CHAPTER 13.docx

CHAPTER 13 ========== Medical Law and Ethics ====================== OVERVIEW -------- All health care providers and professionals have a primary responsibility to provide high-quality patient care and to prevent and manage diseases and conditions while respecting patient privacy, maintaining con...

CHAPTER 13 ========== Medical Law and Ethics ====================== OVERVIEW -------- All health care providers and professionals have a primary responsibility to provide high-quality patient care and to prevent and manage diseases and conditions while respecting patient privacy, maintaining confidentiality, and communicating responsibly in fulfillment of this role. To ensure patient protection, health care professionals, including medical assistants, are bound by a variety of laws and regulations and by a wide range of legal and ethical responsibilities to their patients, their employers, and society. This chapter will discuss the different laws and standards that help protect patients, their health information, and their health care. It is important to understand how to apply laws and regulations that guide the practice of patient care, including consent and who can give it and how to protect patient confidentiality and health information. Knowing how to apply ethics and values and how they are the foundation of many laws and regulations for patient care is essential when working in health care. A medical assistant should understand diversity and how biases may prevent some individuals from accessing health care and what role they have in improving that through cultural competency. Objectives ---------- Upon completion of this chapter, you should be able to - Identify legal and regulatory requirements. - Identify patient consent as needed. - Identify professional codes of ethics. - Describe and differentiate medical directives. - Describe patient privacy and confidentiality, including medical records. - Identify legal requirements regarding reportable violations or incidents. - Identify personal or religious beliefs and values and provide unbiased care. MEDICAL LAWS ============ Patient\'s Bill of Rights ------------------------- An important aspect of patient care is understanding medical law and defining the rights and responsibilities of both the patient and health care provider. For patients, the American Hospital Association (AHA) created the original Patient\'s Bill of Rights in 1973, which provides guidelines and guarantees by federal law to ensure the protection and safety of patients. Although the Patient\'s Bill of Rights was originally intended for the hospital setting, most medical practices, hospitals, insurance companies, and even governments have adopted some form of the legislation. *The primary purposes of the Patient\'s Bill of Rights are to help patients feel more confident in the health care system, to strengthen the relationship between patients and their health care provider by defining their rights and responsibilities and those of their health care provider, and to emphasize the role patients play in their health.* The Patient\'s Bill of Rights outlines 15 guarantees for all patients seeking medical care in a health care organization and basic rights and responsibilities for effective patient care. Medical assistants must adhere to patient rights and uphold duties while administering and assisting with patient care. A summary of these guarantees is as follows: The Patient\'s Bill of Rights: - The patient has the right to be treated fairly and respectfully. - The patient has the right to get information they can understand about their diagnosis, treatment, and prognosis from their health care provider. - The patient has the right to discuss and ask for information about specific procedures and treatments, their risks, and the time they will spend recovering. They also have the right to discuss other care options. - The patient has the right to know the identities of all their health care providers, including students, residents, and other trainees. - The patient has the right to know how much care may cost at the time of treatment and long term. - \'The patient has the right to make decisions about their care before and during treatment and the right to refuse care. The hospital must inform the patient of the medical consequences of refusing treatment. The patient has the right to other treatments provided by the hospital and the right to transfer to another hospital. - The patient has the right to have an advance directive, such as a living will or a power of attorney for health care. A hospital has the right to ask for their advance directive, put it in their file, and honor its intent. - The patient has the right to privacy in medical exams, case discussions, consultations, and treatments. - The patient has the right to expect that their communication and records are treated as confidential by the hospital, except as the law permits and requires in cases of suspected abuse or public health hazards. If the hospital releases their information to another medical facility, they have the right to expect the hospital to ask the medical facility to keep their records confidential. - The patient has the right to review their medical records and to have them explained or interpreted, except when restricted by law. - The patient has the right to expect that a hospital will respond reasonably to their requests for care and services or transfer them to another facility that has accepted a transfer request. They should also expect information and explanation about the risks, benefits, and alternatives to a transfer. - The patient has the right to ask and to be informed of any business relationships between the hospital and educational institutions, other health care providers, or payers that may influence their care and treatment. - The patient has the right to consent to or decline to participate in research studies and to have the studies fully explained before they give their consent. If they decide not to participate in research, they are still entitled to the most effective care that the hospital can provide. - The patient has the right to expect reasonable continuity of care and to be informed of other care options when hospital care is no longer appropriate. - The patient has the right to be informed of hospital policies and practices related to patient care, treatment, and responsibilities. - The patient has the right to know whom they can contact to resolve disputes, grievances, and conflicts. And they have the right to know what the hospital will charge for services and their payment methods. LAWS AND REGULATIONS ==================== The health care field is a heavily regulated environment, given that people\'s lives and health are affected. There are several federal, state, and local regulatory agencies that establish rules and regulations for the health care industry to ensure compliance and to provide safe health care to every person who accesses the system. Medical assistants should be familiar with laws that affect their profession. The most common laws and regulations that affect medical practices and patient care are shown in the table below. Comply with Legal and Regulatory Requirements --------------------------------------------- ### Patient Protection and Affordable Care Act Commonly called the Affordable Care Act (ACA) or \"Obamacare,\" named after former president Barack Obama, who signed it into law in 2010, this federal statute was a major step in health care reform by expanding access to more affordable, quality health insurance, increasing consumer insurance protection, emphasizing prevention and wellness, and curbing rising health care costs. ### Health Insurance Portability and Accountability Act of 1996 (HIPAA) HIPAA gives patient's rights over their health information and sets rules and limits on who can look at and receive patients\' private information. HIPAA applies to protected health information (PHI), whether electronic, written, or oral. ### Health Information Technology for Economic ### and Clinical Health (HITECH) Act The HITECH Act expands on HIPAA and includes provisions that allow for increased enforcement of the privacy and security of electronic transmission of patient information, such as prohibiting the sale of PHI, making business associates and vendors liable for compliance with HIPAA, and creating a penalty and violation system. ### Occupational Safety and Health (OSH) Act The OSH Act is overseen by the Occupational Safety and Health Administration (OSHA) and states that employers are accountable for providing a safe and healthful workplace for employees by setting and enforcing standards and by providing training, outreach, ed cation, and assistance. ### Controlled Substances Act (CSA) CSA is a federal policy that regulates the manufacture and distribution of controlled substances. Controlled substances can include narcotics, depressants, and stimulants. The CSA classifies medications into five schedules, or classifications, based on the likelihood for abuse and if there are any medical benefits provided from the substance. ### ### Emergency Medical Treatment and Active Labor Act (EMTALA) The EMTALA of 1986 requires any hospital emergency department that receives payments from federal health care programs, such as Medicare and Medicaid, to provide an appropriate medical screening to any patient seeking treatment. This was enacted to eliminate \"patient dumping,\" where a facility would transfer a patient based on a potentially high-cost diagnosis or refuse to treat a patient based on their ability to pay. This legislation requires the emergency department to determine whether a condition is emergent or not and to provide stabilizing treatment in the case of an emergency medical condition. It does not require that treatment be given for nonemergency conditions. Furthermore, outpatient clinics are not medically equipped to handle emergencies and therefore are not bound by the EMTALA. ### Clinical Laboratory Improvement Act (CUA) The CLIA of 1988 is a group of laws that regulate all laboratory facilities for safety and handling of specimens. The objective of CLIA is to regulate accuracy and timeliness of testing regardless of where the test is performed. The Food and Drug Administration (FDA) is the federal agency that authorizes and implements the CLIA laws and determines the test complexity categories. ### Title VII of Civil Rights Act of 1964 The Civil Rights Act prohibits an employer with 15 or more employees from discriminating on the basis of race, national origin, gender, or religion. The Civil Rights Act has also been amended several times to protect other groups. For example, the Pregnancy Discrimination Act of 1978 amended the Civil Rights Act and prohibited discrimination based on pregnancy and other related medical conditions. Sexual harassment is a form of sex discrimination that also violates the Civil Rights Act. ### Americans with Disabilities Act of 1990 (ADA) ADA forbids discrimination against any applicant or employee who could perform a job regardless of a disability. ADA also requires an employer to provide \"reasonable accommodations\" that are necessary to help the employee perform a job successfully unless these accommodations are unduly burdensome. ### Heads of the European Radiological Protection ### Competent Authorities (HERCA) Provides clarity on the regulator\'s approach to the roles of the undertaking and a range of professionals regarding the justification process. ### Good Samaritan Acts Allows bystanders to get involved in emergency situations without fear that they will be sued if their actions inadvertently contribute to a person\'s injury or death. ### Genetic Information Nondiscrimination Act of 2008 (GINA) Prohibits discrimination on the basis of genetic information with respect to health insurance and employment. ### Patient Safety and Quality Improvement Act (PSOIA) Framework for gathering and analyzing information regarding patient safety within the confines of protected health information laws. ### Anti-Kick Back Statute (AKBS) Criminal law that prohibits receiving benefits for referral or business involving federal health care programs. ### No Surprise Act (NSA) The No Surprise Act protects individuals from surprise billing if they have a group health plan or individual health insurance coverage. This includes banning surprise bills for emergency services from an out-of-network provider or facility without prior authorization. PROTECT PATIENT PRIVACY AND CONFIDENTIALITY =========================================== Legal Requirements for Maintenance, Storage, and Disposal of Records -------------------------------------------------------------------- ### Sharing Information and Release of Information The medical record contains sensitive information regarding patient history, current health status, and planned treatment. Training in proper documentation and maintenance of medical records and following federal and state laws and guidelines is essential to maintain patient privacy. There are many laws and regulations that guide how patient information and medical records should be managed. The most important law regarding protection of medical records is HIPAA, which outlines patient privacy and confidentiality and how patient information is managed. HIPAA gives patients' rights over their health care information. Patients have the right to receive a copy of their information, ensure the medical record is correct, and know who has had access to the record. Covered entities, such as health insurance companies, clearinghouses, and providers, must adhere to HIPAA. Employers are not considered covered entities because employee health records maintained by an employer are not used for HIPAA-covered transactions. The HIPAA Security Rule requires implementing reasonable and suitable safeguards to protect protected\' health information and to prevent breaches of confidentiality. HIPAA also requires providers to explain patient rights. The law requires patients to sign a form indicating they have received a privacy notice from a health care provider or hospital. HIPAA requires written consent when sharing health care information. HIPAA does not require a provider or health plan to share information with a patient\'s family or friends unless the person is legally identified as the patient\'s personal representatives. 1. *Administrative safeguards are used to refer to the policies and procedures documented in writing that show how covered entities comply with HIPAA.* 2. *Physical safeguards refer to the physical monitoring and access to PHI.* 3. *Technical safeguards refer to the responsibility of the health care provider to monitor and safeguard patient information through all technology- related items.* Patient data ownership can be broken into the ownership of the data versus the medical records and the ability of patients to access their data. Medical records are legal documents generated by the health care provider or facility. Because it is a legal document and even though the information in the medical records pertains to the patient, the patient\'s original medical records must remain with the health care facility, and the health care provider is the owner of the medical records. However, based on HIPAA, the patient has a right to the information that is in the medical record. Thus, with few exceptions, patients have the right to inspect, review, and receive a copy of their medical records and billing records that are held by health plans and health care providers. In addition, only the patient and any of their authorized representatives, such as a family member with the patient\'s consent, have the right to access the patient\'s medical record. To summarize the concept, the medical provider or the facility owns the actual medical record, but the patient owns the information, or data, found within the record. Patients may also request release of medical records or to receive copies of their medical records from the health care provider with a signed release form. This signed release form ensures that the confidentiality of the medical record is protected and can be shared only with an approved and authorized health care provider or entity. For example, if a patient transfers to another health care provider, the new health care provider may obtain the medical records only after the patient signs a release form. Health care staff should always prioritize patient privacy. However, there are a few exceptions that would allow for the release of medical records without the patient\'s authorization or a signed release form from the patient. These exceptions include the following. - **Criminal acts:** Evidence used in abuse cases, stabbings, gunshot wounds, or sexual assaults. - **Legally ordered:** The court can order medical records to be submitted as evidence in court case through the process of a subpoena. When the court orders someone to appear in court (a summons) and bring records with them it is termed subpoena duces tecum. - **Communicable diseases:** The Centers for Disease Control and Prevention or local health departments can require release of information in case of the possibility of diseases that potentially could cause a pandemic or sexually transmitted diseases, such as human immunodeficiency virus (HIV), syphilis, or tuberculosis. - **Mandated examinations:** Ordered by employers\' insurance companies for workers\' compensation cases. INFORMED AND IMPLIED CONSENT ============================ Consent is an act of reason, meaning the person giving consent must be of sufficient mental capacity and be in possession of all essential information to give valid consent. Consent must be free of force or fraud. There are many distinct types of consent. It is important for medical assistants and all health care professionals to be aware of them to protect themselves and their practice against cases of malpractice and torts, including assault and battery. Implied Consent --------------- This is inferred based on signs, actions, or conduct of the patient rather than oral communication. For example, an MA asks the patient if they can take their temperature, and the patient responds by opening their mouth and lifting their tongue. This concept also applies to emergent care for individuals who are unconscious or unable to speak. The law assumes implied consent to administer CPR and other lifesaving medical treatments to stabilize the patient. Expressed Consent ----------------- This is given either by oral or written words. For example, when an MA is giving an injection, they ask the patient if they are ready to receive the injection, as well as which arm they prefer. The patient responds by agreeing to the injection and stating which arm they would like the injection to go into. Informed Consent. ----------------- This is a process that ensures the patient (or the guardian of the patient) knows, understands, and accepts the treatment that has been explained. For example, a patient is informed they must have a procedure performed, it has been explained to them, and they sign off on having the procedure performed. In the health care setting, one of the most important types of consent is informed consent, which is a clear and voluntary indication of preference or choice, usually oral or written, and freely given in circumstances where the available options and their consequences have been made clear. Informed consent involves shared decision making between the patient and the health care provider. The health care provider must disclose appropriate information to a competent, adult patient so that the patient may make a voluntary choice to accept or refuse treatment. A competent adult must be oriented to time and place. They must be of clear mind and be able to understand all of the information given by the health care provider. *Consent is a critical aspect of patient autonomy, in protecting the legal rights of patients, and guides the ethical practice of health care.* The health care provider must detail all possible risks and potential prognoses for having a treatment or procedure performed and the available alternatives. Failure to obtain informed consent may lead to a case of medical negligence and malpractice. Unless it is an emergency, health care professionals should not proceed with any procedure without the consent of the patient. Minors (those under the age of 18) cannot give consent except in these two situations. First, if the minor is seeking birth control, pregnancy care, sexually transmitted disease treatment, or substance abuse treatment, then they may do so without the consent of a parent. Second, if the minor has been declared by the courts as emancipated, then they are able to make medical, financial, and housing decisions for themselves without the approval of a parent or guardian. Emancipated minors win the approval of the courts by being enlisted in the military, being financially independent, living independently, or being married. OBTAIN, REVIEW, AND COMPLY WITH MEDICAL DIRECTIVES ================================================== Advance Directives ------------------ It is important to be familiar with laws and different advance directives related to end-of-life issues. Advance or medical directives consist of a set of requests that patients put in writing for their health care provider, family, and other health care professionals to carry out in the case patients are incapacitated and are unable to speak for themselves. An advance directive allows patients to express values and desires related to end-of-life care. It will indicate what medical treatment patients wish to have if they are dying or permanently unconscious and identifies a health care agent for the patient who can help make decisions on the patient\'s behalf. The health care provider must obtain, review, and comply with these directives. The two main elements in an advance directive are a living will and durable power of attorney for health care. Living Will ----------- A living will is a legal document stating what procedures patients would want, which ones they would not want, and under what conditions these decisions would apply, such as the following. - Analgesia (pain relief) - Antibiotic and antiviral treatment - IV hydration - Artificial feeding - Cardiopulmonary resuscitation (CPR) - Ventilators - Dialysis - Organ donation - Do-not-resuscitate (DNR) orders Durable Power of Attorney ------------------------- The durable power of attorney (DPOA) for health care is a legal document naming a health care agent or proxy to make medical decisions for patients when they are not able to do so, in the case they become incapacitated or unable to communicate. The agent will be able to decide as the patient would when treatment decisions need to be made. The agent communicates the same rights to request or refuse treatment that the patient would have if capable of making and communicating these decisions. A DPOA for health care enables patients to be more specific about their medical treatment than a living will. The agent may decide on a wide range of health care issues, including whether to admit or discharge the patient from a hospital or nursing home, what treatments may or may not be given, who can have access to the patient\'s medical records, and even how the patient\'s body is disposed of after death. For example, the agent may donate the patient\'s organs, order an autopsy, and even direct funeral arrangements. If the patient has specific requests, such as how to dispose of the patient\'s body after death, it must be in writing. If an individual does not designate a health care agent or proxy and cannot make health care decisions, state law often appoints an individual who can make decisions on the individual\'s behalf, including the following. - Court-appointed guardian or conservator - Spouse or domestic partner - Adult child - Adult sibling - Close friend - Nearest living relative Advance directives are legally valid throughout the United States as soon as the patient signs them in front of the required witnesses. Once the patient has completed a medical directive, a copy should be given to the family, hospital, and providers to review and have on file. The laws governing advance directives vary by state. Providers must fully evaluate the patient\'s condition before advance directives can be applied. Advance directives do not expire; they remain in effect until they are officially changed. The directive should be reviewed often and revised if necessary. Do Not Resuscitate ------------------ Medical assistants should also be aware of several other forms that may be supplements to a patient\'s advanced care plan. As discussed earlier, a do-not-resuscitate order (DNR order) is a legal order written either in the hospital or on a legal form to communicate the wishes of a patient to not undergo CPR or advanced cardiac life support if the patient\'s heart stops or the patient stops breathing. A DNR order does not affect any treatment other than that which would require intubation or CPR. Patients who have a DNR order can continue to get chemotherapy, antibiotics, dialysis, or any other life- sustaining treatments. ### POLST Form Physician Orders for Life-Sustaining Treatment (POLST) is another type of advance directive, typically reserved for patients who may be near end of life. A physician fills out a life-sustaining treatment (POLST) form that contains a set of medical orders completed by the health care provider detailing the patient\'s end-of-life care. The POLST forms involves a shared decision-making process between the health care provider and patient with advanced or terminal illness and adheres to the patient\'s goal of care. An important aspect of the POLST form is the portability, meaning that the medical orders move with you as you move to other health care providers and practices. LEGAL REQUIREMENTS REGARDING REPORTABLE VIOLATIONS OR INCIDENTS =============================================================== Criminal and Civil Acts ----------------------- To ensure patient protection, health care professionals are bound by a variety of laws and regulations and by a wide range of legal and ethical responsibilities to their patients, employers, and society. The MA should be familiar with the different types of laws and how to protect themselves and their employer against medical malpractice. In general, there are two main categories of law: criminal and civil. Criminal Law ------------ This is concerned with violations against society based on the criminal statutes or codes. The remedies or punishments for violating state or federal criminal laws are monetary fines, imprisonment, and capital penalty (death). Violations of criminal laws are called crimes. Misdemeanors ------------ These are lesser crimes punishable usually by monetary fines established by the state but may also include imprisonment of 1 year or less. Felonies -------- These are more serious crimes punishable by larger fines and/or imprisonment for more than 1 year, and in some states, the death penalty may be levied on a convicted felon for severe crimes, such as murder. In many states, a felony conviction for a health care professional may also include the revoking of a license to practice in their profession. A health care professional may be prosecuted for a crime for practicing without a license, falsifying information in obtaining a license, or failing to provide life support for a patient. As discussed in the previous section, a health care provider failing to get informed consent from a patient may constitute a type of felony called battery, which is the actual nonconsensual physical contact on another person. Civil Law --------- These laws protect the private rights of a person or a person\'s property. Civil laws include the areas of contracts, property, labor, privacy issues, and family law. A violation of civil law may lead to a civil lawsuit by the victim, which is a case brought to the courts to hold a party responsible for a wrongdoing. A wrongdoing or violation of civil law is called a tort. A tort is an action that wrongly causes harm to an individual but is not a crime. Torts ----- There are two major classifications of torts: intentional and unintentional, which is classified as negligence. Intentional Tort ---------------- This is a deliberate act that violates the rights of another. Examples of intentional torts include assault, battery, defamation of character, invasion of privacy, and administration of an injection without the consent of the patient. Negligence ---------- This is a common tort in the health care setting. Negligence does not require a specific intent to harm someone and is not a deliberate action but is the result of an individual or party failing to act in a reasonable way where a duty was owed. Malpractice ----------- Malpractice is an act of negligence and describes an improper or illegal professional activity or treatment, often used regarding a health care professional causing an injury to a patient. The negligence might be the result of errors in diagnosis, treatment, or postoperative care or a violation of patient confidentiality. Malpractice requires proof of a breach of a standard of care, and the breach must cause damage or harm. In general, the standard of care in a medical malpractice case is defined as the type and level of care an ordinary, prudent health care professional, with the same training and experience, would provide under similar circumstances. In other words, the critical question in a medical malpractice case is: \"Would a similarly skilled health care professional have provided me with the same treatment under the same, or similar, circumstances?\" Penalties in civil law are almost exclusively monetary, which the court decides on for damages. The plaintiff or injured party may receive a monetary award for injuries sustained as a result of a particular incident, as well as compensation for medical expenses, lost wages, and the pain and suffering associated with the negligence. There are four basic elements in negligence. They are known as the four D's of Negligence. - **Duty of Care:** One party has a legal obligation to act in a certain manner toward the other. - **Dereliction of Duty:** Also called a breach, this is a failure to use reasonable care in fulfilling the duty. - **Direct Cause:** The failure in the duty leads to harm suffered by the injured person. - **Damages:** The harm or injury can be remedied by monetary compensation. Mandated Reporting ------------------ There are federal and state laws and statutes that mandate health care providers and professionals to report and document incidents of concern for a patient\'s safety and for the safety of the public at large. In the health care field, mandatory reporting duties refer mainly to the responsibility of health care professionals to report vital information and incidence to the appropriate agencies for the protection and welfare of the public, as well as specific vulnerable populations. Although these mandatory reporting guidelines may vary by state, prompt reporting of the following is mandatory. - Births - Deaths - Certain communicable diseases, including specific sexually transmitted infections (STis) - Assaults or criminal acts - Abuse, neglect, and exploitation-child, older adult, and intimate partner According to the Centers for Disease Control and Prevention (CDC), there are more than 120 national notifiable diseases, or diseases required by law to be reported to government authorities. This includes tuberculosis, meningitis, acquired immunodeficiency syndrome (AIDS), and many sexually transmitted diseases. If a disease can be quickly transmitted to many individuals and may endanger the general population and may create an epidemic, it is the responsibility of health care providers· and professionals to notify the proper authorities to prepare and, hopefully, prevent or limit the spread of that disease or illness. In fact, it is a legal and ethical mandate that these cases are reported to the local department of health, which may then be reported to the CDC. In addition, the information gained from reporting allows the local, state, and federal government to make informed decisions on laws and policies about specific activities, such as food handling, insect control, sexually transmitted infections, and disease tracking and immunization programs. Although this may vary by state, in general, physicians; veterinarians; podiatrists; nurse ; practitioners, nurses, and nurse midwives; physician assistants; medical examiners and coroners; dentists; and administrators of health facilities and clinics, dispensaries, correctional facilities, or any other institution that diagnoses or treats a communicable disease are required to report communicable diseases to their local health department. Most local and state health departments have specific forms for reporting. Abuse ----- Every state has mandatory reporting laws for abuse, specifically child abuse and elder abuse, and many states have requirements for reporting domestic violence. Abuse is defined as a misuse or maltreatment and may take many forms but includes the following types and actions. - **Physical:** Pushing, hitting, shoving, punching, biting, choking, and physically trapping or impeding movement - **Verbal/emotional:** Criticizing, degrading, swearing, blaming, and attacks that harm self-esteem - **Psychological:** Isolation from family and friends, controlling actions and decisions, stalking, and invading privacy or space - **Sexual:** Forcing or demanding sex, forcing unwanted sex with another person, forcing engagement into prostitution or pornography, and refusing to use safe sex practices - **Economic:** Forbidding an individual from working, controlling access to money, and exploiting citizenship or lack of citizenship to work or to prevent from working Statutes in each state provide more specific details describing the behaviors that are considered grounds for abuse or neglect and the penalties and proof needed to sustain the cases. In the case of child or olq.er adult abuse, there are several signs, such as the following. - Previously filed reports of physical or sexual abuse of the child - Documented abuse of other family members - Different stories between parents and child on how an accident happened - Stories of incidents and injuries that are suspicious - Injuries blamed on other family members - Repeated visits to the emergency department for injuries - Discolorations/bruising on the buttocks, back, and abdomen - Elbow, wrist, and shoulder dislocations - Delays in the normal growth and development patterns - Erratic school attendance - Poor hygiene - Malnutrition - Obvious dental neglect - Neglected well-baby procedures (e.g., immunizations) Every state has statutes that require specific professionals and persons to report suspected abuse and neglect to appropriate agencies. They often include the following. - Social workers - Teachers, principals, and other school personnel - Physicians, nurses, and other health care professionals - Counselors, therapists, and other mental health professionals - Childcare providers - Medical examiners or coroners - Law enforcement officers Since each state varies in terms of what constitutes abuse and the reporting mechanism, the MA should familiarize themselves with the child protection statutes in the area in which they work as a medical assistant. The law requires reporting all cases of suspected, but not necessarily proven, abuse. Anyone who reports their suspicions in good faith is protected from lawsuits. Information elicited during a child abuse evaluation may potentially be used in a legal proceeding against the alleged perpetrator. ETHICS AND VALUES ================= Medical assistants are accountable to a health care provider or a hospital, but this does not exclude them from personal responsibility. Understanding the law, standards of practice, and ethical principles that govern them and their profession will help them make legal and sound decisions when confronted with an ethical situation or dilemma. Ethics are the rules, standards, and moral principles that govern a person\'s behavior and on which the person bases decisions. Ethics are concerned with questions of how individuals in a society should act by defining right and wrong and appropriate conduct to serve the greater good. Ethics encompasses several different facets. One aspect of morals describes how \'\'good or bad\" or how \"right or wrong\" an action is. Similarly, values, or an individual\'s ethics, refer to one person\'s moral principles or what an individual believes is right or wrong. Values govern a person\'s decisions, with a goal of maintaining one\'s integrity or conscience. An individual\'s values may be influenced by concepts of honesty, fidelity, equality, compassion, responsibility, humility, and respect for life. There are many types and fields in ethics, including personal, common, and professional. Personal ethics determines what an individual believes about morality and right and wrong. It includes one\'s personal values and moral qualities and is influenced by family, friends, culture, religion, education, and many other factors. Personal ethics has an impact on areas of life such as family, finances, and relationships and may change during one\'s life. An example of one\'s personal ethics may be for a person to believe in the death penalty but support a woman\'s right to an abortion. Common ethics, also called group ethics, is a system of principles and rules of conduct accepted by a group based on ethnicity, political affiliation, or cultural identity. An example of common ethics is for a person who is religious to believe all abortion and the death penalty are bad and all life should be preserved. Professional ethics is a type of ethics that aims to define, clarify, and criticize professional work and its typical values. Professional ethics sets the standards for practicing one\'s profession and can be learned only through education or training or on the job. It involves attributes such as commitment, competence, confidence, and contract. Professional ethics is often used to impose rules and standards on employees in an organization or members of a profession. Examples of professional ethics are in employee handbooks, codes of ethics, and the Hippocratic Oath taken by physicians. A branch of ethics is medical ethics, which is the morals, moral principles, and moral judgments that health care professionals use to determine whether an action should be allowed based on \"right and wrong.\" In addition to examining facts, medical ethics uses moral analysis to assess the obligations and responsibilities of health care professionals on various issues and challenges related to health care and medicine. It specifically addresses how to handle ethical issues arising from the care of patients and focuses on the health care professional\'s duty to the patient. The basic principles of medical ethics are the following. ### Adhere to Professional Codes of Ethics #### Autonomy The capacity to think, decide, and act on one\'s own free will and initiative. The patient\'s decision-making process must be free of coercion or coaxing. Health care professionals should help patients come to their own decisions by providing full information. #### Justice The principle that ethics should be based on is what is consistent and fair to all involved. Patients in similar situations should have access to the same care. Health care professionals must consider four main areas when evaluating justice: fair distribution of scarce resources, competing needs, rights and obligations, and potential conflicts with established legislation. #### Beneficence This is the general moral principle of doing the \"most good\" or doing what is best for patients. This must consider the patients\' pain, their physical and mental suffering, the risk of disability and death, and their quality of life. What is best for the patient may agree or disagree with the health care provider\'s clinical judgment. #### Nonmaleficence This is the principle of\" do no harm\" to the patient or to the fewest number of people in society. It is difficult for health care providers to always apply successfully the \"do no harm\" principle because, for example, most treatments involve some degree of risk or adverse effects. IDENTIFY BELIEFS AND VALUES AND PROVIDE UNBIASED CARE ===================================================== MAs will interact and provide care to a diverse patient population with different backgrounds, beliefs, values, experiences, and identities. This may include race, ethnicity, sex, age, religion, language, education, sexual orientation, and gender identity. Health care providers, professionals, and systems must create and deliver culturally competent patient care. Cultural competence is defined as the ability of providers and organizations to effectively deliver health care services that meet the needs of patients. To build communities that are successful at improving conditions and resolving problems, MAs need to understand and appreciate many cultures, establish relationships with people from cultures other than their own, and build strong alliances with different cultural groups. This is particularly true in health care as they will need to successfully interact with patients, family members, and coworkers from many different cultures. Although it is a broad concept, culture can be defined as the act of belonging to a designated group or community that shares common experiences that shape the way its members understand the world. Cultural practice and norms are often learned, shared, and passed on through generations. It may include groups that a person is born into, such as race, national origin, sex, class, or religion. Culture is a strong part of people\'s lives. It influences their views, their values, their humor, their hopes, their loyalties, and their fears. Culture helps guide thinking, decision making, and actions. Culture also affects interpersonal relationships, including marriages, communication patterns, and sexual habits. A bias denotes a preference for a certain group, concept, or set of things. Biases may be held by an individual, group, or institution and can have negative or positive consequences. The two main types of biases are conscious bias (also known as explicit bias) and unconscious bias (also known as implicit bias). Most people understand that there is no place for this in the modern workplace. In fact, there are many laws and policies that exist to prevent prejudice based on race, age, sex, gender identity, physical abilities, religion, sexual orientation, and many other characteristics. Violations of these laws and policies may result in disciplinary action, termination of employment, and even criminal charges. It is important to note that biases, conscious or unconscious, are not limited to ethnicity and race. Though racial bias and discrimination are well documented, biases may exist toward any social group. One\'s age, sex, gender identity, physical abilities, religion, sexual orientation, weight, and many other characteristics are subject to bias. Whether recognized or not, bias and prejudice can substantially undermine multicultural acceptance and inclusion in the health care setting. Confronting one\'s own biases and prejudice is a great first step toward building multicultural competence. Cultural competence is an ongoing learning process. Health care professionals must continue to be aware of the influences that sociocultural factors have on patients and health care providers and professionals and the clinical relationship. WRAP-UP ======= This chapter has provided an overview of laws that pertain to health care, standards, and guidelines that help to regulate the practice of patient care. All members of the health care profession must understand their responsibility to themselves, their employers, and their patients. By understanding the different types of law and how they apply to the role as a medical assistant, MAs will be better able to provide better patient care and conduct themselves in a manner that is legal and compliant. In addition, they will be more capable of making sound decisions concerning their role in providing quality patient care and in protecting themselves and their employer from negligence and malpractice lawsuits. Chapter Vocabulary ================== **advance directives.** Written statements of a person\'s wishes regarding medical treatment, such as a living will. **Americans with Disabilities Act of 1990 (ADA).** Law that forbids discrimination based on disability. **Anti-Kick Back Statute (AKBS).** Criminal law that prohibits receiving benefits for referral or business involving federal health care programs. **autonomy.** The capacity to think, decide, and act on one\'s own free will and initiative. **beneficence.** A moral obligation to act in the best interest of others. **Clinical Laboratory Improvement Act (CLIA).** A 1988 amendment that regulates federal standards that apply to all clinical laboratory testing performed on humans in the United States. **Controlled Substances Act (CSA).** Statute that identifies all regulated substances into one of five schedules depending on potential for abuse. **do-not-resuscitate (DNR).** An order written in the hospital or on a legal form to communicate the wishes of a patient to not undergo CPR or advanced cardiac life support if the patient\'s heart stops or the patient stops breathing. **durable power of attorney (DPOA).** A legal document naming a health care agent or proxy to make medical decisions for patients when they are not able to do so, in the case they become incapacitated or unable to communicate. **Emergency Medical Treatment and Active Labor Act (EMTALA).** Law that requires any hospital emergency department that receives payments from federal health care programs, such as Medicare and Medicaid, to provide an appropriate medical screening to any patient seeking treatment. **Genetic Information Nondiscrimination Act of 2008 (GINA).** Law that prohibits discrimination on the basis of genetic information with respect to health insurance and employment. **Good Samaritan Acts.** Law that allows bystanders to get involved in emergency situations without fear that they will be sued if their actions inadvertently contribute to a person\'s injury or death. **Heads of the European Radiological Protection Competent Authorities (HERCA).** Association that provides clarity on the regulator\'s approach to the roles of the undertaking and a range of professionals regarding the justification process. **Health Information Technology for Economic and Clinical Health (HITECH) Act.** Law that includes provisions that allow for increased enforcement of the privacy and security of electronic transmission of patient information, such as prohibiting the sale of PHI, making business associates and vendors liable for compliance with HIPAA, and creating a penalty and violation system. **Health Insurance Portability and Accountability Act of 1996 (HIPAA**). Federal law that required the creation of national standards to protect sensitive patient health information from being disclosed without the patient\'s consent or knowledge. **implied consent.** Consent granted when a patient assumes the position and allows the medical professional to perform it. **informed consent.** An oral or written agreement of mutual communication that ensures the patient has been notified about their health care choices before making them. **justice.** Fair distribution of benefit, risk, resources, and cost to ensure equal treatment. **malpractice.** Any treatment by a medical professional that does not follow the standards of care. **medical law.** Laws that explain the rights and responsibilities of medical providers and patients. **negligence.** When a patient does not receive adequate and appropriate care, which leads to suffering and harm. **No-Surprise Act (NSA).** Law that protects individuals from surprise billing if they have a group health plan or individual health insurance coverage. **nonmaleficence.** A commitment not to cause harm. **Patient Safety and Quality Improvement Act (PSQIA).** Framework for gathering and analyzing information regarding patient safety within the confines of protected health information laws. **Physician Orders for Life-Sustaining Treatment (POLST).** Type of advance directive, typically reserved for patients who may be near end of life. **subpoena duces tecum.** A requirement to bring requested documentation to the court of law when appearing for the summons. **Title VII of Civil Rights Act of 1964.** Law that prohibits an employer with 15 or more employees from discriminating on the basis of race, national origin, gender, or religion. **tort.** \"Wrong,\" or a harmful act committed by one individual to another.