Bioethics

1. Bioethics Medical Therapeutics Ms. Bettag RN, BSN

2. Bell Work • Write out abbreviations.

3. Learning Objectives • Standard 3, Compare and contrast the specific laws and ethical issues that impact relationships among patients and the healthcare professional. • At the conclusion of class today I CAN: • Identify the structure of an ethical dilemma • Define key terms related to bioethics and use them in context • Describe the importance of understanding ethical issues in health care • https://www.youtube.com/watch?v=ghzHrO7Lm04

4. Greys Anatomy • Man in video is on death row and scheduled for execution in 5 days. The young boy needs a liver transplant and will die if he does not get a liver in the next 24 hours. The man is a match for the boy for a liver. • https://www.youtube.com/watch?v=cC_cCe7bgak • What is unethical? Is this legal, illegal, ethical, or/and unethical?

5. Ethics and Morals • Morals—personal beliefs of right and wrong behavior based on religious beliefs, cultural norms, family customs, and past experiences • Ethics—human behavior and its effect on society, more concerned with the big picture as well as the immediate situation

6. Laws and Ethics • Laws can be made to designate actions that are right and wrong even though the same action may not be viewed as unethical • Another action may be viewed by some as ethical but is considered illegal

7. Susan is a respiratory therapist at a large hospital. It was discovered that Susan had an affair with the chief of staff at the hospital. She was later fired by the board of the hospital. Were Susan’s actions illegal or unethical? • Illegal: go to the right side of the room by the window • Unethical: go to the left side of the room by the door • Both: go to the back of the room

8. Bell Work • Review for quiz

9. Learning Objectives • Standard 3, Compare and contrast the specific laws and ethical issues that impact relationships among patients and the healthcare professional. • At the conclusion of class today I CAN: • Identify the structure of an ethical dilemma • Define key terms related to bioethics and use them in context • Describe the importance of understanding ethical issues in health care

10. Bioethics • Specialized branch of ethics concerned with human behavior within the context of modern medicine • Medical research develops new technology and advances at a rapid rate • Human cloning, stem cell research, and euthanasia are examples

11. Ethical Principles • Ethical rules regarding people’s behavior • Ethical reasoning process • Seem simple and straightforward, may be complicated • Nonmaleficence • Beneficence • Autonomy • Distributive justice • Paternalism • Veracity • Fidelity

12. Nonmaleficence • Pertains to health-care workers • “Do no harm” • Hippocratic Oath, professional codes • In medicine there is always a potential to do harm

13. Beneficence • Health-care workers aim to provide benefit in addition to avoiding harm • Medications are proven to be safe before they are released • Medications and treatments should have a reasonable likelihood of being helpful • Risks should be made known to patients • https://youtu.be/EsvxAFvSgTI

14. Bell Work • Review for quiz

15. Learning Objectives • Standard 3, Compare and contrast the specific laws and ethical issues that impact relationships among patients and the healthcare professional. • At the conclusion of class today I CAN: • Identify the structure of an ethical dilemma • Define key terms related to bioethics and use them in context • Describe the importance of understanding ethical issues in health care

16. Autonomy • Right of patients for self-determination • Freedom of choice • Patient’s right to refuse or accept medical treatment • Obtain informed consent before treatment or procedures • https://www.youtube.com/watch?v=LSeiur_-0IU

17. Distributive Justice • Includes concept of fairness • Fair allocation of scarce resources • People waiting for transplant organs • Who decides who receives the organ and who does not

18. Paternalism • “Father” role is taken on by health-care provider, judge, or other person or entity who makes the decision for a person based on his or her best interests • Right to autonomy is denied • Parent makes decisions for minor child

19. Veracity • Duty to be honest • Is there an appropriate time to withhold information from a patient? • Is there such a thing as the acceptable “little white lie”?

20. Fidelity • The duty to keep reasonable promises and to meet obligations • Clients have a right to expect health-care workers to keep their information private • Reasonable expectations and unreasonable expectations

21. Anatomy of an Ethical Dilemma • A decision must be made • The outcome will have profound consequences • There is a disagreement among involved parties about right course of action

22. Ethical Dilemma • Cystic fibrosis patient • https://youtu.be/pqSo7_dSX9g

23. Ethical Decision Making • Bias—response based on previous experience • Uses ethical reasoning process • Thoughtful decision making based on solid understanding of ethical principles and careful reasoning

24. Bell Work • Write out abbreviations, you have 5 minutes. • MI-NSAID

25. Learning Objectives • Standard 3, Compare and contrast the specific laws and ethical issues that impact relationships among patients and the healthcare professional. • At the conclusion of class today I CAN: • Identify the structure of an ethical dilemma • Define key terms related to bioethics and use them in context • Describe the importance of understanding ethical issues in health care

26. Ethics Committees • Serve as resource to health-care organizations • Formulate institutional policies • Provide education for staff • Serve as consultant role between patients and providers

27. Health care Ethical Behavior • What do these words mean to you as a future healthcare provider? • Trust and loyalty • Confidentiality • Respect and dignity • Commitment to professional development This Photo by Unknown Author is licensed under CC BY-ND

28. Malpractice vs Negligence • https://www.nso.com/Learning/Videos/Failure-to-Diagnose-Case-Study • Malpractice: Improper, illegal, or negligent professional activity • Negligence: Failure to take proper care in doing something

29. Exit Ticket—On your Post-IT • How would you explain the difference between malpractice and negligence? Does a patients autonomy influence a medical providers care? Should medical providers be penalized when a patient won’t agree to orders. Should we enforce paternalism, and make our patient get a test done?

30. Bell Work • John is a 61-year-old cancer patient who has been told that he has 3 months left to live. He has a daughter who is trying to force him to take chemotherapy treatment, even though he specifically has stated he does not want chemotherapy but would like to move to a state where physician assisted suicide is legal. His daughter is trying to make him take treatment is saying she will force him to go and that he is just being an “old crazy man”. • Why is this an ethical dilemma? What are his rights and what should he fill out to make sure that the doctors know his wishes? Is his daughter guilty of anything, if so what could she be charged with?

31. Learning Objectives • Standard 3, Compare and contrast the specific laws and ethical issues that impact relationships among patients and the healthcare professional. • Objective: To be able to analyze specific laws and ethical issues that impact professional practice such as confidentiality, informed consent, and patient self-determination. • Success Criteria: • At the conclusion of class today I CAN: • Understand consent and difference between informed and implied • Interpret barriers to consent • Review a case study and apply theoretical knowledge to data in case study

32. Consent Implied consent— patient consents to treatment through actions What would be an example of implied consent? Informed consent— written form, signed by patient explaining procedure or treatment, who will perform, risks, and expected results When would informed consent be necessary?

33. Barriers to Informed Consent • Interpreters may be necessary if a patient is hearing impaired or speaks a different language • Good Samaritan law protects emergency personnel when a patient may not be able to speak or give consent • When might the Good Samaritan law be used?

34. Confidentiality Patient’s medical and personal information used for treatment, payment, and administrative operations “Need to know” Authorized release of information HIPAA

35. Case Study • Using the case study you were given • Read through the situation • Discuss in your group; your feelings on the situation. Do you feel strongly personally one way or another? Will this affect your care of the patient. • What is the issue at hand in your case study? What vocabulary can you tie into this situation that we have discussed previously? • What would you do as the medical professional in this case? • What is the outcome of your case study?

36. Exit Ticket • What is not required when obtaining informed consent? A. Who will perform the procedure B. The name of the procedure and general description C. The exact time the procedure will take place D. The risks of the procedure

37. Bell Work • Which of the following PHI can a patient be denied access to? • medication records • psychotherapy notes • sexually transmitted disease test results • surgical notes from an organ transplant surgery •  After you complete bell work check grades. • Complete both in 5 minutes.

38. Learning Objectives • Standard 3, Compare and contrast the specific laws and ethical issues that impact relationships among patients and the healthcare professional. • Objective: To be able to analyze specific laws and ethical issues that impact professional practice such as confidentiality, informed consent, and patient self-determination. • Success Criteria: • At the conclusion of class today I CAN: • Understand consent and difference between informed and implied • Interpret barriers to consent • Review a case study and apply theoretical knowledge to data in case study

39. Intentional Torts: gross negligence, a form of negligence that involved an intentional act or failure to act that causes harm Assault—threat or perceived threat of bodily harm to another person Battery—touching inappropriately without permission Defamation—slander/libel False imprisonment—holding a patient against his or her will Fraud—intentional misrepresentation of facts for financial gain Invasion of privacy—release of private information

40. Thnik/Pair/Share • Turn to your partner and give examples of the 6 intentional torts. This Photo by Unknown Author is licensed under CC BY-SA-NC

41. Criminal Law Protects the safety and welfare of the public Determines what is legal and illegal The crime is considered to be against society or the state This Photo by Unknown Author is licensed under CC BY-NC

42. Civil Law Private law Protects the rights of individuals Most commonly exercised type of law in ambulatory care This Photo by Unknown Author is licensed under CC BY-NC-ND

43. Statute of Limitations Determined by each state Determines length of time during which a lawsuit may be filed Medical records Accurate documentation

44. Patient Noncompliance Physician and patient enter into contract Physician responsible for diagnosing and treating patient, being available for patient care and communication, and arranging for different physician if absent Patient responsible for truthfully relating medical history, following treatment recommendations, and keeping appointments Patients who fail to comply with treatment recommendations cannot expect the treating physician to be responsible for the outcome of their care

45. Patient Noncompliance • Either party may end the physician–patient contract • Physician must send certified letter to patient • If physician does not follow proper procedure, abandonment may be charged

46. Malpractice Medical form of negligence proven by four criteria, the 4 “D’s” Duty: must prove relationship existed (how?) Dereliction of duty: Must prove standard of care was not met (Use of expert witness) Direct cause: Damages suffered were a direct result of action in question Damage: must prove injury occured

47. The Lawsuit Process Subpoena—legal document requiring appearance in court or for a deposition Deposition—formal gathering of information Trial—information is gathered, date is set by court, expert witnesses, jury, verdict, and settlement Malpractice insurance—mandatory in most states https://media.giphy.com/media/SVBnJefWTb0RhtgT9D/giphy.gif https://media.giphy.com/media/SVBnJefWTb0RhtgT9D/giphy.gif

48. Bell Work • What are 4 D’s of malpractice? • Complete both in 5 minutes.

49. Learning Objectives • Standard 3, Compare and contrast the specific laws and ethical issues that impact relationships among patients and the healthcare professional. • Objective: To be able to analyze specific laws and ethical issues that impact professional practice such as confidentiality, informed consent, and patient self-determination. • Success Criteria: • At the conclusion of class today I CAN: • Understand what to report with abuse • Distinguish between child abuse and elder abuse

50. Reporting Abuse Healthcare professionals are required by law to report all suspected abuse Procedures and forms vary from state to state Follow office policy and procedure manual