17 - LEGAL, ETHICAL & MORAL ISSUES OF HEALTH CARE

Ethics

A set of principles relating to what is morally right or wrong; providing a standard of conduct or code of behavior. Ethical practices are usually the basis of most dealings between persons in a profession. provided by external source

Morality

A system of conduct that is right and wrong. own personal principle

NNR a. Never discuss the patient or his or her condition with family and friends b. Never discuss a patient's illness in the patient's presence or with another worker or family member unless it is within the scope of practice. c. Refer questions by the patient regarding his or her disease and treatment to the physician in charge of the patient's care

7. Keep all information confidential

Legal responsibilities

Actions or behaviors authorized or based on law created and enforced by the government to promote a sense of security for each individual.

Autonomy (self-governance)

Having the freedom to make choices about issues that affect one's life. every individual has the freedom to make choices not concerned in general public

Right to be informed of his rights and obligations as a patient

Every person has the right to be informed of his rights and obligations as a patient.

Justice

Fairness; to give to each one what he deserves or what is his due.

BEFB a. To be able to make responsible decisions through correct moral reasoning and well-grounded judgment in healthcare situations. b. To enhance competence by understanding the patient c. To face complex ethical challenges that resulted from bioscientific developments d. Basis for legislation and public policy

Importance of Bioethics/ Health ethics

SSEBG spouse son or daughter of legal age; either parent; brother or sister of legal age, guardian

In case the patient is incapable of giving consent and a third-party consent is required, the following persons, in the order of priority stated, may give consent:

right to information

In the course of his/her treatment and hospital care, the patient or his/her legal guardian has a right to be informed of the result of the evaluation, of the nature and extent of his/her disease, any other additional or further contemplated medical treatment on surgical procedure or procedures, including any other additional medicines to be administered and their generic counterpart including the possible complications and other pertinent facts, statistics or studies, regarding his/her illness, any change in the plan of care before the change is made, the person's participation in the plan of care and necessary changes before its implementation, the extent to which payment maybe expected from Phil health or any pay or and any charges for which the patient may be liable, the disciplines of health care practitioners who will furnish the care and the frequency of services that are proposed to be furnished.

legal age and of sound mind.

Informed consent shall be obtained from a patient concerned if he is of---

AJBN Autonomy (self-governance) Justice Beneficence Nonmaleficence

Major Ethical Principles

AIPICSRMLPCEB Right to appropriate medical care and humane treatment Right to informed consent Right to privacy and confidentiality Right to information Right to choose health care provider and facility Right to self-determination Right to religious belief Right to Medical records Right to leave Right to refuse participation in medical research Right to correspondence and to receive visitors Right to express grievances Right to be informed of his rights and obligations as a patient

Patient's Rights as declared in the Philippines Patient's BIll of Rights

PUOIOOTTAIB 1. Perform only those procedures for which you have been trained and are legally permitted to do. 2. Use approved correct methods while performing any procedure. 3. Obtain proper authorization before performing any procedure. 4. Identify the patient 5. Obtain the patient's consent before performing any procedure 6. Observe all safety precautions 7. Keep all information confidential 8. Think before you speak and carefully consider everything you say. 9. Treat all patients equally regardless of race, religion, social or economic statues, gender or nationality 10. Accept no tips or bribes for the care you provide. 11. If any error occurs or you make a mistake, report it immediately to your supervisor, 12. Behave professionally in dress, language, manners & actions

Professional Standards

The privacy of the patients must be assured at all stages of their treatment. The patient has the right to be free from unwarranted public exposure

Right to privacy and confidentiality

IRD a. he is informed of the medical consequences of his choice; b. he releases those involved in his care from any obligation relative to the consequences of his decision; c. his decision will not prejudice public health and safety.

Right to self-determination provided that:

Bioethics (Paula, Walker & Nixon, 2010)

The discipline devoted to the articulation of good decisions in the practice of health care. by? who and when?

Right to informed consent

The patient has a right to a clear, truthful and substantial explanation, in a manner and language understandable o the patient, of all proposed procedures, whether diagnostic, preventive, curative, rehabilitative or therapeutic, wherein the person who will perform the said procedure shall provide his name and credentials to the patient, possibilities of any risk of mortality or serious side effects, problems related to recuperation, and probability of success and reasonable risks involved:

Right to self-determination

The patient has the right to avail himself/herself of any recommended diagnostic and treatment procedures. Any person of legal age and of sound mind may make an advance written directive for physicians to administer terminal care when he/she suffers from the terminal phase of a terminal illness:

MPP a) when his mental or physical condition is in controversy and the appropriate court, in its discretion, orders him to submit to a physical or mental examination by a physician, b) when the public health and safety so demand; and c) when the patient waives this right.

The patient has the right to be free from unwarranted public exposure, except in the following cases:

Right to correspondence and to receive visitors

The patient has the right to communicate with relatives and other persons and to receive visitors subject to reasonable limits prescribed by the rules and regulations of the health care institution.

SITI when such disclosure will benefit public health and safety; when it is in the interest of justice and upon the order of a competent court; and when the patient waives in writing the confidential nature of such information; when it is needed for continued medical treatment or advancement of medical science subject to re-identification of patient and shared medical confidentiality for those who have access to the information.

The patient has the right to demand that all information, communication and records pertaining to his care be treated as confidential, except:

Right to express grievances

The patient has the right to express complaints and grievances about the care and services received without fear of discrimination or reprisal and to know about the disposition of such complaints. dont be palengkera naman parin

Right to leave IRD a. he/she is informed of the medical consequences of his/her decision; b. he/she releases those involved in his/her care from any obligation relative to the consequences of his decision; c. his/her decision will not prejudice public health and safety.

The patient has the right to leave the hospital or any other health care institution regardless of his physical condition: Provided, That

Right to religious belief

The patient has the right to refuse medical treatment or procedures which may be contrary to his religious beliefs, subject to the limitations described in the preceding subsection: Provided, That such a right shall not be imposed by parents upon their children who have not reached the legal age in a life threatening situation as determined by the attending physician or the medical director of the facility. - can't impose upon their children

Right to Medical records

The patient is entitled to a summary of his medical history and condition, at his expense and upon discharge of the patient, he may obtain from the health care institution a reproduction of the same record whether or not he has fully settled his financial obligation with the physician or institution concerned. The health care institution shall safeguard the confidentiality of the medical records and to likewise ensure the integrity and authenticity of the medical records and shall keep the same within a reasonable time as may be determined by the Department of Health. The health care institution shall issue a medical certificate to the patient upon request. Any other document that the patient may require for insurance claims shall also be made available to him within a reasonable period of time.

Right to choose health care provider and facility

The patient is free to choose the health care provider to serve him as well as the facility except when he is under the care of a service facility or when public health and safety so demands or when the patient expressly or impliedly waives this right. The patient has the right to discuss his condition with a consultant specialist, at the patient's request and expense. He also has the right to seek for a second opinion and subsequent opinions, if appropriate, from another health care provider/practitioner.

IWWWWW a. In emergency cases, when the patient is at imminent risk of physical injury, decline or death if treatment is withheld or postponed. b. When the health of the population is dependent on the adoption of a mass health program to control epidemic; c. When the law makes it compulsory for everyone to submit to a procedure; d. When the patient is either a minor, or legally incompetent, in which case, a third-party consent is required; e. When disclosure of material information to patient will jeopardize the success of treatment, in which case, third party disclosure and consent shall be in order; f. When the patient waives his right in writing.

The patient will not be subjected to any procedure without his written informed consent, except in the following cases:

Beneficence

To do good; provide a benefit without the patient's consent

Right to appropriate medical care and humane treatment

can refuse because of limitations Every person has a right to health and medical care corresponding to his state of health, without any discrimination and within the limits of the resources, manpower and competence available for health and medical care at the relevant time. The patient has the right to appropriate health and medical care of good quality. In the course of such care, his human dignity, convictions, integrity, individual needs and culture shall be respected.

Right to refuse participation in medical research

the patient has the right to be advised if the health care provider plans to involve him in medical research, including but not limited to human experimentation which may be performed only with the written informed consent of the patient. Provided, further, that, an institutional review board or ethical review board in accordance with the guidelines set in the Declaration of Helsinki be established for research involving human experimentation: Provided, finally, that the Department of Health shall safeguard the continuing training and education of future health care provider/practitioner to ensure the development of the health care delivery in the country.

Nonmaleficence

to do no harm, to prevent, or to remove or not to risk harm (physical, mental, psychological, social, financial, spiritual)