Ethics in Respiratory Therapy

• Civil law enforces standards through state statutes, professional board regulations, and common law, compensating injured individuals.
• Illegal acts violate general conduct standards, while ethical misconduct breaches professional norms.

Philosophical Foundations of Ethics

• Ethics originates in philosophy, focusing on how we should act and respecting humanity.

Ethical Dilemmas in Practice

• Respiratory therapists face ethical dilemmas: rationing care, conflicts with third-party standards, cost constraints, staffing issues, HIPAA, and PPACA.
• Managed care's "restrictive gatekeeping," requiring payer approval, creates dilemmas when needed care exceeds coverage.
• Understaffing can lead to ethical dilemmas, such as prioritizing patients without clear protocols.

Code of Ethics

• A code of ethics is essential for self-regulating professions.
• AARC's Statement of Ethics sets behavioral parameters for members.
• Moral obligations impose ethical duties on therapists.

Ethical Theories and Principles

• Autonomy: Respects patient's personal liberty and treatment decisions, forming the basis for informed consent; deceit to change a patient's decision is unethical.
• Veracity: Requires truthfulness between healthcare provider and patient; withholding truth is generally disfavored, as most Americans want full disclosure.
• Nonmaleficence: Obligates providers to avoid and prevent patient harm, carefully considering treatment side effects and unintended results.
• Beneficence: Requires healthcare workers to contribute to patients' health and well-being, leading to "advanced directives."

Beneficence

• Ethical dilemmas arise in cases where life can be prolonged without meaningful recovery, necessitating patient/family decisions and advance directives.
• Advance directives allow patients to make choices BEFORE adverse events, with Living Wills (specifying wishes) and Durable POA (assigning decision-makers).
• Confidentiality: Requires respecting patient privacy even after death, but can be breached in cases like abuse or gunshot wounds.
• Justice: Involves fair care distribution, balancing expenses and ability to pay, warranting "distributive justice."
• Compensatory justice seeks damages for medical malpractice.

Role Duty

• Practitioners must understand their role limits and practice with fidelity.
• It is not an RT’s role to inform family members of the critical state of the patient, that is a doctor's role.

Ethical Viewpoints and Decision Making

• Decision-making varies based on upbringing and education.
• Formalism: Relies on rules and principles, judging right and wrong accordingly.
• Consequentialism: Judges acts based on consequences, aiming for the greatest good.
• Rule utilitarianism focuses on which rule promotes the greatest good, risking inconsistent decisions due to caregiver variability.
• Virtue ethics: Based on character and virtue, asking how a "good RT" would act.
• Intuitionism: Holds certain self-evident truths, but depends on caregiver intuition due to different backgrounds.

Legal Issues Affecting Respiratory Care

• Public law: Includes criminal (acts against public welfare) and administrative law (government regulations).
• Civil law: Protects citizens from unfair advantage, enforcing private rights; courts decide if the plaintiff has been wronged, and the degree of reparation required.
• Tort Law: Addresses civil wrongs, substituting compensation for personal injury: negligent, intentional, and strict liability torts.
• Intentional tort: A willful act violating another’s interest.
• Negligent tort: Failure to competently perform one’s duties.
• Damages: Economic, noneconomic (pain, suffering), and punitive (punishing conduct) damages.
• Elements of negligence: Duty to patient, breach of duty, causation, and harm.
• Malpractice classifications: Criminal, civil, and ethical.
• Defenses against intentional torts: No intent to harm, and informed consent.
• Avoiding lawsuits: Awareness of legal aspects, risk management, malpractice insurance, and guest relations.

HIPAA

• HIPAA was established in 1996 to set standards for health information privacy, balancing protection and information exchange for quality care.

Medical Supervision

• RTs must work under competent medical supervision, with the employer (physician or hospital) liable for their actions.

Professional Licensure Issues

• RTs should know the Respiratory Care Practice Act and therapist-driven protocols, understanding causes of discipline (substance abuse, incompetence, etc.).

Interaction of Ethics and the Law

• Corporate compliance officer (CCO): Oversees hospital's business practices and law conformity.
• The PPACA improves whistleblower protections.
• The NLRA protects hospital workers, even non-union, for acts benefiting all employees.
• The False Claims Act: Forbids false claims against the government, with severe sanctions.
• Health care changes affect ethical decisions, requiring consideration of best services and managed care outcomes, based on factual premises, legal concepts, mandates, and managed care outcomes.

Health Care Advanced Directives

• All US states and DC have health care advance directives, and the 1991 Patient Self-Determination Act directs hospitals to ascertain if patients have advance directives.
• Advanced directive instruments are state regulated.