Ethics and Legal Considerations in Clinical Decision Making PDF

Ethics and Legal Considerations Clinical Kinesiology Graduate Certificate- Professional Practice  Ethics by Definition A system of moral principles The principles of right and wrong The rules of conduct recognized in respect to a particular class of human actions or a particula...

Ethics and Legal Considerations Clinical Kinesiology Graduate Certificate- Professional Practice  Ethics by Definition A system of moral principles The principles of right and wrong The rules of conduct recognized in respect to a particular class of human actions or a particular group, culture, etc. Moral principles, as of an individual Branch of philosophy dealing with values relating to human conduct, with respect to the rightness or wrongness of certain actions and to the goodness and badness of the motives and ends of such actions Ethics vs. Law The law may be understood as The systematic set of universally accepted rules and regulation created by an appropriate authority such as government, which may be regional, national, international, etc. It is used to govern the society and the action and behavior of its members and can be enforced, by imposing penalties. 3 A Moral Compass Individual ethics are like snowflakes – no two are alike. What one person sees as just and right, another may view as unfair or immoral. Not all immoral acts are illegal, not all illegal acts are immoral 4  Professional Ethics Historically, professional ethics were confined within the professions themselves Unquestioned trust and admiration on the part of the clients or the general public Professional ethics improve professional service and assist with public confidence Members of a profession are bound together by common aspirations, values, and training The profession is a moral community The public puts its trust in individual professionals AND professional groups. They rely on the group to guarantee that its members fulfill their agency obligations 5 COKO Code Of Ethics Respect Honesty & Excellence Integrity Communication, Autonomy & Collaboration & Well being Advocacy  Steps To Ethical Decision Making There is an ethical issue or something is making you uncomfortable Recognize What is the problem & who is involved Identify Facts, laws, principles & values Consider Are there barriers? Take action What information should be recorded? & implement What was the outcome & is further action needed? What did you learn? How can you prevent future occurrences? Evaluate  Reflective Practice Today’s health care professionals must function in complex and changing health care systems, continuously refresh and update their knowledge and skills, and frame and solve complex patient and healthcare problems Reflection & reflective practice are essential attributes of competent health care professionals who are prepared to address these challenges As one’s professional identity is developed, there are aspects of learning that require understanding of one’s personal beliefs, attitudes and values, in the context of those of the professional culture To learn effectively from one’s experience is critical in developing and maintaining competence across a practice lifetime Building integrated knowledge bases requires an active approach to learning that leads to understanding and linking new to existing knowledge Taken together, these capabilities may underlie the development of a professional who is self-aware, and therefore able to engage in self-monitoring and self-regulation  Using Clinical Reasoning A skill, process, or outcome wherein clinicians observe, collect, and interpret data to diagnose and treat patients In order to do this effectively, practitioners must incorporate information from a variety of areas to make informed decisions over a period of time Collect a thorough description of the problem or concern Apply appropriate testing measures Evaluate and utilize evidence-based practices Have a thorough understanding of the healing process for injured tissue and optimal performance The client & their overall goals CKO Complaints Process 10 Complaints Against Kinesiologists If someone has a concern or complaint about the care received/provided from a kinesiologist, they have the right to submit a complaint to the College. Among the reasons for complaints are concerns that a kinesiologist has: ignored the basic rules of practice; sexually abused a patient/client; not maintained the standards of practice; provided inappropriate care/service; a physical or mental condition or disorder that interferes with their ability to practice. The Complaints Process By law, the college must address all complaints it receives about kinesiologists. This includes complaints from patients/clients, their family members, friends, or caregivers, other professionals, employers and insurers. As an employer or facility operator, mandatory reporting obligations A complaint can be withdrawn at any time however the committee may decide to proceed with an investigation A record of the complaint must be submitted for an investigation to begin,, indicating: the complainants name & contact information, the name of the kinesiologist, a description of the behavior, action or inaction you are concerned about The college cannot investigate anonymous complaints There is no time limit to file a complaint Inquiries, Complaints & Reports Inquiry: relates to issues of incapacity If a member is suffering from a physical or mental condition that makes it desirable in the interest of the public that their certificate of registration be subject to terms, conditions or limitations, or that they not be permitted to practice Complaint: expression of concern regarding a member by one or more complainants Report: information received by the College from any source regarding a members professional misconduct or incompetence Mandatory reports (e.g. by self, employer, fellow health professional) regarding conviction, sexual abuse, termination, loss of privileges Other reports (e.g. media, other health professionals, members of public, etc.) Complaints Vs. Reports COMPLAINT REPORT Must be in writing or recorded (Code Can be verbal s.25(4)) The member and complainant must Potentially anonymous information be identifiable (no anonymous source (e.g. media report) complaints) The complainant and member are The information source is not a party parties (participants) to proceeding (participant) to the proceeding Specific rules regarding timelines, Fewer specific rules regarding disclosure, appeals, etc. timelines, disclosure, etc. The Complaints Process After a complaint has been filed College staff will contact the complainant within 14 days of receiving the complaint to confirm they have received the documentation. A College investigator will be appointed to investigate the matter and collect information The kinesiologist receives a copy of the complaint and have an opportunity to respond in writing. Information collected will be reviewed by the Inquiries, Complaints and Reports Committee (ICRC). The panel includes kinesiologists and members of the public. ICRC Decisions When the committee comes to a conclusion regarding a complaint they can: Refer the matter to the College’s Discipline Committee Refer the matter to another panel of the Issue a caution to the kinesiologist Require the kinesiologist to complete programs that will improve their practice. Issue written advice with or without recommendations Enter into an agreed upon undertaking with the kinesiologist that outlines things he/she must do Decide that no further action is required Both the complainant and the kinesiologist have the right to appeal the ICRC's decision to the Health Professions Appeal and Review Board (HPARB) if they feel the investigation was inadequate or the decision was unreasonable. Information on how to file an appeal is provided to the parties. What Does The Public See? Posted on the Public Register Referrals to Discipline, including information about the allegations and the hearing Cautions Specified Continuing Education or Remediation Program (SCERP) Undertakings Terms, Conditions, Limitations Suspensions Not Posted on the Public Register Practice Advice No Action  Ethical Issue vs. Legal Issue Not all ethical complaints will result in legal action however, any legal action taken against you will result in ethical investigations from your professional organizations 18 Legal Considerations 19 Assumption of Risk Participation in any activity or intervention comes with risk You should make these known and this can be done through the use of a waiver When signed, it is assumed that they understand this concept and it does NOT waive their right to take legal action against you &/ an organization It is assumed you will do your job and conduct yourself and your duties in an appropriate manner 20 Liability You will always be held accountable for your actions You are liable for all actions that you perform (or do not perform) when you are working in a health care capacity The term ‘Liability’ refers to being legally responsible for the harm you cause another person You must always take great care in following procedures to prevent harm to others thereby reducing the risk of being sued In Ontario, the statute of limitations is 2 years 21 Torts Torts are legal wrongs committed against the person or property of another It is expected that you will “first do no harm” to others Tort law provides damages to victims as compensation for their losses Under legal obligation to ensure reasonable care to ensure others will not be injured because of careless Under legal obligation to ensure reasonable care to ensure others will not be injured because of careless conduct When injury occurs, either intentionally or by negligence, they can be required by a court to pay money to the injured party. Intentional Tort: Battery and Assault are examples Unintentional Tort: Negligence 22 Legal “wrongs” can emanate from: Nonfeasance (act of omission): Failure to perform your legal duty Malfeasance (act of commission): Individual commits ab act that is not legally theirs to perform Misfeasance (act of commission): An individual improperly does something that he or she has the legal right to do 23 Negligence Negligence: the failure to use ordinary or reasonable care Care that persons would normally exercise to avoid injury to themselves or others under similar circumstances To establish negligence a complainant must establish 4 things: 1. A duty of care existed between the injured person and the person responsible for that injury 2. The defendant breached this duty by conduct that fell short of the standard of care 3. The defendant caused the injury to occur 4. Personal, property, or punitive damages resulted  Professional Liability Insurance Liability insurance covers claims of negligence on the part of individuals Its major concern is whether supervision and actions were reasonable and if unreasonable risk of harm was perceived by the individual who was injured 25 Reducing the risk of litigation Establish the trust of the athletes/parents/guardians Work cooperatively with all Establish policies and guidelines Detailed job description in writing Established hours of operation Develop an understanding that injured athletes should not be allowed to reenter until cleared appropriately Develop, review continually your EAP Be familiar with the health status of your athletes 26 Reducing the risk of litigation Work within your scope of practice Work within your ethical guidelines Obtain consent Documentation Keep factually accurate and timely medical records (Objective tests vs. subjective judgement) Ensure medical records are kept confidential 27 Recall: Scope of Practice Kinesiology Scope of Practice Personal Scope of Practice 28