Infant Mortality

Infant Mortality

Question • True or False: • A good system of ethics will provide answers to most health care decisions.

Answer • False • Many health care issues have no easy answers and present serious ethical dilemmas

Chapter 3 Ethical and Legal Responsibilities

Ethics • Ethics • System of principles for determining right and wrong • Guides decision making • Helps with difficult and complex problems • Varies among cultural groups • Influenced by religion, history, and collective experiences • Ethical dilemmas • Situations that have no clear answers or correct courses of action • E.g., gun control, capital punishment, freedom of speech

Ethics and Health Care • Many health care issues involve ethical decisions • Hippocrates was concerned with medical ethics • Hippocratic Oath • Impact of technological advances • Definition of life • Expense of care • Professional Code of Ethics • Standards of professional conduct • Ensure high quality of care • Many professional organizations have codes • Codes provide guidelines for handling difficult issues

Personal Values • Foundation for making decisions and guiding behavior • Influenced by family, religion, education, and personal experience • Establish priorities • Values not necessarily right or wrong • Belief on which decisions are based • Tends to be personal

Ethics and the Law • Ethics provide general principles on which laws are based • Sometimes laws conflict with individual ethics • Laws can have negative, unintended consequences

Guiding Principles of Health Care Ethics • Preserve life • Do good • Respect autonomy • Uphold justice • Be honest • Be discreet • Keep promises • Do no harm

1. Preserve Life • Life is precious • Take all possible means to preserve it • No agreement on definition of life • Artificial means of supporting life • Euthanasia to relieve suffering • Illegal in almost all states • Dilemmas: • Organ transplants • Stem-cell research • Rationing care and resources

2. Do Good • Promote welfare of others • Basic duty of health care professional • Work in best interest of patients • Perform one’s job without expectation of receiving anything extra

3. Respect Autonomy • Self-determination • Patients have right to make own decisions • May choose type of treatment • May refuse treatment

Consent • Permission patient must give for treatment • Can be given by the following: • Mentally competent adults • Emancipated minors • Informed consent • Procedure explained including possible consequences • Implied consent • Indicated by patient’s actions • Express consent • Given in writing

Violations of Consent • Battery = crime • Touching or treating patients without consent • Assault = crime • Threatening to touch or treat without permission • False imprisonment • Holding mentally competent patients against their will

Question • If a patient schedules a root canal and shows up at the appointed time for the procedure, this is an example of _____ . • Express consent • Implied consent • Informed consent

Answer • B. Implied consent • Implied consent • Given by patient’s actions • In this case, patient makes and keeps appointment for procedure

Advance Directives • Written instructions containing patient’s desires regarding health care • Designation of health care surrogate • Also known as health care power of attorney • Gives specific people authority to make health care decisions • Living will • Contains written instructions regarding health care • Patient Self-Determination Act of 1991 • Health care facilities must provide adult patients with information about advance directives • Without instructions, care of incompetent patients can be difficult

4. Uphold Justice • Justice refers to fairness • All patients must receive same level of care • Dilemma: • Equitable distribution of health care resources • Ranking and rationing of health care services

Reporting Abuse • Protect others from harm • Laws require reporting of abuse • Federal Child Abuse Prevention and Treatment Act • States have laws and reporting systems for elder abuse • Report suspected abuse to supervisor • Patient confidentiality does not apply • Occupational Safety and Health Act • Requires employers to be responsible for employees • Controlled Substances Act • Helps prevent abuse of addictive drugs • Provides guidelines for prescribing and handling

5. Be Honest • Good health care relies on honesty • Patient’s trust important • Dilemma: • How much to tell patients about their condition • Honesty essential among coworkers and with supervisor

Fraud • Dishonesty involving cheating or trickery • Health care examples: • Insurance claims for services not performed • Selling ineffective treatments • Claiming education or credentials one does not have

Question • True or False: • Poor communication between the patient and the health care professional is a major cause of malpractice lawsuits.

Answer • True • Major contributors to malpractice lawsuits: • Poor communication • Resulting patient anger

6. Be Discreet • Preserve confidence and respect privacy • Confidentiality • Patients’ information cannot be released without their written consent • Health Insurance Portability and Accountability Act (HIPAA) • National standards to protect patient privacy • Follow facility policies • Maintaining patient privacy • Close doors and curtains • Drape patients appropriately • Do not discuss patients in public areas • Discuss patients only with other authorized personnel • Dilemmas: • Public safety • Patient has contagious disease • Patient desire to harm self • Genetic testing

Violations of Discretion • Defamation of character • Disclosing unauthorized information that can harm reputation of another person • Libel • Disclosing information in writing • Slander • Disclosing information orally

7. Keep Promises • Promises are important part of relationships with others • Contracts • Formal promises enforceable by law • Contain three components: • Offer • Acceptance • Consideration • Types of contracts: • Express • Discussion and agreement on specific terms and conditions • Implied • Actions of parties create and carry out contract • Breach of contract • One party fails to carry out part of agreement • Damages • Money to compensate for injury or loss • Agent • Someone who represents another person when making contract • Respondeat superior • Legal doctrine holding employer responsible for actions of employees

Question • Which of the following is an example of a breach of contract? • A patient refuses to pay for treatment because he is not happy with the results • A physician refuses to perform a treatment based on information from lab tests • A physical therapist cancels future appointments because the patient will not do the prescribed exercises

Answer • A. A patient refuses to pay for treatment because he is not happy with the results • Patient who refuses to pay physician for services given is not fulfilling his or her part of agreement • Results in breach of contract

8. Do No Harm • Essential responsibility of health care professionals • Negligence • Failure to meet reasonable standard of care • Malpractice • Professional negligence • May result in lawsuit against health care provider and/or facility • Good Samaritan laws • Protect individuals who give care in emergency situations • Best to stay within scope of training

Handling Ethical Dilemmas • Priority: • Well-being of patient • Accept responsibility for making difficult decisions • Part of health care work • Report illegal behavior • Resources: • American Medical Association Council on Ethical and Judicial Affairs • Ethics committees at health care facilities • Clergy and counselors • Lawyers and risk management specialists

Infant Mortality