Law, Ethics, & Professionalism in Health Care

Professional Codes of Ethics

- Quality of Care - Primary commitment to patient - Education - Collegiality - Ethics - Collaboration - Research - Resource utilization - Confidentiality

Patient Consent

A consent is a legal document a patient has signed and which states a patient is agreeing to and giving approval to, someone or for something. When patients are given information about their care and voluntarily consent to particular treatments or procedures, this is referred to as informed consent. Implied consent is assumed consent since there is no signed consent. This type of consent is used in emergency life saving situations such automobile accidents, fires, or other life saving situations.

Legal Guardian

A legal guardian is someone appointed by a judge to act for another person, such as a minor or mentally incompetent adult. The duties of a guardian are to oversee the welfare and safety the person under guardianship, and to attend to the financial needs of the individual, using his or her assets wisely. A guardian has a legal duty to act in the best interests of the individual. A legal guardian acts as the primary caretaker of a child or minor. This person may be personally selected by the child's biological parents, or appointed by the court.

Patient Advocate

A patient advocate always supports the best interest of all patients and helps them secure quality care. To deal objectively with each situation, a caregiver must be willing and able to put aside personal opinions, beliefs, and biases. Can you think of a situation when you might have to become a patient advocate? A patient advocate helps patients communicate with their healthcare providers so they get the information they need to make decisions about their health care. Patient advocates may also help patients set up appointments for doctor visits and medical tests and get financial, legal, and social support. Ensure Safety. Give Patients a Voice Educate Protect Patients' Rights Double Check for Errors Connect Patients to Resources

Health Insurance Portability & Accountability Act (HIPAA)

A patient's right to privacy is a basic civil right protected under the Health Insurance Portability and Accountability Act (HIPAA). HIPAA is about protecting a patient's confidential information such as: Name Age E-mail Social security number Address & Phone number Medical history & Medical diagnosis Observations on health Medical record number

Invasion of Privacy

All patients have a right to privacy when receiving medical care. A provider who intentionally and unreasonably exposes a patient's body or reveals a patient's personal information without consent commits an invasion of privacy. Example #1: this would involve a patient who gets tested for STD's and the provider intentionally shares that information with someone other than the patient. Example #2: would be a surgeon not properly covering a patient's body during surgery therefore, exposing the patient's private areas.

Assault

An assault happens when a threat or attempt is made to touch a person without his or her permission. By law a competent person has the right to refuse medication or a medical procedure such as surgery. An assault occurs when a healthcare provider threatens to force a patient to take medication or undergo a procedure against his will.

False Imprisonment

Any attempt to restrain an individual or restrict his or her freedom is false imprisonment. Example: A health care provider who refuses to allow a mentally competent patient to leave the hospital against medical advise (AMA).

Ethical Principles for Health care Professionals

Autonomy: The right to self determination, respecting patients rights to make their own choices. Justice: Treat others fairly and equitably Nonmaleficence: One should never cause needless harm and injury to a patient. (do no harm) Beneficence: Weighing the good of actions against the risks. (do good) Veracity: The patient has the right to know the truth (honesty) Fidelity: Providing quality health care to all patients. (keeping promises) Confidentiality: Keeping medical and personal patient information private (respecting patient's privacy).

Battery

Battery in healthcare occurs when a non-consenting patient is actually touched against his will. Battery also occurs when a healthcare provider touches a patient aggressively or forcefully performs a procedure without his permission.

Law

Citizens depend on the legal system to protect them from the wrongdoings of others. The American legal system ensures the rights of all citizens. Guidelines in the legal system protect health care workers, patients, and employers. All health care professionals must understand the legal nature of the health care provider-patient relationship and their roles and responsibilities as the patient's advocate. Litigation is a legal proceeding in a court. Litigation, or a lawsuit, may result from an unintentional medical error that has little or no consequences or from a life-ending mistake.

Civil Rights continued

Civil Rights Come From: Age Discrimination Act of 1975, Unfair or unequal treatment of an employee by an employer because of the employee's age. Americans with Disabilities Act (ADA), This law made it illegal to discriminate against a disabled person in terms of employment opportunities, access to transportation, public accommodations, communications and government activities. Voting Rights Act of 1965, This was a law that was passed at the time of the civil rights movement. It eliminated various devices, such as literacy tests, that had traditionally been used to restrict voting by black people.

Civil Law

Civil law: This is often referred to as private law because it focuses on issues between private citizens, such as medical malpractice. (these are issues between a patient and a healthcare provider(s)). The following laws are Medically Related Categories: - Tort law: this is a wrongful act that results in harm, for which restitution, or financial compensation must be made. - Intentional torts: are deliberate acts intended to cause harm. -Unintentional torts: these are accidents or mistakes that result in harm.

Civil Rights

Civil rights are personal rights guaranteed and protected by the U.S. Constitution and federal laws enacted by Congress, such as the Civil Rights Act of 1964 and the Americans with Disabilities Act of 1990. Civil rights include protection from unlawful discrimination.

Patients Rights

Civil rights: these are the basic civil rights held by all U.S. citizens. They ensure equal protection under the law. Constitutional rights: are the rights afforded to all citizens through the United States Constitution. The first 10 amendments to the U.S. Constitution. The rights that protect people from unfair and unconstitutional treatment by the state or federal government. Human rights: these are the fundamental rights of all people regardless of their citizenship status. Examples: the right to life, liberty, and property, freedom of expression, pursuit of happiness and equality before the law, and social, cultural and economic rights.

Advanced Directives continued

Durable power of attorney for health care: Another form of an advance care directive is a durable power of attorney for health care, this is also a legal document that designates a person to make health care decisions on behalf of the patient in the event the patient becomes incapacitated.

Ethical Dilemmas

Ethical Dilemmas - Genetic testing - Stem cell research - Cloning - Physician-assisted suicide

Ethical Principles

Ethical principles are standards of conduct based on moral judgment. Morality involves traditions of belief about right and wrong human conduct.

Legal Guardian continued

For example : 1 - Guardianship arrangements are necessary when a child's biological parents are unable to provide care. 2 - Guardianship for adults who have a clinically diagnosed medical condition and are unable to make or communicate effective decisions about their everyday self-care, health, and safety. Guardian can make some or all personal decisions on the adult's behalf.

Right to Die

Health care providers have a professional and ethical duty to protect human life. At times this responsibility may conflict with a patient's wishes. Patient's have the right to make decisions affecting their own health care, including the right to refuse or discontinue treatments that can sustain life. Can you think of a famous person who recently made this decision? Answer: Brittany Maynard

Human Rights

Human rights are rights inherent to all human beings, regardless of race, sex, nationality, ethnicity, language, religion, or any other status. Human rights include the right to life and liberty, freedom from slavery and torture, freedom of opinion and expression, the right to work and education, and many more. Everyone is entitled to these rights, without discrimination.

Professionalism

In health care professionalism involves a set of values, behaviors, and relationships that form a foundation in which trust is formed. Health related careers are often prestigious and exciting, but they also require a responsibility to the patients being served. Tips to keeping a professional image at work: - Patients come first - Observe patient privacy rules at all times - Accept assignments without complaining - Offer to go above and beyond what is expected

Types of Law

Laws are rules of conduct that are enforced by government authorities. The two main branches of the legal system are public law and civil law. Public law: enforces issues between the government and it's citizens and involves the following three laws: - Criminal law: example of this would be practicing medicine without a license - Constitutional law: abortion issues and Civil Rights violations - Administrative law: laws enforced by the FDA, IRS, and each state's Board of Medical Examiners

Professional Competence

Lifelong learning Continuing education units Membership in peer association or professional organization Humility & willingness to give & receive constructive criticism

Advanced Directives

Living will All patients have the right to make their own decisions in regards to health care, regardless of the outcome. This includes the right to refuse or discontinue treatments that can sustain life. In the event a patient is unable to communicate his or her wishes, care providers must follow the patient's specific instructions which may have been previously outlined in an advance care directive. A living will documents what steps, if any, are to be taken in order to save or prolong a person's life. A living will becomes effective as a person becomes incapacitated.

Defamation of Character

Making false or malicious statements that cause harm to a person's reputation this is called defamation of character. Attacks on a person's professional character or claims that a person has done something immoral are examples of defamation of character.

Restitution

Most legal issues in health care do not involve criminal law, or law concerned with punishing those whose conduct is so harmful or threatening to society that it is prohibited by governmental statute. Instead, most legal issues in health care involve tort law. A tort is any wrongful act that results in harm, for which restitution, or monetary compensation must be made.

Negligence

Negligence: Careless or senseless behavior by a practitioner that results in harm. Examples: An unlicensed health care worker such as a CNA, administering a vaccine, drawing blood, or administering an IV (Intravenous therapy) because it was delegated to him. - By law this is considered outside of his scope of practice. An untrained CNA Improperly using equipment (i.e., Lifts, shower chairs, wheelchairs). - By law this is considered outside of his scope of practice because he has not been properly trained.

Reporting Abuse

One of the most important legal and ethical duties of any health care provider is guarding their patients' well-being. Generally, any mistreatment of people who are unable to protect themselves must be reported by health care providers. Federal law requires health care workers to report threats to a child's physical or mental well-being. The law shields health care workers, teachers, and social workers who report suspected child abuse. The reporters are not identified and they are protected from being sued for reporting their suspicions.

Professional Associations

Professional Associations: - Continuing education classes - Subscriptions to professional publications - Access to online resources - Professional conferences, conventions, & workshops - Networking opportunities - Information on new technologies - Management tools - Ethics guidelines - Patient educational materials

United States Legal System

Public Law: Focuses on issues between government and citizens Medically Related Categories: Criminal Law: Practicing medicine without a license falls within this category Administrative Law: Laws enforced by the Food and Drug Administration, Internal Revenue Service, and each state's Board of Medical Examiner's fall within this category. Civil Law: Focuses on issues between private citizens Medically Related Categories: Tort Law: Laws pertaining to a breach of legal duty (such as injuries suffered by someone as the result of another person's wrongdoing or misdeeds) fall within this category Most lawsuits against health care professionals fail within this category.

Women's Right to Vote

The 19th amendment guarantees all American women the right to vote. Achieving this milestone required a lengthy and difficult struggle. Victory took decades of agitation and protest. Beginning in the mid-19th century, several generations of woman suffrage supporters lectured, wrote, marched, lobbied, and practiced civil disobedience to achieve what many Americans considered a radical change of the Constitution. Sadly, very few early supporters lived to see the final victory in 1920.

The Joint Commission Code of Ethics

The Joint Commission - Mission: improve safety & quality of care to the public - Provides Accreditation to al health care facilities - Supports performance improvement - Establishes standards of health care related to ethics

Patient's Bill of Rights

The Right to Information The Right to Choose Access to Emergency Services Being a Full Partner in Health Care Decisions Care Without Discrimination The Right to Privacy The Right to Speedy Compliant Resolution Taking on New Responsibilities

Vulnerable Populations

The economically disadvantaged Racial & Ethnic minorities The uninsured low-income children The elderly The homeless Those with HIV Those with chronic health conditions Those with mental illness The very young The very old

Medical Malpractice

The term "malpractice" involves any illegal, unethical, negligent, or immoral behavior that results in a failure of duties or responsibilities on the part of the health care professional. Examples of medical malpractice include: - Medication errors - Improper physical assessment - Improper use of medical equipment - Failure to properly communicate a patient's decline in condition to a physician

TORTS:

Unintentional: Negligence: 1.) Professional Negligence (Malpractice) 2.) Statutory Negligence 3.) Criminal Negligence Intentional: Assault Battery False Imprisonment Invasion of Privacy Defamation of Character 1.) Slander 2.) Libel

Slander

When false or malicious statements that cause harm to a person's reputation are spoken, this is called slander.

Libel

When false or malicious statements that cause harm to a person's reputation are written, it is called libel.

The Joint Commission Code of Ethics

You are guided by your profession's code You maintain patient confidentiality You need to be a patient advocate. You give care in a nonjudgmental and nondiscriminatory manner that is sensitive to patient diversity. You give care in a manner that preserves and protects the patient's autonomy, dignity, and rights. You seek available resources to help formulate ethical decisions.