Situation 10: You notice that one of your coworkers seems to get daily care and vital signs done early every day. A little. more observation makes you aware that the person is not changing sheets daily and does not really take the vital signsof many of the clients.

l. How would you handle this situation?

2. What is your reason for your choice of action?

You Be the Judge

Verdict 1In July 1991, a surgeon at the Osteopathic Medical Center in Fort Worth, Texas, removed the cancerous right lung ofBenjamin H. Jones, Jr., age 59 years. Unfortunately, an altered test report and prodding by a colleague during the oper-ation led to removal of the wrong lung.

After the pathology examination confirmed that a healthy lung had been removed in error, no one informed Mr. Jonesas to what had happened. Court records demonstrated that a top official at the hospital was informed of the discrepancybetween the cancer screening and surgery results. The official stated that he relied on the doctors to inform Mr. Jones ofthe mix-up.

Two medical experts swore that Mr. Jones would have had a 60% chance of survival, even with only the cancerouslung, if he had received radiation therapy. At the time of the surgery, the cancer had not spread past the tumor. Mr. Jonesdied in February, 1992.

The Jones family settled out of court for $5.5 million with seven defendants in a wrongful death suit. Along with20 other defendants, the hospital declined to settle.

Mr. Jones had begun smoking in his teens and had quit after suffering a heart attack about 7 years before the surgery.

Questions

l. What was the breach of law in this case?

2. In your opinion, who was legally responsible for Mr. Jones' death and why?

3. What safeguards might be used to prevent this type of mistreatment in a hospital?

4. In your opinion, was the settlement in this case fair?

Verdict 2In September 1993, Fairfax Hospital in Virginia began to appeal a prior federal court's ruling that it must continue toprovide life-sustaining treatment for an anencephalic baby born 11 months earlier. The baby was born with a brain stemthat supported respiration and heart activity, but the infant had no cortex. Without a cortex, the baby never had conscious-ness, sensation, or the ability to think.

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Copyright © 2007 Elsevier, Inc. All rights reserved. Chapter 4 Legal and Ethical Principles

Situation 10: You notice that one of your coworkers seems to get daily care and vital signs done early every day. A littlemore observation makes you aware that the person is not changing sheets daily and does not really take the vital signsof many of the clients.

1. How would you handle this situation?

2. What is your reason for your choice of action?

You Be the Judge

Verdict 1In July 1991, a surgeon at the Osteopathic Medical Center in Fort Worth, Texas, removed the cancerous right lung ofBenjamin H. Jones, Jr., age 59 years. Unfortunately, an altered test report and prodding by a colleague during the oper-ation led to removal of the wrong lung.

After the pathology examination confirmed that a healthy lung had been removed in error, no one informed Mr. Jonesas to what had happened. Court records demonstrated that a top official at the hospital was informed of the discrepancybetween the cancer screening and surgery results. The official stated that he relied on the doctors to inform Mr. Jones ofthe mix-up.

Two medical experts swore that Mr. Jones would have had a 60% chance of survival, even with only the cancerouslung, if he had received radiation therapy. At the time of the surgery, the cancer had not spread past the tumor. Mr. Jonesdied in February, 1992.

The Jones family settled out of court for $5.5 million with seven defendants in a wrongful death suit. Along with20 other defendants, the hospital declined to settle.

/"", Mr. Jones had begun smoking in his teens and had quit after suffering a heart attack about 7 years before the surgery.

Questions

1. What was the breach oflaw in this case?

2. In your opinion, who was legally responsible for Mr. Jones' death and why?

3. What safeguards might be used to prevent this type of mistreatment in a hospital?

4. In your opinion, was the settlement in this case fair?

Verdict 2In September 1993, Fairfax Hospital in Virginia began to appeal a prior federal court's ruling that it must continue toprovide life-sustaining treatment for an anencephalic baby born 11 months earlier. The baby was born with a brain stemthat supported respiration and heart activity, but the infant had no cortex. Without a cortex, the baby never had conscious-ness, sensation, or the ability to think.

41

Copyright © 2007 Elsevier, Inc. All rights reserved. Chapter 4 Legal and Ethical Principles

After birth, the baby was periodically taken from the nursing home in which he lived to the hospital for treatmentof respiratory crisis and to be placed on a respirator. The hospital desired to decline care for the baby. The American .~Academy of Pediatrics filed a brief supporting the hospital's position that life-sustaining treatment of this baby wasinappropriate.

The mother insisted that the baby be kept alive, contrary to the recommendations of the doctors and medical ethicsboard of the hospital. In fact, the abnormality had been detected before birth, and the mother had declined abortion. Thebaby's father, who had never been married to the mother, supported the hospital's position.

The court decided that refusing treatment violated the Americans with Disabilities Act and the mother's FourteenthAmendment right to "bring up children." The cost of the baby's care, approximately $1,500 a day, was provided by themother's health maintenance organization.

Questions

1. Most cases involving treatment of severely damaged children raise the question of terminating life instead ofprolonging life, as in this case. What is the central issue in both of these circumstances?

2. Why do you think the judge gave the most authority in determining care for this baby to the mother?

3. Which of the facts regarding this case do you feel are most important to making a decision about it?

INTERNET ACTIVITIES

Scope of PracticeUse the Internet to research the scope of practice of a nurse assistant, Registered Nurse, or other health care practitioner.Discuss the scope of practice of the chosen occupation with class members as directed by your instructor.

42

Chapter 4 Legal and Ethical Principles Copyright © 2007 Elsevier, Inc. All rights reserved.

UGTOR SHEET 18-1

Application of Ethics by Health Care Workers

Ethical Principle

1. Preserve life.

Examples of Health Care Worker Responsibilities

Provide all patients, including the terminally ill, with caring attention.

Learn about the stages of dying and grieving.

Become familiar with your state laws regarding organ donations.

2. Do good. Practice good oral communication skills.

Treat every patient with respect and courtesy.

Serve as a role model and promote healthy living.

3. Respect autonomy. Be sure that patients have consented to all treatment and procedures.

Become familiar with the state laws and facility policies dealing withadvance directives.

4. Uphold justice. Treat all patients equally, regardless of economic or socialbackground.

Know the rules for handling all categories of controlled substances.

Learn the state laws and your facility's policies and procedures forhandling and reporting suspected abuse.

Follow all safety rules and OSHA guidelines to ensure the safety ofyourself and others.

5. Be honest. Admit mistakes promptly. Offer to do whatever is necessary to correctthem.

Refuse to participate in any form of fraud.

Document all procedures accurately.

Perform coding accurately, if this is one of your responsibilities.

Give an "honest day's work" every day.

6. Be discreet. Never release patient information of any kind unless there is a signedrelease.

Do not discuss patients with anyone who is not professionallyinvolved in their care.

Conduct necessary conversations about patients with other healthcare workers in private areas.

Keep documentation out of the view of people who are not authorizedto see it.

Do not leave records or patient registers on the reception desk in plainsight of anyone who approaches the desk.

Keep phone conversations with or about patients private.

Protect the physical privacy of patients.

INSTRUCTOR SHEET 18,-2

Suggested Methods for Maintaining Patient Confidentiality

Computer

• Allow only authorized personnel access to computers containing patient records.

• Allow only authorized personal to enter confidential patient information.

• Do not use obvious passwords that someone else might guess.

• Clear monitor screens before leaving the work area.

• Close programs containing patient information when not in use.

• Do not allow patients or other unauthorized persons to enter the area where data entry is takingplace.

• Shred discarded printouts before throwing them in the trash.

Take care when working on a laptop in a public area to prevent others from reading the data on thescreen.

• Do not leave laptops where they can be accessed by others.

Source: Adapted from J, Mitchell, & L, Haroun (2002), Introduction to health care, Clifton Park, NY: Delmar Learning,

Written

• Shred any documents containing patient information before throwing them in the trash.

• Do not leave patient sign-in sheets out on the reception desk where patients and others can seethem.

• Do not leave medical records or charts unattended in areas such as examining rooms where otherpatients might see them.

• Take care with materials that seem harmless, such as appointment reminder letters with the pa-tients' names on them.

• Secure areas, such as physician's office, when they are unoccupied.

Spoken

• Do not discuss patients in public areas where you might be overheard.

• Do not discuss patient issues with your friends and family members.

• Be discrete when speaking on the telephone so that the patient's name is not overheard.

• Take care when giving highly confidential information, such as test results, over the telephone.

• Provide patient privacy as appropriate by closing examination room doors, pulling curtains be-tween beds, or providing a private place to hold a conversation.

Copyright © 2004 Delmar Learning, a division of Thomson Learning, lnc. ALL RIGHTS RESERVED,

516

7. Keep promises. Be sure that necessary contracts have been completed.

Be very careful about what you say to patients. They may only hearthe II good news. II

8. Do no harm. Focus on providing excellent customer service.

Always work within your scope of practice. Never give information orperform duties you not qualified to do.

Observe all safety rules and precautions. Keep areas safe fromhazards.

Perform procedures according to facility protocols (standard methodsfor performing tasks). Never take shortcuts.

Ask an appropriate person about anything you are unsure of.

Keep your skills up-to-date.

Keep certifications current (CPR, first aid, professional certifications orlicenses).

Stay informed about new laws that affect health care.

Source: J. Mitchell & L. Haroun, 2002, Introduction to health care, Clifton Park, NY: Delmar Learning. Used withpermission.

CONCEPT APPLICATIONS

In the NewsUse a newspaper or magazine article that describes a current legal or ethical case relating to the health care industry.Complete the information regarding the article in the designated spaces.

1. Title of article

2. Name of publication

3. Date of publication

4. What is the legal breach or issue in dispute in the case described in the article?

5. Summarize the plaintiff's point of view in the case.

6. Summarize the defendant's point of view in the case.

7. Predict the outcome of this legal dispute based on the information provided in the article.

Classifying ConductIn the following situations, identify whether a legal or ethical breach of conduct is described. Circle the word that corre-sponds to your choice. If the breach is a legal consideration, explain which crime has occurred. Use the table of Legaland Ethical Terminology in the textbook for reference.

1. A client in the hospital is angry about her care. She rings her bell 10 or more times an hour. You decide thatshe is just seeking attention, and you ignore the bell.

Legal or Ethical

Explanation:

37Copyright © 2007 Elsevier, Inc. All rights reserved. Chapter 4 Legal and Ethical Principles

2. You are helping a nurse who is changing a dressing on a client's wound, and you drop the sterile dressing onthe floor. You know that no one saw the dressing drop, and you replace it on the sterile tray to save time andavoid getting into trouble.

Legal or Ethical

Explanation:

<:>

3. On arriving home, you find that you have accidentally taken a pen and a roll of tape from work. You decidethey are not worth returning and place them in your drawer for use at home.

Legal or Ethical

Explanation:

4. You tell your best friend that, in your role as a student health care worker, you saw a student from yourschool admitted to the hospital due to an overdose. You name the student who was admitted, and your friendpromises not to tell anyone else about it. Your friend does not tell anyone.

Legal or Ethical

Explanation:

..•..•..•... /

5. You observe a family in the emergency department after an accident in which one of the children was injured.The family acts very dramatically by crying and clinging to the hospital staff. You mimic that family'sreaction for your friends during the football game that evening.

Legal or Ethical

Explanation:

CRITICAL THINKING

Understanding HIPAAObtain a copy of the HIPAA regulations or a release form used by a health care facility. Design a pamphlet to teach thecontent of the law to someone. Use the pamphlet to explain the law to a student in the class as directed by the instructor.

Planning Legal and Ethical StrategiesRead the following situations, which could create legal and ethical dilemmas in the health care setting. Describe howyou would handle the situation and justify your answer in the space provided. Discuss your choices with a partner or thegroup as directed by your instructor.

/..,./

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Chapter 4 Legal and Ethical Principles Copyright © 2007 Elsevier, Inc. All rights reserved.

STUDENT HANDOUT 18-7

What Do You Think?

Euthanasia

Euthanasia, also known as mercy killing, means painlessly ending a person's life to release them fromsuffering an incurable and/or painful disease.

Case #1. A 75-year-old man, Mr. Gilbert, was convicted of murder in the "mercy killing" of his wife of51 years to end her suffering from Alzheimer's disease. The judge immediately sentenced Gilbert to lifein prison, with a 25 year mandatory term. The state had waived the death penalty, making the life sen-tence the only possible punishment for first-degree murder.

Gilbert had testified that he shot his wife, Emily, 73, twice in the head out of compassion. He called po-lice and surrendered after the shooting. Mrs. Gilbert, killed in the couple's condominium apartment,was senile from brain degeneration caused by Alzheimer's disease and suffered from osteoporosis, apainful bone disintegration. Witnesses testified that she longed for and begged for death.

The prosecutor had urged jurors to ignore pleas for compassion, saying that the shooting was pre-meditated, cold-blooded murder. The defense lawyer begged jurors to ignore laws and set legal prece-dent with an acquittal. [The Boston Globe, May 10, 1985] (Source: M. Flight, 1998, Law, liability, andethics for medical office professionals (3rd ed.), Clifton Park, NY: Delmar Learning.)

Case #2. The Andersons, a couple who lived in Long Pond in Centerville, had been married for 52years, but a stroke followed by two operations left the wife, Olive, an invalid. She was paralyzed on oneside, could not talk, and was incontinent after her second operation. Ten days after her return homefrom therapy following brain surgery, Anderson, a retired chef, placed a plastic bag over his wife's headand sealed it with duct tape. He then called his daughter, Shirley, who called police.

Anderson made no attempt to cover up his crime. When the Barnstable Police arrived, the tape and bagwere still on his wife's face. Anderson pleaded guilty to first-degree manslaughter and was sentencedby the judge to one year on probation. [The Boston Globe, October 31, 1985] (Source: M. Flight, 1998,Law, liability, and ethics for medical office professionals (3rd ed.), Clifton Park, NY: Delmar Learning.)

Discussion Questions for Euthanasia

1. Why do you think the two husbands received such different sentences?

2. Which do you believe was the most fair? Explain your answer.

3. How would you define quality of life?

4. Are there any conditions that justify euthanasia?

5. Do you think any of the following conditions justify euthanasia?

• Severe pain that cannot be relieved.

• Terminal conditions.

• Patient in a coma with no reasonable hope of regaining consciousness.

• No brain function.

• Patient requests that treatment be discontinued.

• Patient asks that his or her life be terminated.

(Questions 2-5 adapted from J. Mitchell & L. Haroun, 2002, Introduction to health care. Clifton Park, NY: DelmarLearning.)

STUDENT HANDOUT 18-6

Eight Guiding Principles of Health Care Ethics

1. Preserve life.

2. Do good.

3. Respect autonomy.*

4. Uphold justice.

/""'\ 5. Be honest.

6. Be discreet.

7. Keep promises.

8. Do no harm.

*Autonomy: self-government; in this case, it refers to patients making health care decisions for themselves.

Source: From J. Mitchell & L. Haroun (2002). Introduction to health care. Clifton Park, NY: Delmar Learning.

Copyright © 2004 Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED.

523

PRESENTATION RUBRIC - Office Safety

Name: ------ Date: ------

Grade: .--======-== Teacher: .,.,,------..,,:::::-_._----

Criteria Value

1 2 3 4------ --- ----- ----- -

Organization Audience cannot Audience has Student presents Student presentsunderstand difficulty information in information in

, presentation following .logjcalsequence logical,because there is presentation which audience interesting 20

i no sequence of because student can follow. sequence whicbi information. ; jumps around. .audience can

follow.. ----- _._--

Content Student does not Student is Student is at ease StudentKnowledge have grasp of uncomfortable with content, but demonstrates full

information; with information fails to elaborate. knowledge (morej student cannot and is able to than required) 20I answer questions answer only with explanationsabout subject. rudimentary and elaboration.

questions.---- --- ----

Visuals Student used no Student Visuals related to Student usedvisuals. occasionally used text and visuals to

visuals that rarely presentation. reinforce screen 20support text and text andpresentation. presentation.

- --,-- --- - ---. Mecbanics Student's Presentation has Presentation has Presentation has

i presentation has three misspellings no more than two no misspellings or· four or more ' and/or misspellings grammaticali spelling errors ; grammatical and/or errors. 20, and/or I errors. grammatical, grammatical errors.· errors.

r-- --- -- -,--- - -.Delivery · Student mumbles,

incorrectlypronounces terms,and speaks tooquietly for allaudiencemembers to bear.

Studentincorrectlypronounces terms.

! Audiencemembers havedifficulty hearingpresentation.

Student's voice isclear. Studentpronounces mostwords correctly.

Student used aclear voice andused correct,precise

. pronunciation ofterms.

20

Total:-- 100

TEACHER COMMENTS: Each student will have an evaluation form completed by:l) The teacher 2) One audience color group chosenat random 3) Self evaluation. The total possible for this project therefore is 300 points. Presentation limitations are only to summarize theinformation in order to teach the remainder of the class tomorrow, and that every student in the group must participate. They may use anyinstructional format that they would like with the only restrictions that they may not violate legal, ethical, or moral regulations.

I