risks involved have been explained in terms the person can understand
Person has right to withdraw consent at any timeAll procedures must be explained to patient and
none performed without consentExamples of assault and battery include
performing a procedure after a patient has refused to give permission and improper handling or rough treatment of a patient while providing care
Invasion of PrivacyMay involve unnecessarily exposing an
individualMay also be caused by revealing personal
information without consentExamples: improperly draping or covering a
patient during a procedure so that other patients or personnel can see the patient exposed sending information regarding a patient to an insurance company without patient's written permission or informing media without permission
False Imprisonment
Restraining an individual or restricting an individual’s freedom
Examples: keeping patients hospitalized against their will or applying physical restraints without proper authorization or with no justification
Abuse
Care that results in physical harm, pain, or mental anguish
Physical abuse: hitting forcing people against their will; restraining movement; depriving people of food or water; not providing physical care
Verbal abuse; speaking harshly, swearing or shouting, using inappropriate words to describe a person’s race or nationality or writing threats or abusive statements
Abuse
Psychological abuse: threatening harm; denying rights; belittling; intimidating or ridiculing the person; threatening to reveal information about the person
Sexual abuse: any unwanted sexual touching or act using sexual gestures and/or suggesting sexual behaviors
Signs of abuseUnexplained bruises, fractures, burns or injuries
\Signs of neglect such as poor personal hygiene
Irrational fears or a change in personality
Aggressive or withdrawn behavior
Patient statements that indicate abuse or neglect
Reportable Incidents
Laws required all forms of abuse be reported to the proper authorities
Presence of a sign or symptom of abuse indicated need for more investigation
Health care workers are required to report any signs or symptoms of abuse to their immediate supervisor
Defamation
Occurs when false statements cause a person to be ridiculed or damage the person’s reputation
Incorrect information given out in error can result in defamation
2 types: slander and libel
Slander
Occurs when the information is spoken
Libel: Occurs when the information is written
Examples: reporting that a patient has an infectious disease to a government agency when laboratory results are inaccurate or telling others that a person has a drug problem when another medical condition actually exists
Objective 6.02
Analyze contracts, privileged communication and HIPAA .Understand the elements of a contractPrivileged communicationPrivacy Act
Contracts
An agreement between two or more partiesHas three parts
Offer: competent individual enters into a relationship with a health care provider and offers to be a patient
Acceptance: the health care provider gives an appointment or examines or treats the patient
Consideration: the payment made by the patient for the services provided
Contracts
May be implied or expressedImplied: those obligations that are understood
without verbally expressed terms. Example: qualified health worker prepares med and patient takes med. This makes it implied that patient accepts treatment
Expressed: stated in distinct and clear language either orally or in writing. Example: Surgery permit where all promises of care must be kept and all risks associated with treatment bust be explained completely to the patient
Contracts
All parties entering into a contract must be FREE from LEGAL DISABILITY.
Examples: minors, mentally incompetent, one that is under the influence of drugs that alter mental state, semiconscious or unconscious persons. Parents or legal guardians permitted by law must form the contract for these persons.
Contracts
Care given must be performed per the agreement. Failure to do so will breach the contract
Failure to pay will be a breach of contract
A translator must be used when a contract is explained to non-English-speaking person or the deaf
Contract
Agent – a person that works under the direction of another person – the employee
Principal – the employerThe Principal is responsible for the
actions of the agent.
Privileged Communications
Include all information given to health care personnel by a patient.
This information must be kept confidential and shared only with other members of the patient’s health care team
Must have written consent of the patient to tell anyone else that states:What information is to be releasedTo whom the information is to be givenAny time limits
Privileged Communications
Certain information is exempt by law from privacy act and MUST be REPORTED:Births and deathsInjuries due to violence (assault and battery,Abuse, stabbingsDrug abuseCommunicable diseasesSexually Transmitted diseases
Health Care Records
Also privileged communicationsContain information about care given to
patientBelong to the providerPatient still has right to get a copy Used as legal records in court of law
Health Care RecordsErasures are not allowed. Errors should be crossed out with a single line so
material is still readableCorrect information should be inserted, initialed,
and datedHealth care records must be properly maintained,
stored in a locked or secure area, kept confidential, and retained for the amount of time required by state law
After correct amount of time, records may be destroyed only by shredding or burning
Health Care Records
Many employers are creating safeguards to protect confidential records and informationLimiting those that have access to recordsUsing codes to prevent accessRequiring passwords in order to access
specific information on recordsConstantly monitor and evaluate computer
use
Privacy Act
Federal Government passed the HIPAA or Health Insurance Portability and Accountability Act in 1996
Requires the US DHHS to set standards to protect health information
These Standards are called Standards for Privacy of Individually Identifiable Health Information of Privacy Rule
Privacy ActAble to see and obtain copies of their medical
recordsGiven info by providers on how they use
medical infoAllowed to set limits on personal info usedAble to request that providers take reasonable
care to keep communications confidentialAble to state who has access to info and to limit
giving info to familyGiven info on how to file a complaint against
provider
Objective 4.02
Evaluate ethical behavior in a health care setting
Ethics
A set of principles relating to what is morally right or wrong.
Give a standard of conduct or code of behavior
Ethical Dilemmas
Is euthanasia ever justified?Should a patient be told that a health
care provider has AIDS?Do parents have a religious right to
refuse a life saving blood transfusion?Should a physician be allowed to
prescribe marijuana for treatment if a patient would benefit?
Latest Ethical Dilemma
Should aborted embryos be used to obtain stem cells for research since they can be used to cure diabetes, osteoporosis and Parkinson’s diseases?
Ethical CodesPut the saving of life and promotion of health
above all elseMake patient as comfortable as possible and
preserve life when possibleRespect patient’s choice to die with dignityTreat all patient’s equallyGive care for all individuals to best of your
abilityMaintain competent skill levelStay informed and up to date
Confidentiality
Information about a patient must remain private and can be shared only with other members of patient’s health care team. To ignore this means a legal violation. Gossiping about patient’s is legally wrong
Refrain from immoral, unethical, and illegal practices
Ethics and Confidentiality
Show loyalty to patients, co-workers, and employers. If you observe others you must report such actions to the proper authorities
Be sincere, honest, and caring. Treat others as you would want to be treated. Show respect and concern for feelings, dignity, and rights of others
Patient’s Rights
Federal and state legislation requires health care agencies to have written policies concerning patient’s rights. These are the factors of care that a patient can expect to receive.
AMA has adopted a “Patient’s Bill of Rights” that is recognized and honored by many health care facilities.
Resident’s Bill of Rights
OBRA or Omnibus Budget Reconciliation Act of 1987 guaranteed residents of long term care facilities certain rights. Every LTF is required to inform their residents of their rights and a copy must be posted in every facility.
Resident’s Bill of Rights :Free choice regarding MD, treatment, care and
participation in researchFreedom from abuse, chemical or physical
restraintsPrivacy and confidentiality of personal and clinical
recordsVoice grievances without fear Organize and participate in group activities and be
accommodated for needs and choice of activitiesManage personal funds & Unlimited access to
familyRemain in facility and not be transferred without
medical reasons
Objective 4.03
Explore legal and ethical issues related to death and dying.
Advance Directives
Also called legal directivesAllows individual to state what medical
treatment they want or do not want in the vent that they become incapacitated and cannot state their wishes regarding medical care.
Advance Directives
Two Types:Living WillDurable Power of Attorney (POA) for
Health Care
Living Will
Documents that allow individuals to state what measures should or should not be taken to prolong life when their conditions are terminal.
Must be signed when the individual is competent and witnessed by two adults that cannot benefit from death
Frequently results in a DNR (Do Not Resuscitate) order for a terminally ill individual
Means that CPR is not performed when patient stops breathing
Durable Power of Attorney
Document that permits an individual to appoint another person to make any decisions regarding health care if the principal should become unable to make decision.
Includes giving or withholding specific medical or surgical procedures, hiring or dismissing health providers
Patient Self Determination ActStates that all health care facilities receiving any
type of federal aid comply with the following requirements
Inform every adult orally and in writing of their rights to make decisions about health care
Give info and assistance in preparing advance directives
Document any advance directive on the patient’s record
Written statements to implement the patient’s rights in the decision making process
Affirm that there will be no discriminationEducate the staff on the medical and legal issues
Professional Standards
Perform only those procedures that you have been trained and are legally allowed to do
Use approved, correct methods Obtain proper authorization before startingIdentify the patient and obtain the patient’s
consent before performing any procedureObserve all safety precautionsKeep all info confidential
Professional Standards
Think before you speak and consider everything you say
Treat all patient’s equally regardless of race, religion, or social or economic status
Accept no tips or bribesIf any error occurs report it immediatelyBehave professionally in dress, language,
manners,and action.
EuthanasiaCalled “mercy killing” and is the act of ending the
life of a person that suffers from a terminal illness or an incurable condition. Euthanasia carried out by lethal injection or by suspending extraordinary medical treatment. 4 types:Voluntary – when the patient requests itNon-voluntary – when patient gave no consentInvoluntary – When the patient made a specific request
to the contraryAssisted Suicide – When someone gives patient help and
means to take their own life with the intention of it being used for this purpose.
This is a controversial issue. Euthanasia is legal in Oregon.
Euthanasia
The administration of a lethal agent by another person to cause the patient's death and thereby relieve the patient’s intolerable and incurable suffering.
Healthcare workers should respond to the needs of patients at the end of life instead engaging in euthanasia. Patients should not be abandoned once it is determined that a cure is impossible.
Active versus Passive Euthanasia
Active euthanasia is the intentional killing of the terminally ill. Example: injecting a lethal dose of medication
Illegal in all states except Oregon, which allows physician-assisted suicide but not homicide. Some physicians engage patient-assisted suicide where the physician gives patient the knowledge and the perscription to take his/her own life.
Passive Euthanasia
Allows a patient to die naturally.
This is legal everywhere.
Includes withholding basic needs such as hydration and nutritional feedings.
Arguments in Favor
Respect for patient self-determination. Individuals should have the right to determine the outcome of their lives.
Gives a means for harvesting viable organs.
Gives relief for family of patientGives a means to end terminally ill
person’s suffering.
Arguments in OppositionNo certainty in regard to death. Many
terminally ill patients have been known to recover.
Modern technology may find a cure for a terminal disease.
Families may be examining euthanasia just to relieve burden of stress and financial problems
There is value and dignity in every human life.The involvement of health care workers in
euthanasia erodes the dignity of their profession.
Only God has domination over life.
Important Fact
Many patients will often ask for advice from health care workers on what course of action they should take for a dying loved one. Remember that only the physician can advise the patient on a course of treatment.
Stages of DyingDeath – the final stage of growthElizabeth Kubler-Ross performs extensive
research on process of death and dying and is the leading expert on that field.
In America, most healthcare personnel feel a patient should be told of their terminal diagnosis.
It is important that patients be left with some hope and the knowledge that they will not be left alone
You need to be aware of what information was given to the patient and their reaction to it.
Five Stages of Grieving
Stages may not occur in order, may overlap or be repeated several times. Patients may not go through all stages before death. Some stop or go back and forth between stages
Stage One: Denial = “No, not me!” Person is first told diagnosis and cannot accept truth or their loved ones cannot accept the truth. Patients will seek second opinions. Statements such as “It must be hard for you” or “You feel additional test will help” can help patients move on.
AngerHappens when the patient is no longer able to
deny death.Statements like “Why me” or “It’s your fault
are common.Patients may strike out at anyone who comes in
contact with them and become hostile and bitter. They may blame themselves, their loved ones, or health care personnel for their illness.
Health care workers need to remember that this is not personal, and give patience, support, listen, and respond to patient’s demands quickly and with kindness.
Bargaining
Occurs when patient accepts deathPatient turns to religion and spiritual beliefsPatients fight hard to achieve goals they have
set. Example wedding of a child etcPatients make promises with God to obtain
more time.Health care workers must be supportive and be
good listeners and help patients meet their goals.
Depression
Happens when patients realize death will come soon and they’ll no longer be with families or able to complete goals.
Will express regrets, withdraw, become quietExperience great sadness, despair.Offer quiet understanding, support, a simple
touch, allowing them to cry and express grief
Acceptance
Final stagePatients understand that they will dieComplete unfinished business, help those
around them deal with their coming deathThey separate themselves from others
and the worldOffer emotional support and your
presence even if only a hand touch
HospiceProvides supportive care to patients when they
need it mostOffers palliative care that gives support and
comfortNot limited to a specific time period in a
patient’s lifeOnly starts when a patient has 6 months or less
to liveFamilies are reluctant to begin hospice as it
recognizes end of life
Hospice
Their philosophy is to allow patient to die with dignity and comfort.
Uses palliative measures of care and death with dignity and comfort
Helps family find closureProvides hospital equipment, psychological,
spiritual, social and financial counseling and gives free or less expensive pain medication
Provides support, understanding, and allows patient to die with dignity and in peace
Senses
Vision will blur and then fail. Patient may be frightened of dark room. Keep room well lit. Good eye care essential as secretions will collect in corners. If eyes stay open apply ointment.
May people hear until moment of death, even when unconscious. Always assume patient can hear you. Offer comforting words
Speech will be difficult. Anticipate patient’s needs. Ask yes/no questions
Mouth, Nose, Skin
Oral hygiene essential. Give frequently as death approaches
Crusting in nostrils can occur due to oxygen, ng tube or nasal secretions. Apply a lubricant to nostrils.
Circulation fails and body temp rises. Skin is cool, pale and mottled (blotchy). Perspiration increases. Patient needs good skin care, bathing and pressure ulcer prevention. Change linens and gowns prn. Use only light bed coverings.
Elimination Comfort and Positioning
Expect urinary and fecal incontinence. Use bed protectors and briefs Pericare prn. Possible constipation and urinary retention. Dr may order enemas or foley catheters.
Good skin care, back massages, oral hygiene, personal hygiene. Give pain medications, frequent position changes, promote comfort. Care when turning. Patients usually prefer semi fowlers position
Signs of DeathMovement, muscle tone, sensation lost. Starts in
feet and legs and spreads to rest of body. Mouth muscles relax, jaw drops, mouth stays open.
Peristalsis and GI functions slow down. Abdominal distention, fecal incontinence, impaction, nausea and vomiting.
Circulation fails, body temp rises, Person feels cool, looks pale, perspires heavily. Pulse is fast, weak, irregular. BP falling.
Respiratory system fails, cheyne stokes respirations noted, mucus in throat called death rattle. Rigor mortis develops 2 to 4 hrs after death.
Organ Procurement and Donation
Organ donation – the removal of tissues from an individual who has died recently or a living donor.
Organ procurement – the obtaining of organs for donation; includes transporting, surgical removal and transplantation.
The following can be transplanted: heart, intestines, kidneys, lungs, liver, pancreas, bones, skin. These tissues can be procured: tendons, corneas, heart valves, bone marrow, veins.
Signs of DeathNo pulse, no respirations, no blood pressure.
Pupils fixed and dilated. A doctor determines that death has occurred and
pronounces person dead.Postmortem care is care of the body after death.
Starts as soon as death is pronounced. Use standard precautions. Done to maintain body’s appearance.
Includes gathering personal items and valuables. Patient has right to be treated with dignity,
privacy and respect.