MS 02.00: Differentiate between legal and ethical

issues impacting health care.

Objective MS 02.01: Analyze legal responsibilities, limitations, and implications of actions.

Legal Responsibilities

• According to Webster’s New World Dictionary: 

– LAW is defined as all the rules of conduct established and enforced by the authority, legislation, or custom of a given community or other group.

LAWS

• Criminal Law – deals with wrongs against a person, property or society.

• The offender can go to jail or prison.• Examples of criminal laws: 

– Practicing in a health care profession without a required license

– Misuse of narcotics– Theft– Murder

LAWS

• Civil Law – deals with legal relationships between people and the protection of a person’s rights.

• Health Care is mainly affected by Civil Law.

TORTS

• Tort – from the French word, “wrong.”

• Tort can be defined as a civil wrong committed against a person or property excluding breach of contract.

Malpractice

• interpreted as “bad practice.”

• Defined as the failure of a professional to use the degree of skill and learning commonly expected in a particular profession resulting in injury, loss, or damage to the person receiving care.

 

Negligence

• failure to give care that is normally expected of a reasonable person in the same situation, (or doing something that a reasonable person would not do) with resulting injury to another person.

Assault and Battery

• Assault – any threat or willful attempt to injure another person with the apparent ability to do so.

• Battery – unlawful touching of another person without consent.

Assault and Battery

• A physician may be charged with

assault and battery because of

failure to obtain proper consent for

treatment.

Informed consent

• is permission granted voluntarily by a person who is of sound mind after the procedure and all risks involved have been explained in terms the person can understand.

• They understand: What will be done, Who will do it, How it will be done, Expected outcomes. 

Informed consent• The patient/client must also

understand treatment alternatives and consequences of not having treatment.

• The health care worker does not perform the procedure if the patient does not give consent.

Invasion of privacy• Unnecessary exposure of an

individual or revealing personal information about an individual without consent.

False imprisonment

• Restraining an individual or restricting an individual’s freedom.

 

Defamation of Character

• Damaging a person’s name and/or reputation by making public statements that are false and malicious.

• There are two types: – Libel – if the information released is

written– Slander – if the information released is

spoken.

Abuse• Any abuse that results in physical harm, pain, or

medical anguish. • Abuse can be classified as:

– Physical – hitting, forcing persons against their will, restraining movements, depriving of food or H2O, or not providing physical care.

 – Verbal – talking harshly, swearing or shouting,

teasing, ridiculing, intimidating a person. – Sexual – any unwanted sexual touching or act.

Abuse

• Child Abuse

• Elder Abuse

• Spousal (domestic) Abuse

• Can be physical abuse, passive neglect, active neglect, psychological abuse, financial abuse

Abuse

• **Laws in all states require reporting of any form of abuse to proper authorities.**

 CONTRACTS

• A Contract is a voluntary agreement between two or more parties

•  It has three parts.

 CONTRACTS

1. Offer – competent individual enters into a relationship with health care providers and offers to be a patient. 

2. Acceptance – health care provider gives an appointment or examines or treats a patient. 

3. Consideration – payment made by the patient for services provided.

Types of Contracts

• Implied – gives rise to contractual obligations by some action or inaction without verbally expressed terms.

Types of Contracts

• Expressed– actual agreement between the parties, the terms are stated in distinct and explicit language, either orally or in writing.

Contracts

• All parties in a contract must be free of legal disabilities.

• A person with legal disabilities does not have the legal capacity to form a contract.**

Legal Disabilities

• Minors– anyone under 18, or the age of majority, is

called “an infant” under the law. 

• Mentally incompetent persons

• Individuals under the influence of drugs that alter the mental state

• Semi-conscious or unconscious people

Law of Agency

• Agency is a personal relationship, created by the mutual consent of:

– The Agent (employee)

– The Principal (employer)

Law of Agency

• The AGENT (employee) acts on behalf of the PRINCIPAL (employer) while supervised by the principal.

• The principal is responsible for the actions of the agent and can be required to compensate or pay people who have been injured by the agent.

Law of Agency

• Health care workers must be aware of the role as agents and work to protect the interests of the employer.

 

• Agency may be expressed or implied, but is usually implied in the medical office.

Law of Agency

• Privileged Communication– Covers all information given to health personnel by

a patient.

 • Physician/Patient information cannot be told to

anyone else without the written consent of the patient.

• By law, this information must be kept confidential. 

Privileged Communication

Written consent should state:

• 1.   What information can be released.

• 2.    Who can get the information.

• 3.     Any time limits related to the release of information.

•  There are some exceptions to this……..

Privileged Communication

Law requires these items be reported to appropriate governmental agencies

1.  Births and deaths2.  Injuries caused by violence (abuse, etc.)3.  Drug abuse4.  Communicable disease5.  Sexually transmitted diseases

Health Care Records

• Contain information on the care that has been provided to the patient.

• Medical records belong to the health care provider but the patient has the right to obtain a copy.

Health Care Records

• The medical record is a legal document and may be subpoenaed as evidence in a court of law.

Health Care Records

• Errors must be corrected by drawing a single line through the mistake, inserting the correct information, dating the change, and signing your initials.

• Erasures are not allowed!!!!!!!!!!!!!!

Health Care Records

• Never chart any treatment(s) or procedure(s) until after you have done them

Health Care Records

• Records must be maintained and retained for the amount of time as required by state law (2 to 7 yrs).

• When records are destroyed, they must be burned or shredded.

Health Care Records

• Computerized records have created modern dilemmas on maintaining confidentiality.

Patient Confidentiality

• Health Insurance Portability and Accountability Act of 1996 (HIPAA)

• Original goal – make it easier for people to move from one health insurance plan to another as they change jobs or stop working.

HIPAA

• Also people must be able to move their medical records from provider to provider.

• HIPAA requires all providers to use the same insurance forms to make it easier to share information.

• BUT……………….

HIPAA

• …..as information becomes simpler and easier to share, the risks of confidential information being released increases.

• Additionally with more information being sent over computer networks and computerized records, the potential for leaks and abuse rises even more.

HIPAA

• HIPAA makes it illegal to release health information to inappropriate parties or to fail to protect patient information!

Before HIPAA…….

An employer fired an employee after learning he had tested positive for a genetic illness that could lead to lost work days and increased insurance payments.

Before HIPAA…….

A congresswoman who had suffered from depression had her medical records released to a newspaper.

Before HIPAA…….

Medical information was used in divorce and custody cases.

AFTER HIPAA……….

Civil penalties, which can accumulate into the thousands if multiple patients are involved.

AFTER HIPAA……….

Criminal penalties include large fines and jail time. Penalties increase for selling information.

Releasing information with harmful intent or profit can lead to 10 year jail sentence and $250,000 fine.

Legal Directives

• Legal documents that allow individuals to state what medical treatment they want or do not want in the event that they become incapacitated and unable to express their wishes.

Legal Directives

• Also known as advanced directives.

• There are two main directives:– Living Wills

– Healthcare Power of Attorney

Living Wills

• Documents that allow individuals to state what measures should or should not be taken to prolong life when their condition is terminal.

• Most states have laws that allow the withholding of life-sustaining procedures and honor living wills.

• These frequently result in a DO NOT RESUSCITATE (DNR) order for a terminally ill individual.

Durable Power of Attorney

• Document that permits an individual (principal) to appoint another person (agent) to make any decisions regarding health care if the principal is unable to make decisions

Durable Power of Attorney

• Includes:– Providing or withholding specific medical

or surgical procedures– Hiring or dismissing health care

providers– Spending or withholding funds for health

care– Having access to medical records

Patient Self-Determination Act (PSDA) of 1991

• a federal law passed by Congress in 1990 which requires all health-care institutions that receive Medicare or Medicaid funds to inform all adult patients through written information about their rights to accept or refuse medical or surgical treatment and the right to execute an "advance directive."

Patient Self-Determination Act (PSDA) of 1991

• but it does not require states to adopt or change any substantive laws. The written information must clearly state the institution's policies on withholding or withdrawing life-sustaining treatment.

Patient Self-Determination Act (PSDA) of 1991

• Also requires facilities to:– document in each patient's medical

record whether an advance directive has been executed 

– educate staff and the public about the right to forgo treatment

– and to ensure institutional compliance with state law.

Patient Self-Determination Act (PSDA) of 1991

• Violation of the act can lead to loss of federal funding.

Landmark Cases involving “Right to Die”.

• Karen Quinlan

• Nancy Cruzan

• Terri Schiavo

MS 202.00: Differentiate between legal and ethical

issues impacting health care.

MS202.02 Contrast Personal and Professional Ethics.

Ethics

• Ethics is a set of principles dealing with what is morally right or wrong.

• They provide a standard of conduct or a code of behavior representing ideal behavior for a group of people.

Study of Ethics

• Study of ethics is based in philosophy.

• Ethos is a Greek word meaning custom, usage or character.

• Two major divisions of ethical theories: Deontological and Teleological.

Deontological ethics

• Comes from Greek word-deonotos -meaning duty or obligation.

• States decisions are based on the intrinsic right or wrong of an action.

Teleological ethics

• Comes from Greek word-teleos meaning end and logos meaning words or sayings.

• Concerned with the outcomes of actions –whether the result of the action produces greater good in the world.

Basic Rules of Ethics

1. Put the saving of life and the promotion of health above all else.

2. Treat all patients equally, regardless of race, age, sex, religion, socioeconomic status or nationality

Basic Rules of Ethics

3. Avoid bias, prejudice and discrimination

4. Maintain a competent level of skill consistent with the occupation.

5. Maintain confidentiality and respect for the privacy of others.

Basic Rules of Ethics

6. Refrain from immoral and illegal practices.

7. Report illegal actions of others to the proper authority.

8. Show loyalty to patients, co-workers, and employer.

Basic Rules of Ethics

9. Be sincere, honest and caring.

10.Treat others the way you want to be treated “The Golden Rule”

Universal Principles of Biomedical Ethics.

• Autonomy: Patient has right to make own decisions regarding his medical care. Opposite is Paternalism (“I know what is best for you. I’ll make your decisions for you”)

Universal Principles of Biomedical Ethics.

• Veracity: Health care personnel must tell the truth to the patient. They must be honest in all their dealings with patient. Includes billing, recommending procedures, referrals, etc.

Universal Principles of Biomedical Ethics.

• Beneficience: Any action taken by health care personnel must be for the benefit of the patient. Further defined as doing the right thing for the patient.

Universal Principles of Biomedical Ethics.

• Nonmaleficience: Health care personnel must not take any action that will cause harm to the patient. Also known as “inflict no evil or harm”.

Universal Principles of Biomedical Ethics.

• Confidentiality: Patient has a right to his privacy.

Universal Principles of Biomedical Ethics.

• Justice: Health care personnel promote and assure the equal distribution of scarce resources (ex. Donated organs).

Universal Principles of Biomedical Ethics.

• Role Fidelity: Health care personnel stay within their scope of practice. Example-a nurse does not perform surgery, a dietitian does not prescribe medicine, or a nursing assistant does not tell a patient his diagnosis. 

Ethics in Action

• Professional organizations have created “codes of ethics” to redefine the ethical principles as they apply to that specific profession.

Code of Ethics for all Healthcare Professionals

• Perform only those procedures for which you have been trained and are legally permitted to do. – If you are asked to perform procedures for which you

have not been trained REFUSE.

– Use approved and correct methods while performing any procedure.

– Obtain correct authorization before performing any procedure.

– Identify patient and obtain the patient’s consent before performing any procedure. Check patients name band and state patient’s name clearly, repeating if necessary.

Professional Standards for all Healthcare Professionals

• Keep all information confidential.

• Treat all patients equally.

• Think before you speak and watch everything you say. Do not tell a patient information unless you have been instructed to do so.

Professional Standards for all Healthcare Professionals

• Accept no tips or bribes for care you provide.

• If an error occurs or you make a mistake, report it immediately to your supervisor.

• Behave professionally in dress, language, manners and actions.

Patient’s Bill of Rights

• Developed by American Hospital Association in 1973

• Revised in 1992.

• States the ethical treatment patients should receive in the hospital.

• Serves as a reminder to the professional as to how they should approach the patient.

A Patient has the right to

– Considerate and respectful care

– Obtain complete, current information concerning diagnosis, treatment, and prognosis

– Receive information necessary to give informed consent prior to the start of any procedure or treatment.

A Patient has the right to:

– Refuse treatment to the extent permitted under law.

– Privacy concerning a medical-care program

– Confidential treatment of all communications and records.

– Reasonable response to a request for services.

A Patient has the right to– Obtain information regarding any

relationship of the hospital to other health care and educational institutions.

– Be advised of and have the right to refuse to participate in any research project.

– Expect reasonable continuity of care.

A Patient has the right to:– Examine bills and receive explanation of

all charges.

– Be informed of hospital rules or regulations.

Hippocratic Oath

• One of oldest binding documents in history.

• Principles held sacred by doctors to this day.– Treat the sick to the best of one’s ability.– Preserve patient privacy– Teach secrets of medicine to next

generation

Nightingale Pledge

• Composed in 1893 by Lystra Gretter and the Farrand Training School for Nurses.

• Named for founder of modern nursing.