Legal, Moral, and Ethical Standards

1. Legal, Moral, and Ethical Standards Diagnostic Medicine

2. I. Understanding Laws, Morals, and Ethics: • The main sources for standards of behavior include: • Laws made by the governing bodies • Rules of behavior established by the society in which we live • Personal feelings of what is right and wrong

3. I. Understanding Laws, Morals, and Ethics: • Effective and successful health care professionals must be familiar with certain legal and ethical standards and follow them in performing daily duties • These standards will be your professional guidelines

4. 1. Laws: • A law is a rule of conduct or action • They are enacted and enforced by a controlling authority, such as the federal, state, and local government • There are penalties for breaking the law

5. Types of Laws:A. Criminal Laws: • Protect members of society from certain harmful acts of others • A crime is committed when the law is broken • A crime is defined as an offense against the local, state, or federal government

6. Criminal acts may be: • Commission—if there is a law forbidding a certain act • Omission—in violation of a law requiring a certain act

7. Criminal Laws: • Criminal laws are passed at local, state, and federal levels and generally carry stricter penalties for offenders than civil statutes do

8. B. Civil Laws: • Concerned with private rights and remedies • Under civil law, a person may sue another person, a business, or the government

9. Examples of Civil Laws: • Trespassing • Automobile accidents • Product liability • Family matters such as divorce, child support, and child custody

10. Civil Law: • Court judgments in civil cases often require the payment of a sum of money to the injured party

11. Types of Civil Laws:A. Torts: • Broadly defined as a civil wrong committed against a person or property, excluding breach of contract

12. Torts may have: • Caused physical injury • Resulted in damage to someone’s property • Deprived someone of his/her personal liberty and freedom

13. Torts may be: • Intentional or willful—may also be crimes and be prosecuted in both civil and criminal courts • Unintentional or accidental

14. Torts: • Negligence or unintentional torts are acts that are not intended to cause harm, yet they are committed “unreasonably” or without regard for the consequences

15. B. Medical Malpractice: • AKA Negligence • Most common unintentional tort within the health care delivery system • Negligence is charged when a health care practitioner fails to exercise ordinary care and a client is injured

16. B. Medical Malpractice: • The practitioner may have performed an act that a reasonable person, in similar circumstances, would not have • Or the practitioner may have failed to perform an act that a reasonable person would have • According to the legal principles of negligence, the “three D’s” of negligence must be present for a lawsuit to have merit

17. B. Medical Malpractice: • In a lawsuit involving medical malpractice, the plaintiff must prove that the defendant: • Owed a duty to the plaintiff. That is, a healthcare practitioner—client relationship existed and the client was being treated • Was derelict or did not live up to the obligation of caring for the client or plaintiff • Committed a breach of duty that was a direct cause of damages to the client or plaintiff

18. B. Medical Malpractice: • A health care practitioner is liable only if it can be established that he/she has been negligent in the delivery of professional services and therefore has caused injury to the client

19. Medical Practice Acts: • State statutes that govern medical practice • Similar in all fifty states

20. Medical Practice Acts do the following: • Cover requirements and methods for licensing health care providers • Establish medical licensing boards • List grounds for revoking licenses

21. Medical Practice Acts: • Protect people from dishonest or unqualified people defrauding the public

22. 2. Morals and Ethics: • Morals are formed from your personal values—your concept of right and wrong • You develop moral values through the influence of family, culture, and society

23. 2. Morals and Ethics: • Ethics are standards of behavior developed as a result of your moral values • Unethical acts are not always illegal—however illegal acts are always unethical

24. 2. Morals and Ethics: • Your personal moral values are always at work as you make decisions in your daily life • For further guidance, most health care organizations have established codes of ethics to help their professional members with difficult decisions

25. 3. Noncompliance: • There are penalties for noncompliance with legal responsibilities and ethical standards • Penalties for breaking the law are usually stricter than those for unethical behavior

26. Noncompliant health care workers may: • Face fines or prison sentences • Lose their license to practice their profession by the state • Face a peer council review from their professional organization • Censure or expulsion from the professional group

27. II. Licensure, Registration, and Certification: • Depending on the state and job classification, members of the health care team may be licensed, registered, or certified to perform specific duties • Each state’s medical practice acts define the requirements for each job classification or profession

28. 1. Licensure: • Required for certain professions to practice within a state • Persons who do not meet state standards for a license may not legally practice • For those professions that require a state license, reciprocity may be granted • Reciprocity means that a state licensing authority will accept a person’s valid license from another state without requiring reexamination

29. 2. Registration: • Means that a person’s name has been listed in an official registry or record as having satisfied the standards for a certain health care occupation

30. For positions where registry is not required in order to practice: • Persons simply add their name to the list of names in the registry • Unregistered workers are not barred from working if they are qualified

31. For positions where registry is required in order to practice: • These professionals must fulfill certain education requirements and/or pay a registration fee • Unregistered individuals may not work at the job, even if they have qualifying education and experience

32. 3. Certification: • Usually voluntary and national in scope • Certification by a professional organization is most often achieved by taking an examination • Passing the examination shows that an individual has attained a certain level of knowledge and skill • Since the process is voluntary, lack of certification does not prevent an employee from practicing the profession

33. Standard of Care and Scope of Practice: • According to the legal doctrine of standard of care, health care workers should perform only those duties within the scope of their license or job description • Standard of care is the level of performance expected of a healthcare worker in carrying out his/her duties • Standard of care is based on the profession’s scope of practice

34. A profession’s scope of practice is based on the: • Job description • Level of training • Qualifications • Job classification

35. For example: • Physicians are held to a higher standard of care than nurses • Registered nurses are held to a higher standard of care than licensed practical nurses • LPNs are held to a higher standard of care than nursing assistants • Individuals trained to perform specific tasks are held to a standard of care consistent with their training

36. Standard of Care and Scope of Practice: • Standards of care are an important legal concept • If a health care worker performs a procedure that is not within the scope of his/her duties and causes injury to a client, the health care worker may be liable or legally responsible if a lawsuit is filed

37. Standard of Care and Scope of Practice: • Standards of care and scope of practice concepts help to define each worker’s role on the health care team

38. Working within your scope of practice fulfills two important job requirements: • Do not injure clients or put them at risk by performing procedures that are beyond your ability • Will not be held liable for a standard of care that is beyond your training, experience, and job description if a legal situation arises

39. The Law of Agency: • Closely linked to the concept of standard of care • According to this legal doctrine, an employer is legally liable for acts performed by employees

40. Example: • Suppose that on a busy day in a medical office, a certified medical assistant (CMA) is asked to draw blood from a client. • According to her state’s laws, drawing blood is not within the CMAs scope of practice, but she believes she is capable and since the office is short-handed, she complies.

41. Over the next two weeks, the client develops an infection at the site where blood was drawn and must be hospitalized. • The infection finally heals, but the client’s arm is permanently scarred. • The client decides to sue the physician who employs the medical assistant.

42. The CMA is liable for her actions, and in the even of a lawsuit, could be held to the standard of care of a phlebotomist, who, by the scope of his/her practice, is qualified to draw blood. • Under the law of agency, the physicians affiliated with the medical office that hired the medical assistant are also held liable in the case of the lawsuit.

43. III. Informed Consent: • Many procedures and tests require clients to sign a consent form giving the facility permission to perform the procedure or test • Health care workers in charge of documenting treatment should include in a client’s medical record the signed consent form and a statement saying that the client was duly informed before signing the consent—this is known as informed consent

44. The requirements for informed consent include verbally explaining: • The proposed methods of treatment • Why the treatment is necessary • The risks involved in the proposed treatment • All available alternative types of treatment • The risks of any alternative methods of treatment • The risks involved if treatment is refused

45. III. Informed Consent: • Adults of sound mind are usually able to give informed consent • Persons who cannot legally be expected to give informed consent include minors, mentally incompetent individuals, and speakers of foreign language

46. Minors: • Individuals under the age of majority (18 in most states, 21 in others) • Exceptions can include minors who live away from home and support themselves or those who have been judged by the court to be mature minors

47. Minors have the right to obtain the following care without first obtaining parental consent: • Seek birth control • Care during pregnancy • Treatment for reportable communicable diseases • Treatment for drug- and alcohol-related problems

48. Mentally Incompetent Individuals: • Persons judged by the court to be insane, senile, mentally retarded, or under the influence of drugs or alcohol cannot give informed consent • In these cases, a competent person may be designated by the court to act for the individual

49. Speakers of a Foreign Language: • Interpreters may be necessary in order to inform these clients and obtain consent for treatment

50. IV. Confidential: • Considered “the condition of being private or secret” • Clients have a legal and ethical right to have all personal medical information kept private • Privileged communication refers to information held private within a protected relationship, such as that of a physician and client