Ethical and Legal Issues in Patient Care PDF

Ethical and Legal Issues in Patient Care: Autonomy and Beneficence Professional Issues I: PT 8351 1 Objectives Discuss the ethical principles of autonomy and beneficence. Consider clinical situations when the principles of autonomy and...

Ethical and Legal Issues in Patient Care: Autonomy and Beneficence Professional Issues I: PT 8351 1 Objectives Discuss the ethical principles of autonomy and beneficence. Consider clinical situations when the principles of autonomy and beneficence are linked or in conflict. Apply principles of autonomy and beneficence to the practice of physical therapy. Reference key documents that help with ethical decision making. 2  “The need to identify and clarify ethical issues within a health profession increases as the profession assumes responsibility for those areas of direct care in its domain.” – Guccione, AA “As physical therapists assume a more autonomous role in health care delivery, ethical judgments will play an increasingly important role in the gamut of clinical decisions a physical therapist will have to make.” – Magistro, CM APTA Learning Center: Ethical Compass, 2018 3 Increasing Expectations in PT—Why? Movement to a doctoring profession. Increased autonomy and direct access practice. Increased complexity and change in healthcare. Based upon evidence and/or best practice within a complex and changing healthcare arena. Addressing this heightened expectation is a key purpose of the ethical compass. APTA Learning Center: Ethical Compass, 2018 4 Competing Obligations or Values Physical therapists and physical therapist assistants encounter ethical scenarios on a daily basis. Those requiring careful analysis involve: Competing obligations Clarifying rights of the patient/client Competing values Complex organizational and social implications Complex issues involving competing values or duties call for the ethical compass. APTA Learning Center: Ethical Compass, 2018 5 Ethics vs. Values vs. Law Ethics is a rational reflection. Particularly important when there are competing realms or two or more possible courses of action. Derived from the Greek term “ethos,” meaning a custom, usage, or character. “What happens when you stub your toe on the ethical path of life.” It’s the reflection or analysis needed when confronted with conflicted values or duties. APTA Learning Center: Ethical Compass, 2018 6 Ethics vs. Values vs. Law Values are standards for what is right or wrong, good or bad, worthy, important, desirable, quality, or beautiful. Derived by individuals from personal, professional, organizational, societal, or cultural sources. Values shape our moral framework. Different from ethics, but foundational to ethical decision making. As values influence ethical decision-making, making ethical decisions is inherently tied to one’s awareness of personal and professional values. APTA Learning Center: Ethical Compass, 2018 7 Ethics vs. Values vs. Law Laws include rules, administrative codes, and regulations created by administrative agencies to interpret, delineate, or implement legislation. May be local, state, or national. Can include the minimal standards society wishes to enforce. Ethics prescribed in most state practice acts and woven into the law. Example: Medicare guidelines or rules that interpret state practice acts have the force of law, and are enforced by the promulgating agency. APTA Learning Center: Ethical Compass, 2018 8 Law and Ethics Law and Ethics, Legal and Ethical: Related and overlapping concepts. Law is a minimal standard that represents a kind of consensus on standards of behavior. Ethics — what is “right”: tends to go beyond the minimal standard of law toward “ideal behavior.” Especially applicable to professionals who are expected to adhere to the ethical standards of the profession, as further promulgated by the laws. APTA Learning Center: Ethical Compass, 2018 9 The Ethical and Legal Challenges we Face Legal Unethical but Legal Legal and Ethical Not Ethical Ethical Unethical and Illegal Ethical but Illegal Not Legal APTA Learning Center: Ethical Compass, 2018 10  Types of ethical challenges Dilemma -Two courses of action could be taken Case Example Ethical -Right vs. Right Challenge ? Distress -You know the right choice of action but are not 1. A new wheelchair company tries to give you tickets to empowered to perform it an NFL game hoping that you will recommend their -There may be financial or institutional barriers wheelchairs, even though they cost more than other -Two morally correct courses of action are possible, but comparable chairs. they cannot both be followed Temptation -You may stand to benefit from the wrong decision 2. At a weekly meeting, the boss tells everyone that they -Right vs. wrong need to bill one more unit of time to the insurance company so that the payment will be increased. Raises will Silence No one is speaking about the challenge to values ( this be considered to all that comply. No one has the nerve to say anything. may be the course taken when someone is in moral distress) 3. A 16 year old patient tells you a “secret” and does not want you to tell her parents. But, you feel the parents should know. 4. A medical student overhears a conversation while watching TKR surgery. The hospital is using a cheaper implant on most patients so that they have a greater profit on each case. The surgical resident comments that he is worried about the life span of the implant compared to others. Portions adapted from Dr. Rhea Cohn 11 Frameworks and Resources to Consider Realm ABCDE APTA Code Ethical of Ethics principles State licensure board Code of Ethics Your decision Portions adapted from Dr. Rhea Cohn 12 Realms: The context of the ethical issue Societal The good of all people; population health Focus on systems and structures within the organization to promote or achieve organizational goals Organizational The good of a single person—rights, duties, relationships Individual/ Family Portions adapted from Dr. Rhea Cohn 13 Professional Documents to Guide You APTA Code of Ethics https://www.apta.org/apta-and-you/leadership-and-governance/policies/code-of-ethics-for-the- physical-therapist APTA Guide for Professional Conduct https://www.apta.org/your-practice/ethics-and-professionalism/apta-guide-for-professional- conduct APTA Standards of Practice https://www.apta.org/apta-and-you/leadership-and-governance/policies/standards-of-practice- pt The Guide to Physical Therapist Practice (aka “The Guide”) http://guidetoptpractice.apta.org/ 14 APTA Code of Ethics (2019) “The Code of Ethics delineates the ethical obligations of all physical therapists…” “No code is exhaustive or addresses every situation.” It is built upon our professional roles (eg clinician, educator), the core values of the profession, the realms of the ethical action, and our agency as health care providers. 15 Limitations These documents may not provide definitive answers to difficult ethical decisions: Stated principles or values may conflict. Guidance may be too general in nature to guide specific ethical decisions. Each scenario presents its own unique set of facts and circumstances. 16 State based regulations: Maryland 17 Portions adapted from Dr. Rhea Cohn https://health.maryland.gov/bphte/Pages/comar.aspx MD Code of Ethics Portions adapted from Dr. Rhea Cohn 18 ABCDE Ethical Principles Autonomy Equity Beneficence Do-no Harm Confidentiality Portions adapted from Dr. Rhea Cohn 19 Autonomy The patient has the ability to exercise their own freedom in a given situation. The patient has self-determination or personal “agency” A guiding principle in the practice of “medicine” as we know it. Evidence suggests that patients are more likely to get better if they feel a sense of control and can exercise their autonomy. Questions: 1. Do you believe this? 2. Do you think all patients believe this? 3. How can we foster a patient feeling a sense of control? Portions adapted from Dr. Rhea Cohn 20 Consider………….. For someone to be truly autonomous, they need to be: Well informed. Able to understand the information presented. Not dealing with external pressures that cloud the “informing” process (e.g. bias, coercion, manipulation, feeling sick and/or vulnerable). Portions adapted from Dr. Rhea Cohn 21 Self-Determination Examples Advanced directives Decisions related to treatment options (eg. Chemo versus no chemo) Abortion What should I have for lunch? Should I have a home health aide? Should I go to Bingo today? I don’t want to give up my car. Portions adapted from Dr. Rhea Cohn 22  The ICF Framework Patient Autonomy International Classification of Functioning, Disability, 23 and Health (ICF) Model, (WHO) Challenges to Autonomy (legal and ethical) Religion Culture Age (adult vs. children) Mature minor:(non-emancipated but have capacity to make decisions)- Emancipated minor: ( 14 yrs. Child is capable of giving informed consent Treatment will benefit the minor Treatment does not present a risk to the minor Treatment is within established medical protocols. “Professional Duty” Core Value: “Demonstrating beneficence by providing optimal care.” *https://www.bhclr.edu/!userfiles/pdfs/course-materials/Minors%20Rights%20in%20Medical%20Decision%20Making.pdf 30 Questions: 1. What could “beneficence” look like on an individual level vs. a society level? 2. When might “beneficence” be challenged in the clinic? 3. How is “beneficence” different than “do-no-harm” (non- maleficence)? Portions adapted from Dr. Rhea Cohn 31 Could “beneficence” be “advocacy” in the societal realm? Beneficence Advocacy Core value: Social Responsibility Portions adapted from Dr. Rhea Cohn 32