Ethics for Respiratory Therapists

• Civil law is enforced through state statutes, professional boards, and common law, ensuring ethical and competent practice.

Distinction Between Illegal and Ethical Misconduct

• Illegal acts violate established standards of conduct for all citizens, such as domestic assault.
• Ethical misconduct involves violating professional and ethical norms set by a profession.

Philosophical Basis of Ethics

• Ethics stems from philosophy, emphasizing wisdom and knowledge pursuit.
• Ethics explores how one should act, upholding respect for humanity.

Ethical Dilemmas Faced By Respiratory Therapists (RTs)

• RTs face ethical and legal issues like rationing care, third-party standards, cost constraints, staffing, HIPAA, and PPACA.
• Managed care's restrictive gatekeeping requires pre-approvals, creating dilemmas when patient needs exceed coverage.
• Understaffing can cause RTs to deprioritize patients, potentially violating professional norms and ethics.

Code of Ethics

• A code of ethics is essential for self-regulating professions.
• The AARC's Statement of Ethics and Professional Conduct establishes behavioral guidelines for its members.
• Therapists have moral obligations that create ethical duties, that may be used in legal proceedings

Mini Clini

• Review the problem and consider a solution.
• Assess decision difficulty via Discussion Questions.
• Interpret Guidance section details.

Ethical Theories and Principles

• Professional obligations should be in line with patient rights.

Autonomy

• Autonomy respects patients' liberty to make treatment decisions based on "informed consent".
• Deceit to change a patient's decision to refuse treatment violates autonomy and is unethical.

Veracity

• Veracity (truthfulness) requires honesty from providers and patients.
• Benevolent deception (withholding truth for the patient's own good) poses a challenge to veracity.
• Most patients wants full disclosure, even if the facts are dismal.
• Be careful to chose the right words when talking to patients

Mini Clini on Patient's Right to Refuse

• Review the Mini Clini on page 72 to understand patient's rights to refuse treatment.

Nonmaleficence

• Nonmaleficence compels healthcare providers to prevent harm.
• Weigh potential risks against benefits such as the risk of infection as a result from potentially life saving interventions.
• Problems arise with "double effect" treatments that have serious side effects; harmful effects are viewed as unintended if the initial intent was good.

Beneficence

• Beneficence extends "do-no-harm" to doing what's best for the patient.
• Health care workers must boost health and well-being while preventing harm.
• Ethical domain issues have spawned "advanced directives".
• It is up to the patient and family to decide whether to do everything possible to prolong life, regardless of quality of life.
• Ethical dilemmas occur, because whether to do everything to save someone, is a matter of beneficence.
• Advanced directives, allow patients to make their own decisions

Advance Directives

• Advance directives let patients decide BEFORE adverse events.
• Types: Living Will (specifies wishes) and Durable POA (assigns decision-maker).

Confidentiality

• Confidentiality requires respecting patient privacy, even after death. Review Mini Clini on Page 74
• Breaches may be legal in cases like child abuse or gunshot wounds.
• Healthcare workers may share patient medical history in some cases.
• Digital era has increased potential risks from inadvertent PHI disclosure such as on social networking sites.

Justice

• Justice means fair distribution of care.
• Balance health expenses with the ability to pay for them; rationing calls for "distributive justice".
• Compensatory justice seeks damages for medical malpractice and less than 2% of health care costs relate to malpractice or negligence lawsuits.

Role Duty

• Practitioners must understand their role limits and practice accordingly.
• RTs are not to tell family how critical a situation is; that’s the doctor’s role.
• RTs must not overstep their defined role.
• Read Mini Clini pages 75 and 76 on role duty for further learning.

Ethical Viewpoints and Decision-Making

• Decisions in healthcare vary based on an individual's background.

Formalism

• Formalism relies on established rules and principles.
• Rights and wrongs align with those rules and principles.

Consequentialism

• The rightness or wrongness of an action depends on its consequences.
• It typically uses the principle of utility, maximizing overall good.

Formalist and Consequentialist Example

• During WWII some soldiers had syphilis from brothels and others had battle wounds, who should get the antibiotics?
• Formalists believe in giving them to the sickest patients first (duty oriented).
• Consequentialism resulted in antibiotics being given to soldiers from brothels who needed to fight to win.

Mixed approach to Moral Reasoning

• Mixed approaches include moral reasoning.
• Rule utilitarianism, is a variation of consequentialism, which focuses on which "rule" will promote the greatest good.

Disadvantages of of "rule" for Moral Reasoning

• Variability between caregivers.
• Caregiver value and educational differences.
• Risk of inconsistent ethical decision making.

Virtue Ethics

• Virtue ethics aren't based on rules or consequences but on character..
• Ask, “How would the good RT act?”
• Calls for behavior based on what "good practitioners” would do in similar circumstances
• Virtue Ethics guide most RT's decisions.

Intuitionism

• Intuitionism appeals to "self-evident truths" and moral maxims.
• "Treat others fairly" and “look before you cross the street" etc
• It depends on caregiver intuition while acknowledging varying backgrounds.

Legal Issues: Public Law

• Public law includes criminal law and administrative law, regulating government-private party interaction.
• Criminal law addresses public safety and welfare with punishments like fines and imprisonment while the state is the accuser
• Administrative law incorporates government regulations, with which RTs must comply.

Legal Issues: Civil Law

• Civil law safeguards citizens from exploitation, enforcing individual/organizational rights and duties.
• Civil courts resolves complaints and determines reparation.

Tort Law

• Tort law addresses civil wrongs, maintaining peace, and providing injury remedies.
• Torts have three forms: Negligent torts, Intentional torts, and Liability regardless of fault.
• Intentional tort involves intent to act violating another's interest
• Negligent tort is failure to perform one's duties competently.

Damages in Tort Law

• Damages in negligence lawsuits are classified as economic loss, noneconomic suffering, and punitive for misconduct.

Elements of Negligence

• Negligence involves a duty to the patient, breach of that duty, causation of damages, and harm to the patient.

Malpractice Classifications

• Malpractice classifications include criminal (assault/battery), civil (negligence), and ethical (ethics violations that could censure).

Defenses Against Intentional Torts

• Defenses against intentional torts include no intent to harm and informed patient consent.

Avoiding Lawsuits

• Conform to licensure's aspects and standards of care.
• Establish ongoing risk management and have malpractice insurance.
• Use active risk management and guest relations policies.

HIPAA

• HIPAA of 1996 sets standards for privacy of identifiable health data.
• It balances data protection with the need for health care data exchange.

Medical Supervision

• Medical supervision which is a "scope of practice" requirement, mandates RTs work under competent supervision.
• Employer (physician/hospital) is liable for RT's actions.
• In some states, physicians may be liable, despite hospital employment, through "failure to supervise" (respondeat superior).

Professional Licensure

• Licensure requires knowledge of Respiratory Care Practice Act (Licensure Statute) and ability to perform Therapists-driven protocols.
• Therapists can exercise their independent judgement.
• Decision making in the court increases.
• One must be aware of Causes of Discipline such as, Substance abuse, domestic violence, sexual abuse, and gross incompetence.

Ethics and Law

• Corporate compliance officers (CCO) overseeing hospital practices and conformity to law, tackle legal or ethical issues.
• The 2010 Patient Protection and Affordable Care Act (PPACA) boosts whistleblower protections for hospital staff.

Ethics and Law: NLRA

• The National Labor Relations Act protects hospital workers, union or not.
• It also has a protections even when he or she engages in an act that would benefit of all employees.

Ethics and Law: False Claims Act

• The False Claims Act forbids false claims against government, and is sanctioned with repayment and civil penalties.

Health Care and Change

• Rapid modifications change patients and healthcare workers interactions and also how resources are distributed.
• Ethics and managed care intersect and change decisions.
• Health care workers balance treatment services/outcomes and managed care.

Health Care and Change Considerations

• Specific considerations include factual premises, tort laws, hospital standards, and care outcomes.

Health Care Advanced Directives

• All 50 states and D.C. have health care advance directives.
• The 1991 Patient Self-Determination Act mandates hospitals ascertain if patients have advance directives, which are state-regulated.