Week 9 Ethical Legal Responsibilities Fall 2024 PDF

Introduction to Health Science Ethical and Legal Responsivities  Objectives Explain the meaning of ethics and its importance in health care State the purpose of professional codes of ethics Explain the meaning of values and how they influe...

Introduction to Health Science Ethical and Legal Responsivities  Objectives Explain the meaning of ethics and its importance in health care State the purpose of professional codes of ethics Explain the meaning of values and how they influence personal and professional behavior Describe the relationship between ethics and law List the major ethical principles that apply to health care Explain ethics challenges to the health care community Explain the importance and types of patient consent and importance of it Discuss principles of health care ethics  Ethics  Guides decision making  System of principles a society develops to guide decisions about what is right and wrong  Helps to deal with difficult and complex problems  Varies among cultural groups  Influenced by religion, history, and collective experiences  Ethics & Law  Ethics provide general principles on which laws are based  Sometimes laws conflict with individual ethics: (marijuana legalization)  Laws can have negative, unintended consequences: emergency rooms cannot turn away patients who cannot pay, led to closure of many emergency rooms  Ethics dilemma  Situations that have no clear answers or correct courses of action  E.g., gun control, capital punishment, freedom of speech, abortions, euthanasia(*‫) ق**تلرحيم‬, etc.  Ethics & Health care  The practice of health care involves life-and-death issues, which are often at the heart of ethical questions.  Hippocrates (Greek physician) - ethical considerations of medicine.  Creating a sustainable system that ensures adequate care in a timely and cost-effective way remains a major challenge http://www.pbs.org/wgbh/nova/body/hippocratic-oath-today.html  Professional Codes of Ethics  Health care professionals are guided by principles outlined in occupation specific codes of ethics developed by professional organizations.  Codes provide guidelines for handling difficult issues  Personal Values  Values are the beliefs and ideals that provide the foundation for making decisions and guiding behaviour.  Influenced by family, religion, education, and personal experience.  Establish priorities: family more important than possessions (properties).  Values are not necessarily right or wrong, but it is important to be clear about personal values. Why we need those values ?  Guiding Principles of Health Care Ethics 1. Preserve life 2. Do good 3. Respect autonomy (self-government) 4. Uphold justice (fairness) 5. Be honest 6. Be discreet 7. Keep promises 8. Do no harm 1. Preserve life Life is precious – Take all possible means to preserve it No agreement on definition of life – Artificial means of supporting life – Euthanasia (mercy killing) to relieve suffering Illegal in most of states  1. Preserve life: Dilemmas  Organ transplantation  Allocation of donated organs Medical urgency Blood, tissue, and size match Time the patient has waited Proximity to the donor Age of the patient (children are sometimes given priority)  Rationing care and resources  Role of insurance companies  Certain types of care are not available to all patients  2. Do Good Promote welfare “wellbeing” of others – Basic duty of health care professional Work in best interest of patients Perform one’s job without expectation of receiving anything extra  3. Respect Autonomy Autonomy - self determination – Patients have right to make own decisions May choose type of treatment May refuse treatment Consent – Permission – Patient must give Consent for treatment – Can be given by the following: – Mentally competent adults – Emancipated “free” minors 3. Respect Autonomy: Consent Informed consent – Is the process in which patient will receive information about the procedure/treatment including possible consequences. 1.Implied consent – Indicated by patient’s actions 2.Express consent – More formal – oral or written Given in writing  3. Respect Autonomy: Advance Directives Self-determination about health care decisions is possible through the use of advance directives. These are written instructions that outline individuals’ desires regarding care should they become unable, as the result of illness or injury, to make these decisions Designation of health care surrogate/representative – “health care power of attorney,” individuals designate specific people to act on their behalf if they become unable to make health care decisions. Living will/health care instructions – This document outlines an individual’s wishes regarding the type and extent of care to be given. individual consents to certain procedures 3. Respect Autonomy: Advance Directives 27 year old Terri suffered a cardiac arrest in 1990 & never regained Terry consciousness, lived in nursing homes, & fed & hydrated by tubes. Schiavo In 1998, Michael, Terry’s husband, petitioned the court for guardianship to authorize termination of life- prolonging procedures. Terry’s parents, opposed the petition. https://www.youtube.com/watch?v=8W7tep6lxOQ https://en.wikipedia.org/wiki/Terri_Schiavo_case 4. Uphold justice Justice refers to fairness – All patients must receive same level of care – Dilemmas: Equitable distribution of health care resources Ranking and rationing of health care services Laws require reporting of abuse – Report suspected abuse to supervisor – Patient confidentiality does not apply 4. Uphold justice: Reporting Abuse  Laws require reporting of abuse  Child Abuse (UAE Wadeema’s Law) https://www.khda.gov.ae/CMS/WebParts/TextEditor/Documents/Children_Law _English.pdf https://www.khaleejtimes.com/nation/general/wadeema-law-lays-down-legal-rig hts-of-children  Elder abuse https://www.thenational.ae/uae/government/uae-elder-abuse-law-in-the-works-1.30197 https://www.dfwac.ae/who-are-we 4. Uphold justice: Laws  Occupational Safety and Health Act  Requires employers to be responsible for safety and health of employees  Controlled Substances Act  Helps prevent abuse of addictive drugs  Provides guidelines for prescribing and handling 5. Be Honest Good health care relies on honesty Patient’s trust important Dilemma: – How much to tell patients about their condition Honesty essential among coworkers and with supervisor 5. Be Honest: Fraud Dishonesty involving cheating or trickery Health care examples: – Insurance claims for services not performed – Selling ineffective treatments – Claiming education or credentials one does not have 6. Be Discrete Being careful about what you say, preserving confidences, and respecting privacy. Confidentiality: – Patients have a legal right to privacy concerning their medical affairs. Close doors and curtains Drape patients appropriately Do not discuss patients in public areas Discuss patients only with other authorized personnel 6. Be Discrete Patient information cannot be released to anyone without the patient’s written approval. Dilemmas: – Public safety Patient has contagious disease – Patient desire to harm self 7. Keep promises Promises are important part of relationships with others. Contracts are formalized promises that are enforceable by law. They contain the agreements of people to do certain specified things. – If one of the parties fails to fulfil his or her part of the agreement, this can result in a breach of contract 8. Do No Harm Essential responsibility of health care professionals: Negligence – Failure to meet reasonable standard of care – an honest mistake that leads to an injury Malpractice – Professional negligence – healthcare professional is aware of the possible consequences before making a mistake that led to an injury – May result in lawsuit against health care provider and/or facility 8. Do No Harm Good Samaritan laws – Protect individuals who give care in emergency situations – Best to stay within scope of training Handling Ethical Dilemmas Priority – Well-being of patient Accept responsibility for making difficult decisions – Part of health care work Report illegal behavior Ethics and Health Care: Impact of technological advances – Definition of life: how long should comatose patient on life supporting machines? – Expense of care: with increased price of health care, how could we control costs and maintain quality? – Birth control: should anyone be given birth control information and products? – Vaccinations: should parents be required to vaccinate their children?  Preserve life: Question 1 True or False: – It is illegal in most states to withdraw artificial means of supporting life.  Preserve life: Answer True Illegal to withdraw life support under certain conditions  Preserve life: Question 2 Which of the following patients would most likely receive a liver that becomes available from a donor? A. Patient who has never abused alcohol B. Patient who will likely die within weeks without a transplant C. Patient who can best afford the surgery  Preserve life: Answer B. Although many factors are taken into account when determining who will receive an organ, medical urgency is a common consideration.  Respect Autonomy: Question If a patient schedules a root canal and shows up at the appointed time for the procedure, this is an example of _____. A. Express consent B. Implied consent C. Informed consent  Respect Autonomy: Answer B. Implied consent Implied consent – Given by patient’s actions – In this case, patient makes and keeps appointment for procedure  Respect Autonomy: Question True or False: – A patient admitted to a hospital is legally required to sign a living will.  Respect Autonomy: Answer False Patients are not legally required to prepare advance directives – However, health care facilities must advise patients of their right to do so  Be Discrete: Question True or False: – Individual health care facilities must develop policies for protecting patient confidentiality.  Be Discrete: Answer True – Following federal guidelines, health care facilities must develop policies and procedures for maintaining patient confidentiality  Do No Harm: Question True or False: – Poor communication between the patient and the health care professional is a major cause of malpractice lawsuits.  Do No Harm: Answer True Major contributors to malpractice lawsuits: – Poor communication – Resulting patient anger  Question True or False: – Some laws have harmful results.  Answers True Some laws, though meant to be fair, have unintended consequences that harm rather than help  Question True or False: – A good system of ethics will provide answers to most health care decisions.  Answer False Many health care issues have no easy answers and present serious ethical dilemmas  Question Which of the following is an example of a value? A. Law that protects the welfare of patients B. Professional code for behavior C. Personal belief that education is necessary for a satisfying life  Answer C. Personal belief that education is necessary for a satisfying life Value – Belief on which decisions are based – Tends to be personal Questions  Recap Ethics and its importance in health care Professional codes of ethics Values, personal and professional behavior Ethical principles that apply to health care Ethics challenges to the health care community Patient consent and importance of it Principles of health care ethics