Chapter 3
Ethical and Legal Responsibilities
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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
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Ethics
• Ethical dilemmas
– Situations that have no clear answers or
correct courses of action
Values
Action
Contradiction
Criminals should
be punished for
their crimes.
Capital punishment
for convicted
murderers
If it is wrong to kill, can
society justify killing
anyone, even a
criminal?
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Ethics and Health Care
• Many health care issues involve ethical
decisions
• Hippocrates was concerned with medical
ethics
– Hippocratic Oath
• respect the privacy of my patients
• for the benefit of the sick, all measures that are
required
• prevent disease whenever I can
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Ethics and Health Care
• Impact of technological advances
– Definition of life
• Who makes that decision?
• Anencephalic babies are born without a brain, only
a brain stem. They have no hope for a life other than
a vegetative state.
• Should they be kept alive?
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caviteniofilipino.blog...
Ethics and Health Care
– Expense of care
• How are health care dollars dispersed?
• Should life support be withdrawn from patients who
are in comas and judged to have no chance of
revival,
pensionriskmatters.com
– after one year?
– After five years?
» Stories of people waking up after
19 and 23 years in a coma
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healthjournalism.org
Question
• True or False:
– A good system of ethics will provide answers to
most health care decisions.
• False
– Many health care issues have no easy answers and present
serious ethical dilemmas
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Professional Codes of Ethics
• Standards of professional conduct
– Ensure high quality of care
– Developed by professional organizations
• Codes provide guidelines and standards of behavior for a
specific occupation, not ethical issues
caviteniofilipino.blog...
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Personal Values
• Values are the beliefs that provide the foundation
for making decisions, guide our behavior and
priorities
• They are influenced by family, religion, education,
and personal experience
• Values are what an individual believes to be most
important in their life
• Values are not necessarily right or wrong
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Personal Values
• When might values conflict with your job?
– You believe differently than the job policies
• HIV or abortions
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Question
• Which of the following is an example of a
value?
A. Law that protects the welfare of patients
B. Professional code for behavior
C. Personal belief that education is necessary
for a satisfying life
C. Personal belief that education is necessary for
a satisfying life
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Ethics and the Law
• Ethics provide general principles on which
laws are based
– Laws are a means of enforcing ethical
principles which are deemed to be in the best
interest of society
– Example
• Society agrees life is precious
• It’s members pass laws that make
murder a crime.
graphicsfactory.com
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Ethics and the Law
• Sometimes laws conflict with individual
ethics
– The use of marijuana
• Illegal in many states
• Has a medical use, it has been found to relieve
nausea experienced by patients on chemotherapy
thefreshscent.com
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Ethics and the Law
• Laws can have negative, unintended
consequences
– Legislation requires hospital emergency rooms
to accept all patients who require care,
regardless of their ability to pay.
– Many hospitals have had to close their
emergency rooms due to this legislation
denying their community an important health
care resource.
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Ethics on the Job
• There are eight guiding principles for health
care ethics
–
–
–
–
–
–
–
–
Preserve life
Do good
Respect autonomy
Uphold justice
Be honest
Be discreet
Keep promises
Do no harm
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1. Preserve Life
• Life is precious
– Take all possible means to preserve it
• Difficulties arise about the definition of life
– Artificial means of supporting life
– In society today it is becoming more acceptable
to discontinue life support because studies
have shown in most cases it postpones life
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Preserve Life
• Euthanasia
– Euthanasia (mercy killing) to relieve suffering
• Performing any act that results in the death of a
patient to alleviate suffering or when there is not
hope for recovery
• Illegal in most all states
• Few states have legalized the right to die
–
–
–
–
Oregon
Washington state
Montana
Certain requirements must be met before this can happen
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Oregon State
• Under the Death With Dignity law, a person who sought physicianassisted suicide would have to meet certain criteria:
–
–
–
–
–
The person must be terminally ill.
The person must have six months or less to live.
The person must make two oral requests for assistance in dying.
The person must make one written request for assistance in dying.
The person must convince two physicians that he or she is sincere and not acting
on a whim, and that the decision is voluntary.
– The person must not have been influenced by depression.
– The person must be informed of "the feasible alternatives," including, but not
limited to, comfort care, hospice care, and pain control.
– The person must wait for 15 days.
•
Read more:
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Question
• True or False:
– It is illegal in most states to withdraw artificial
means of supporting life.
• False
- Not illegal to withdraw life support under certain conditions
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1. Preserve Life
• Dilemmas:
– Organ transplants
• Saves lives, but not enough organs available for all that have a
need
• Have to have prior permission to take organs or that of the
family
– Stem-cell research
• Stem cell is one from which other types of cells can develop
• Most effective stem cells from human embryo/aborted fetus
• Researcher looking to create stem cells form human skin
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1. Preserve Life
– Rationing care and resources
• Cost of health care is rising
– What are some of the contributing factors you can think of?
• Organ transplants
– What is the current system?
– Under the National Organ Transplant Act, organ
transplantation in the United States is overseen by the
U.S. Department of Health and Human Services (DHHS).
• How are fair decisions made?
• Is one patient more deserving than another?
– Who decides?
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Question
• Research on stem cells is focused on
finding ways they can be used to _____ .
A. Create drugs to cure cancer
B. Replace damaged cells in humans
C. Prevent abortion
• B. Replace damaged cells in humans
Stem cells hold promise to replace cells damaged
by disease or injury
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2. Do Good
• Promote welfare of others
– Is a basic duty of health care professional
• Work in best interest of patients
– Listening carefully to patients
– Carefully assessing their needs
– Be aware of their ethical beliefs
• Perform one’s job without expectation of
receiving anything extra for doing a this job
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3. Respect Autonomy
• Autonomy means self-determination
– Patients have right to make own decisions
• May choose type of treatment
• May refuse treatment even if it will negatively affect
their health
– The American Hospital Association developed
the “Patient’s Bill of Rights” gives patients the
opportunity to make decisions regarding their
care.
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Consent
• Consent means giving permission
– Patient must give for treatment
– Can be given by the following:
• Mentally competent adults over the age of 18
• Emancipated minors
– Individuals under the age of 18 who are financially
independent, married or in the military
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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
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Consent
• John tells you he does not want the IV inserted by you do
this procedure anyway because the doctor ordered it. You
can be charged with ______________.
battery
• Are you guaranteed protection as long as the patient gives
permission?
• No
• Mary feels threatened when you bring in the nasogastric
tube, she said no again, even though you do not insert the
tube because Mary feels threatened could be_________.
assault
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Consent
• Informed consent
– Procedure explained including possible
consequences
• Two types
– Implied consent
• Indicated by patient’s actions
– Showing up for a doctors appointment
– Express consent
• Given in writing and required for most procedures
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Question
• If a patient schedules a root canal and shows up
at the appointed time for the procedure, this is an
example of _____ .
A. Express consent
B. Implied consent
C. Informed consent
• B. Implied consent
– Given by patient’s actions
• In this case, patient makes and keeps appointment for
procedure
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Advance Directives
• Written instructions containing patient’s desires
regarding health care should they become unable
1. Designation of health care surrogate
• Also known as health care power of attorney
• Gives specific people authority to make health care
decisions
2. Living will
• Contains written instructions regarding health care
• DNR, “Do Not Resuscitate”
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Advance Directives
• Patient Self-Determination Act (Law) of
1991
– Health care facilities must provide adult
patients with information about advance
directives
– Without instructions
• care of incompetent patients can be difficult
• Family or state may have to step in for decision
making
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Question
• True or False:
– A patient admitted to a hospital is legally
required to sign a living will.
• False
• Patients not legally required to prepare advance directives
– However, health care facilities must advise patients of rights to do
so
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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
• 2006 Massachusetts enacted a health reform law
that required almost every resident to obtain health
insurance coverage
• # of uninsured people dropped, but an increase in
the shortage of physician to now care for them
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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
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Reporting Abuse
• Federal Child Abuse Prevention and Treatment
Act
• Requires reporting of abuse
– Health care professionals must be aware of the signs
of possible child abuse
– Report suspected abuse to supervisor
– Patient confidentiality does not apply
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Laws that Protect
• 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
– Set up a schedule of narcotics from those that have no
medical use (LSD) to those with high to low addiction
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5. Be Honest
• Good health care relies on honesty
– Patient’s trust important
• Dilemma:
– How much to tell patients about their condition
– How much do you want to know?
• Honesty essential among coworkers and with
their supervisor
– If you disagree with a policy how would you handle this
problem?
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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
• Recently in the news a man posed as a doctor in an
emergency room telling them he was a doctor, but
he really was not.
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6. Be Discreet
• Preserve confidence and respect privacy
– Being careful about what you say
– Preserving confidences
• Confidentiality
– Patients’ information cannot be released
without their written consent
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6. Be Discreet
• Defamation of character
– Disclosing unauthorized information that can
harm reputation of another person
• Libel
– Disclosing information in writing
• Slander
– Disclosing information orally (spoken)
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6. Be Discreet
• Health Insurance Portability and
Accountability Act (HIPAA)
• Maintaining patient privacy
– Close doors and curtains
– Drape patients appropriately
– Do not discuss patients in public areas
– Discuss patients only with other authorized
personnel
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7. Keep Promises
• Promises are important part of relationships
with others
• Contracts
– Formal promises enforceable by law
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7. Keep Promises
• Contracts
– Components of a contract:
1. Offer or action that starts the process of forming a
contract
2. An exchange between the parties of something of
value
3. Acceptance or agreement that both parties want to
enter the contract
4. This can be verbal or written
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7. Keep Promises
• Types of contracts:
– Express
• Discussion and agreement on specific terms and
conditions
• Written or oral
• Important for health care professionals to avoid
making statements that might be interpreted as a
contract
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7. Keep Promises
– Implied contracts
• Actions of parties create and carry out contract
• Visiting a dentist for filling teeth, then paying for the
services is a form of implied contract
• Giving emergency treatment is a form of implied
contract
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7. Keep Promises
• 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
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Question
• Which of the following is an example of a
breach of contract?
A. A patient refuses to pay for treatment
because he is not happy with the results
B. A physician refuses to perform a treatment
based on information from lab tests
C. A physical therapist cancels future
appointments because the patient will not do
the prescribed exercises
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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
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7. Keep Promises
• Respondeat superior
– Legal doctrine holding employer responsible
for actions of their employees
– A patient suffers injuries from a fall caused by a
health care worker can be awarded damages
(money to compensate for injury or loss)
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8. Do No Harm
• Essential responsibility of health care
professionals is to do no harm
• Work must be with the scope of practice
– Performing only duties they have been trained
to do
• Negligence
– Harm due to failure to meet reasonable
standard of care
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8. Do No Harm
• Malpractice
– A term for professional negligence
– May result in lawsuit against health care
provider and/or facility
– Good interpersonal relationships are a key
factor in preventing malpractice lawsuits
– Communication and respect are important
ways to reduce the risk of being sued
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Question
• True or False:
– Poor communication between the patient and
the health care professional is a major cause of
malpractice lawsuits.
• True
• Major contributors to malpractice lawsuits:
– Poor communication
– Resulting patient anger
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Question
• What would you do if you believe the place
you work had a policy that might hurt a
patient?
• Bring the concern to your supervision and
look for ways to change the policy
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8. Do No Harm
• Good Samaritan laws
– Protect individuals who give care in emergency
situations
– Best to stay within scope of training
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Handling Ethical Dilemmas
• Priority:
– Well-being of patient
• Accept responsibility for making difficult
decisions
– Part of health care work
• Report illegal behavior
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Handling Ethical Dilemmas
• Resources:
– American Medical Association Council on
Ethical and Judicial Affairs
– Ethics committees at health care facilities
– Clergy and counselors
– Lawyers and risk management specialists
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