NCM 118: Lesson 11 - Ethico-Legal Considerations in Critical Care PDF

NCM 118: Lecture BSN – 4N || Prof. Dichoso LESSON 11: ETHICO-LEGAL 5. Evaluation CONSIDERATIONS IN CRITICAL CARE B. Establish linkages with community Introduction...

NCM 118: Lecture BSN – 4N || Prof. Dichoso LESSON 11: ETHICO-LEGAL 5. Evaluation CONSIDERATIONS IN CRITICAL CARE B. Establish linkages with community Introduction resources and coordination with A person is considered to be practicing the health team. nursing within the meaning of this Act when C. Provide health education to he or she initiates and provides nursing individuals, families, and services to people, families, and communities communities. in any health care environment, whether D. Teach, guide and supervise students alone or in conjunction with another. Nursing in nursing education programs care covers, but is not limited to, conception, including the administration of labor, delivery, infancy, childhood, toddler, nursing services in varied settings pre-school, school age, adolescent, such as hospitals and clinics; adulthood, and old age. undertake consultation services; engage in such activities that require Scope of Nursing the utilization of knowledge and As independent practitioners, nurses are decision-making skills of a registered primarily responsible for the promotion of nurse; health and prevention of illness. As members of the health team, nurses shall collaborate with other health care providers for the curative, preventive, and rehabilitative aspects of care, restoration of health, alleviation of suffering, and when recovery is not possible, towards a peaceful death. It shall be the duty of the nurse to: A. Provide nursing care through the utilization of the nursing process E. Undertake nursing and health human resource development training and research, which shall include, but not 1. Assessment limited to, the development of 2. Diagnosis advance nursing practice 3. Planning 4. Intervention NCM 118: Lecture BSN – 4N || Prof. Dichoso Provided, that this section shall not apply to As the setting for the provision of health nursing students who perform nursing services, hospitals must provide a foundation functions under the direct supervision of a for understanding and respecting the rights qualified faculty: and responsibilities of patients, their families, physicians, and other caregivers. Provided, further, that in the practice of nursing in all settings, the nurse is duty bound Senate Bill No. 812 – “Magna Carta of to observe the Code of Ethics for nurses and Patient’s Rights and Obligations.” uphold the standards of safe nursing practice. - An act declaring the rights and Basic Concepts of Code of Ethics obligations of patients and establishing a grievance mechanism a. Rights – “the power or privilege” for violations thereof and for other b. Autonomy – “decision-making” purposes. c. Beneficence & Nonmaleficence – - The policy of the State is to protect “rendering nursing care” and promote the right to health of the d. Fidelity – “marital relationship” people and instill health and The nurse is required to maintain competence consciousness among them. It shall by continual learning through continuing likewise be the policy of the State for professional education to be provided by the Congress to give the highest priority accredited professional organization or any to the enactment of measures that recognized professional nursing protect and enhance the right of all organization. people to human dignity. Towards this end, the State shall ensure, provide Provided, finally, that the program and and protect the rights of patients to activity for the continuing professional decent, humane and quality health education shall be submitted to and care. approved by the Board. The Rights of Patients Ethico-legal Considerations in Critical Care Right to Appropriate Medical Care and Humane Treatment – Every person has a Patients Bill of Rights and Obligations right to health and medical care Unconscious Client corresponding to his state of health, with A Patient's Bill of Rights refers to what a respect and consideration, without any patient is guaranteed when receiving medical discrimination and within the limits of the care. Patient rights were developed with the resources, manpower and competence expectation that hospitals and health care available for health and medical care at the institutions would support these rights in the relevant time. interest of delivering effective patient care. Right to Informed Consent – the Patient has Open and honest communication, respect for a right to self- determination and to make free personal and professional values, and decisions regarding himself / herself. sensitivity to differences are integral to Physicians should clearly explain the risks optimal patient care. from receiving the treatment and only NCM 118: Lecture BSN – 4N || Prof. Dichoso administer the treatment after getting explicit 2. Rights of Legally Incompetent written consent from the patient. Patient The patient will not be subjected to any If a patient is a minor or otherwise legally procedure without his written informed incompetent, the consent of a legally entitled consent, except in the following cases: representative is required. Nevertheless, the patient must be involved in the decision a. In emergency cases, when the patient making to the fullest extent allowed by is at imminent risk of physical injury, his/her capacity or circumstance. decline or death if treatment is withheld or postponed. In such cases, 3. Procedures against the Patient’s the physician can perform any Will diagnostic or treatment procedure as Diagnostic procedures or treatments against good practice of medicine dictates the patient’ s will can be carried out only in without such consent; exceptional cases, if specifically permitted by b. when the health of the population is law and conforming to the principles of dependent on the adoption of a mass medical ethics. In such cases, informed health program to control epidemic; consent is secured from next-of-kin c. when the law makes it compulsory for whenever possible. everyone to submit to a procedure; d. when the patient is either a minor, or Right to Privacy and Confidentiality legally incompetent, in which case, a third-party consent is required; The privacy of the patients must be assured at e. when disclosure of material all stages of his treatment. The patient has the information to patient will jeopardize right to be free from unwarranted public the success of' treatment, in which exposure, except in the following cases: case, third party disclosure and when his mental or physical condition is in consent shall be in order; controversy and the appropriate court, in its discretion, orders him to submit to a physical or mental examination by a physician; when 1. Rights of Unconscious Patients the public health and safety so demand; If the patient is unconscious or otherwise Any health care provider or practitioner unable to express his/her will, informed involved in the treatment of a patient and all consent must be obtained whenever possible, those who have legitimate access to the from a legally entitled representative. patient's record is not authorized to divulge any information to a third party who has no If a legally entitled representative is not concern with the care and welfare of the available, and a medical intervention is patient without his consent, except: urgently needed, consent of the patient may be presumed, unless it is obvious and beyond a. when such disclosure will benefit doubt on the basis of the patient’s previous public health and safety; firm expression or conviction that he/she b. when it is in the interest of justice and would refuse consent. upon the order of a competent court; and NCM 118: Lecture BSN – 4N || Prof. Dichoso c. when the patients waive in writing the Right to Medical Records – The patient is confidential nature of such entitled to a summary of his medical history information; and condition. He has the right to view the d. when it is needed for continued contents of his medical records, except medical treatment or advancement of psychiatric notes and other incriminatory medical science subject to de- information obtained about third parties, with identification of patient and shared the attending physician explaining contents medical confidentiality for those who thereof. have access to the information. Right to Religious Belief – The patient has Right to Information the right to refuse medical treatment or procedures which may be contrary to his Every patient has the right to know what is religious beliefs, subject to the limitations the illness that they are suffering, its causes, described in the preceding subsection. the status of the diagnosis (provisional or confirmed), expected costs of treatment. Right to Leave – The patient has the right to leave hospital or any other health care The Right to Choose Health Care Provider institution regardless of his physical and Facility. condition: The patient is free to choose the health care a. He/she is informed of the medical provider to serve him as well as the facility consequences of his/her decision: except when he is under the care of a service b. He/she releases those involved in facility or when public health and safety so his/her care from any obligation demands or when the patient expressly or relative to the consequences of his impliedly waives this right. decision; Right to Self-Determination c. His/her decision will not prejudice public health and safety. The patient has the right to avail himself/herself of any recommended Right to Refuse Participation in Medical diagnostic and treatment procedures. Any Research – The Patient has the right to be person of legal age and of sound mind may advised of plans to involve him/her in make an advance written directive for medical research that may affect the care or physicians to administer terminal care when treatment of his/her condition. Any proposed he/she suffers from the terminal phase of a research shall be performed only upon the terminal illness: written informed consent of the Patient. a. He is informed of the medical a. An institutional review board or consequences of his choice; ethical review board in accordance b. He releases those involved in his care with the guidelines set in the from any obligation relative to the Declaration of Helsinki be established consequences of his decision; for research involving human c. His decision will not prejudice public experimentation: health and safety b. Department of Health shall safeguard the continuing training and education NCM 118: Lecture BSN – 4N || Prof. Dichoso of future health care health authorities and health practitioner provider/practitioner to ensure the must progressively contribute to realize. development of the health care Right to Access to Quality Public Health delivery in the country: Care – The patient has the right to c. The patient involved in the human functioning public health and health care experimentation shall be made aware facilities, goods and services and programs of the provisions of the Declaration of needed and sufficient quantity. They shall Helsinki and its respective guidelines. likewise be provided with health facilities Right to Correspondence and to Receive and services with adequate provision of Visitors – The patient has the right to essential drugs, regular screening programs, communicate with relatives and other appropriate treatment of prevalent diseases, persons and to receive visitors subject to illnesses, injuries and disabilities, including reasonable limits prescribed by the rules and provision of public health insurance. The regulations of the health care institution. government shall, as far as practicable, approximate the international standard Right to Express Grievances – The patient allocation for the health sector as set by has the right to express complaints and World Health Organization. grievances about the care and services received without fear of discrimination or Right to Healthy and Safe Workplace – reprisal and to know about the disposition of The patient has the right to a healthy natural such complaints. workplace environment with adequate supply of safe and potable water and basic sanitation, Right to be Informed of His Rights and industrial hygiene, prevention and reduction Obligations as a Patient of exposure to harmful substances, Every person has the right to be informed of preventive measures for occupational his rights and obligations as a patient. The accidents and diseases, and an environment Department of Health, in coordination with that discourages abuse of alcohol, tobacco health care providers, professional and civic me, drug use and other harmful substances. groups, the media, health insurance Right to Prevention and Education corporations, people’s organizations, local Programs – The patient has the right to government organizations, shall launch and prevention and education programs on sustain a nationwide information and immunization, on the prevention, treatment education campaign to make known to people and control of diseases, for behavior-related their rights as patients, as declared in this Act. concerns, for disaster relief and emergency Such rights and obligations of patients shall situations during epidemics and similar be posted in a bulletin board conspicuously health hazards. placed in a health care institution. Right to Participate in Policy Decisions – Societal Rights of Patients The patient has the right to participate in Right to Health – The patient has the right to policy decisions relating to patient’s right to regain and/or acquire the highest attainable health at the community and national levels. standard of health, in a non-discriminatory, gender sensitive, and equal manner, which NCM 118: Lecture BSN – 4N || Prof. Dichoso Obligations of Patients fees of the health care provider through post- dated checks or promissory notes or any Know Rights – The patient shall ensure that similar medium. he/she knows and understands what the patients’ rights are and shall exercise those Relation to Others – The patient shall so rights responsibly and reasonably. conduct himself or herself so as not to interfere with the well-being or rights of other Provide Accurate and Complete patients or providers of health care. He/she Information – The patient shall provide, to shall act in a considerate and cooperative the best of his knowledge, accurate and manner, respect the rights and property of complete information about all matters others and follow the policies and procedures pertaining to his/her health, including of the health care establishment. medications and past or present medical problems to his/her health care provider. Exhaust Grievance Mechanism – The patient shall first exhaust the grievance Report Unexpected Health Changes – It mechanism provided in this bill before filing shall be the duty of every patient to report any administrative or legal action. unexpected changes to his/her condition or symptoms, including pain, to a member of the health care team. Understand Purpose and Cost of Treatment – The patient shall ensure that he/she understands the purpose and cost of any proposed treatment or procedure before deciding to accept it. He/she shall notify the health care provider or practitioner if he/she does not understand any information about his/her care or treatment. Accept Consequences of Own Informed Consent – The patient shall accept all the consequences of the patient’s own informed consent. If he/she refuses treatment or do not follow the instructions or advice of the health care provider or practitioner, he/she must accept the consequences of his/her decision and thus relieve the health care provider or practitioner of any liability. Settle Financial Obligations – The patient shall ensure that financial obligations of his/her health care are fulfilled as promptly as possible, otherwise, he/she shall make appropriate arrangements to settle unpaid bills in the hospital and/or 12 professional