CHAPTER 11
LEGAL AND ETHICAL
PRINCIPLES
Copyright 2003 by Mosby, Inc. All
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The Qualities of a Successful
Health Care Worker
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Qualities for Success
Understanding Laws, Morals, and Ethics
Licensure, Registration, and Certification
Standard of Care and Scope of Practice
Informed Consent
Confidentiality
Copyright 2003 by Mosby, Inc. All
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Qualities for Success
• Successful health care providers use the 3
Cs:
– Courtesy
– Compassion
– Common sense
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Qualities for Success
• Other helpful qualities include:
– A relaxed attitude when meeting new people.
– A willingness to learn new skills and
techniques.
– An aptitude for working with the hands.
– Empathy for others.
– Good communication and listening skills.
– Patience in dealing with others.
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Qualities for Success
– The ability to work as a member of a health
care team.
– Proficiency in English, science, and
mathematics.
– Tact.
– The ability to keep information confidential.
– The ability to leave private concerns at
home.
– Trustworthiness.
– A sense of responsibility.
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Understanding Laws, Morals, and
Ethics
• Laws – a law, or statute, is a rule of
conduct or action.
– Criminal Laws – protect members of
society from certain harmful acts of
others. A criminal act may be one of:
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Commission, if there is a law forbidding a certain
act.
Omission, in violation of a law requiring a certain
act.
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Understanding Laws, Morals, and
Ethics
– Civil Laws – are concerned with private
rights and remedies. Examples of the causes
of civil disputes include:
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Contract violation.
Slander or libel.
Trespassing.
Product liability.
Automobile accidents.
Family matters such as divorce, child support, and
child custody.
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Understanding Laws, Morals,
and Ethics
– Torts
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A tort is broadly defined as a civil wrong committed
against a person or property, excluding a breach of
contract. (Personal Injury)
Torts may be intentional (willful) or unintentional
(accidental) and, if intentional, may also be crimes.
Unintentional torts are acts that were not intended to
cause harm. However, they are committed without
regard for consequences.
Ex: A health care facility inappropriately left out
equipment in the hallway and an employee tripped and
was injured.
Copyright 2003 by Mosby, Inc. All
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Box 4-1 Code of Ethics
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Health Careers and the Law
• Health care provider is legally
responsible (liable) for his or her
behavior and the care given
• The law of Agency- Employer may also
be liable for the actions of a health care
provider that are not reasonably
prudent (negligent) or that reflect bad
practice (malpractice)
Copyright 2003 by Mosby, Inc. All
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Definitions
• Malpractice- failure of professional skill that results in
injury, loss or damage
• An unintentional tort is caused by negligence. Negligence
is also called medical malpractice.
• Negligence- failure to execute the care that a reasonable
person exercises; An unintentional tort. Ex: leaving the bed
rails down when caring for a confused patient
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The 3 Ds must be present for negligence to occur:
– Duty – health care practitioner/client relationship exists.
– Derelict – health care practitioner did not live up to the
obligation of caring for a client.
– Damage – the breach of duty results in damages to the client
or plaintiff.
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Understanding Laws, Morals, and
Ethics
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Physicians are most likely to be charged with
negligence. However, other health care
practitioners may be subject to such charges.
Medical practice acts are state statutes that
govern medical practices. They do the following:
» Cover requirements and methods for
licensing health care providers.
» Establish medical licensing boards.
» List grounds for revoking licenses.
Copyright 2003 by Mosby, Inc. All
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Malpractice Liability
• It is considered malpractice when the
health care worker is:
– Performing skills that are beyond the level
of the health care worker’s education and
training
– Neglecting to do something that is
considered to be common practice such as
leaving the client in an unsafe situation
Copyright 2003 by Mosby, Inc. All
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Standard of Care and Scope of
Practice
• Standard of care is the level of performance expected of a health care
worker in carrying out his or her professional duties.
– Working outside your scope of practice can make you liable.
– Working within your scope of practice ensures that you:
• 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.
Copyright 2003 by Mosby, Inc. All
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Jurisprudence
• When you are a healthcare provider or
professional- You MUST be jurisprudent!!
• What does that mean???
– The healthcare professional is aware of the laws
that affect the industry and their scope of
practice.
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Informed Consent
A SAMPLE CONSENT FORM
• Informed Consent
– in order for a
client to make an
informed decision
regarding
treatment, the
client needs to be
told the following:
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Consent
• Informed Consent
– 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.
When must written consent be obtained?
• Answer
• Consent must be obtained for many procedures such as surgery
and tests.
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Standard of Care and Scope of
Practice
– People who cannot give informed consent
include:
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Minors – individuals under 18 years of age (21 in
some states). Exceptions include those deemed
mature minors by the court.
Mentally incompetent individuals – persons
judged by the court to be insane, senile, mentally
retarded, or under the influence of drugs or alcohol.
Speakers of a foreign language who do not speak
English.
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Professional Codes of
Conduct
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Ethics are the principles and values that
determine appropriate behavior
– Respect for cultural, social, and ethical
differences of the clients and other workers
– Practicing within the guidelines of laws, policies,
and regulations established for each type of
employment
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Morals are based on the experience,
religion, and philosophy of the individual
and the society
Copyright 2003 by Mosby, Inc. All
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Box 4-1 Code of Ethics
Copyright 2003 by Mosby, Inc. All
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Understanding Laws, Morals, and Ethics
• Noncompliance
– Noncompliant health care workers may face
fines or prison sentences and can lose their
licenses to practice their profession.
– Unethical conduct may result in expulsion or
censure from your professional organization,
but only the state can revoke a license.
IRB- Internal Review Board- panel of experts
reviewing cases pertaining to legal and ethical
matters
Copyright 2003 by Mosby, Inc. All
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Confidentiality
• A patient’s health care is considered
confidential, or private
• The health care worker is ethically
responsible to maintain the patient’s privacy
• “Privacy of Individually Identifiable Health
Information.” The rule applies to all agencies
sharing personal health information (paper,
oral, and electronic) for people who are
insured privately, by public programs, or
uninsured.
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Confidentiality
• Confidentiality
– It is illegal and unethical if a
health care worker does not
observe confidentiality.
– Privileged communication refers
to information held confidential
within a protected relationship.
• Written consent must be obtained
before releasing information to a
third party.
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CONSENT TO RELEASE INFORMATION
Patient Confidentiality
– Guidelines to follow if you have access to a client’s
information:
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Do not decide if information is confidential based on your
approval or agreement.
Do not reveal financial information about a client.
Do not use the client’s name or other information if others in the
room might overhear.
Use caution in giving the results of medical tests to clients over
the telephone.
Do not leave medical charts or insurance reports where clients or
others can see them.
If the client has not given written permission to release
information, do not release it.
Do not discuss clients in public places where others may
overhear, such as the cafeteria or elevator.
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Exceptions to Confidentiality
– Confidentiality for client medical records may be waived
under the following circumstances:
• When a third party requests a medical examination, such as a
preemployment examination, and that third party pays the
client’s bill.
• When a client sues a physician or other health care practitioner
for malpractice.
• When the client signs a waiver allowing the release of
information.
• When you suspect abuse or neglect of a patient; must report to
legal authority
• When there is an infectious disease or STD that must be
reported to the health department
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HIPAA/Confidentiality
• HIPAA- Health Insurance Portability and Accountability
Act (1996)
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*Insurance portability- making sure that people who
move from one health plan to another will maintain
coverage and not be denied
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*Fraud enforcement (accountability)- increases
federal government’s fraud enforcement authority
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*Administrative simplification (reduction in health
care costs)- provide standards for electronic exchange of
health information, assures privacy and security of health
information
Copyright 2003 by Mosby, Inc. All
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HIPAA/Confidentiality
• **Failure to comply can mean either civil or criminal sanction. These
can be up to $250,000 or prison up to 10 yrs
• Patient Rights Under HIPAA
• Access- Patients may ask to inspect or get a copy of their health info
that is maintained by the entity
• Amendment- Patients may request that amendments be made to their
health info
• Restrictions- Patients may want further restrictions placed upon
sharing their records beyond what is required by law
• Accounting of Disclosures- Patients have the right to know how their
health info has been shared with others
• (ex: Notice of Privacy Practices)
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Patient’s Bill of Rights
• The American Hospital Association’s Patient’s Bill of
Rights is followed in most states. It guarantees the
client’s right to:
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Receive considerate and respectful care.
Receive complete and current information concerning his or
her diagnosis, treatment, and prognosis.
Know the identity of physicians, nurses, and others involved
with his or her care, as well as when those involved are
students, residents, or trainees.
Know the immediate and long-term costs of treatment choices.
Receive information necessary to give informed consent prior
to the start of any procedure or treatment.
Have an advance directive concerning treatment or be able to
choose a representative to make decisions.
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Patient’s Bill of Rights
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Refuse treatment to the extent permitted by law.
Receive every consideration of his or her privacy.
Be assured of confidentiality.
Obtain reasonable responses to requests for services.
Obtain information about his or her health care and be allowed
to review his or her medical record and to have any
information explained or interpreted.
Know whether treatment is experimental and be able to
consent or decline to participate in proposed research studies or
human experimentation.
Expect reasonable continuity of care.
Ask about and be informed of the existence of business
relationships between the hospital and others that may
influence the client’s treatment and care.
Know which hospital policies and practices relate to
client care, treatment, and responsibilities.
Patient’s Bill of Rights
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Be informed of available resources for resolving
disputes, grievances, and conflicts, such as ethics
committees or patient representatives.
Examine his or her bill and have it explained and be
informed of available payment methods.
Providing information about past illnesses,
hospitalizations, medications, and other matters
related to their health status.
Following a physician’s orders for treatment. The client has the
right to refuse treatment to the extent permitted by law.
Providing health care agencies with necessary information for
insurance claims and working with the health care facility to
make arrangements to pay fees when necessary.
Copyright 2003 by Mosby, Inc. All
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Legal Directives
• Legal documents that allow patients to express
their wishes about their health care and treatment
and are three types of advance directives
1. Living will allows a person to state in advance
whether to receive life support and what life-support
procedures to withhold if the person is terminally ill
and permanently unconscious; provides instructions
directly to physicians, hospitals, and other health care
providers involved in a client’s medical treatment.
2. Durable Power of Attorney – not specifically a medical
document, but it may serve that purpose. It gives a person, called
a designee, the authority to make a variety of legal decisions on
behalf of another person, called the grantor.
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Legal Directives
3. Health Care Proxy –
or health care power of
attorney, is also an endof-life document. With
it, clients specify an
agent to make medical
decisions for them in the
event that they lose the
ability to reason or
communicate.
SAMPLE HEALTH CARE PROXY
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Health Care and the Internet
• Patients can:
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Access health care information
Join chat groups
Purchase drugs and other medical items
Consult a health care practitioner online
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Medical Records
• Facilities providing health care services are required by licensing
authorities to keep and maintain health care records of clients.
• Medical records provide:
– A format for tracking, documenting, and maintaining a client’s
health data.
– Documentation of a client’s lifelong health care.
– A basis for managing a client’s health care.
– Background information in the event of a lawsuit.
– Clinical data for education, research, statistical tracking, and
assessing the quality of health care.
– Medical records may be kept on paper, microfilm, or computer
tapes or disks. They belong to the owners of the facility, even
though the client owns the information contained in them
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Documentation
• A chart is the written documentation that
serves as the legal record of the care given to
the client
• A chart must be precise, clear, and concise to
show the activities of care (typically written in
black ink)
• Charting is the main technique used by health
care workers to communicate about patients
• **Charting is the most common incident of
liability for health care workers
Copyright 2003 by Mosby, Inc. All
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