Health Care Ethics Lecture Notes must know PDF

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OBLIGATIONS OF A PROFESSIONALCharacteristics of a Profession Competence in a specialized body of knowledge and skill. The provision of a particular service to study. Standards of education and practice. Self-regulation - an acknowledgment of specific duties and responsibilities toward our patients, ...

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NCM 108: Health Care Ethics

OBLIGATIONS OF A PROFESSIONAL Characteristics of a Profession -

Competence in a specialized body of knowledge and skill. The provision of a particular service to study. Standards of education and practice. Self-regulation - an acknowledgment of specific duties and responsibilities toward our patients, colleagues, and society.

the rational analysis of it.” - Joseph Fletcher Morality refers to codes of conduct actually put forward by distinct groups or societies. Ethics - is a process of reflection in which people’s decisions are shaped by their values, principles, and purpose. A generic term for the study of how we make judgments in regard to right and wrong. Code of Ethics for Nurses

Code of Ethics - binding together as a group of practitioners and expressing the aims and aspirations of that group. Legal Practice Act - outlines the activities the providers perform in the delivery of patient care. Fiduciary Relationship - acting primarily in the best interests of those they serve. Professional Etiquette -

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Involves issues such as the need to avoid talking badly about another practitioner, maintenance of appropriate relationships at the workplace, or the need to stay within the role boundaries of our specialty. The professional etiquette requirements of our roles in health care are usually based on the traditions of good practice and good manners. It also helps in maintaining order and civility in our practices.

Health Care Ethics - are designed to promote order and maintain civility. Ethics and Morality - “Morality was what people believed to be right and good, while ethics is the critical reflection about morality and 1

NCM 108: Health Care Ethics

Foundations of Law -

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Law - is a body of rules of action or conduct prescribed by controlling authority and having binding legal force. Law can also be considered as the minimum standard of expected performance between individuals in the society. Obligations of law and ethics are closely aligned with ethical obligations typically exceeding legal duties. The basic sources for modern law are common law, which emanates from judicial decisions; statutory law, which arises from legislative bodies; and administrative law, which flows from rules and regulations and decisions of administrative agencies. Stare decisis which translates to “let the decision stand”. The use of this principle provides the system with needed stability, and yet it has allowed for the creation of new principles as changing patterns of facts have emerged. 2

NCM 108: Health Care Ethics

Fundamental Principles of Law - A concern for justice and fairness - Plasticity and change - Doctrine of Individual Rights and Responsibilities Common Misunderstandings about the Nature of Law - There is a feeling that law is all-inclusive and that if you need a legal determination, all you need to do is to apply the correct legal precedent. In fact, the law is complete and always growing. It is possible in these currently unexplored areas for something to be neither legal nor illegal. - The belief that if one does this, the law will do that is a misunderstanding based on the idea that law is prescriptive and certain. In fact, there are areas where we have no previous legal rulings, and even where we have legal precedence to guide us, growth and changes occur. - The law tells you what to do. In this way of thinking, legal acts are those things you should do. It is wise to view the law as a guide to proper behavior. Public Law - the part of the law that governs relationships between individuals and the government. Private Law - a branch of law that deals with the relations between individuals or institutions, rather than relations between these and the government.

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The Common Elements of a Complaint:

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Lawsuit -

The Complaint and Answer - A plaintiff files a complaint or petition with the court that addresses the elements of the prima facie case. - Prima facie means that it is legally sufficient to establish a case. - The plaintiff needs to provide proof and it requires that he or she present evidence for all the essential facts in the case, and the number of offenses that the defendant is guilty of violating.

A plaintiff is a person who brings an action in a court of law. A defendant is a person against whom an action is brought.

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The notification explains to the defendant the nature of claims. The defendant usually has a statutory required period of time in which a complaint must be answered. Pleadings is the formal presentation of claims and defenses by parties to a lawsuit. Pro se is a Latin phrase meaning ‘for oneself’, or ‘on one’s own behalf’. In legal context it is used when an individual acts without the assistance of legal counsel. After the answer has been filed, the defendant may file a motion for summary judgment or a motion to dismiss. If there is a dispute of the facts of the case, then a motion for summary judgment will not stand. The defendant’s answer must address each of the plaintiff’s allegations. The defendant has three choices: admit, deny, or plead ignorance to each allegation in the complaint. Affirmative defenses are a fact or a set of facts other than those alleged by the plaintiff or prosecutor, that, if proven, defeats or mitigates the legal consequences of the defendant’s otherwise unlawful conduct. Filing an answer moves the case into the pretrial phase.

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NCM 108: Health Care Ethics

Discovery - Often the longest part of the lawsuit. - It is the fact-finding phase meant to eliminate surprises, clarify what the lawsuit is about, and make the parties decide if they should settle or drop claims and/or offenses. - Major elements of discovery are interrogatories, document requests, and depositions. - Interrogatories are a series of questions sent by one side to the other. - Depositions are the opportunity for each side to question witnesses and parties to a suit to elicit information about the case. It is also the most common and effective method of discovery as it allows both parties to be aware of the arguments or claims that are going to be made in the trial. Trial and Judgement - A case may be tried before a judge only or before a judge and jury. - During the trial, each side presents witnesses, and the evidence collected is placed on record. - After they have presented and examined the witnesses each party is allowed time for a closing argument. - The jury’s decisions are not put into effect until the judge makes a judgment, which is the approval to have the trial’s information to be filed in public records. - Civil Case - the judge is allowed at this time to make changes to the jury’s verdict by either adding to or reducing the punishment. - Criminal Case - the judge does not have the authority to change the jury decision. Appeal - Losing party may appeal a trial court decision to a higher court in that particular jurisdiction, however, only a final judgment may be appealed. Arbitration - Involves a neutral third party that both sides have agreed will have the power to decide the outcome and render a binding decision. - The arbitrator listens to statements from both sides, reads documents

presented, reviews the evidence, and proposes a compromise settlement. - It can either be binding or nonbinding. - In binding, the decision is final and not appealable. - If nonbinding, the door is open for appeal or refusal to comply. - Arbitration is chosen because the process is less time consuming and less expensive than a suit and trial proceedings. Hippocratic Oath

Nightingale’s Pledge

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NCM 108: Health Care Ethics

DECISION MAKING IN VALUE ISSUES AND PRIVATE LAW

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specific form of consequentialism and utilitarianism. Consequence-oriented theories judge the rightness or wrongness of decisions based on outcomes or predicted outcomes. Teleological theory is taken from the Greek word telos that means end. Joseph Fletcher said that human need determines what is or is not ethical. Agape: can be defined as general goodwill or love for humanity. If an act helps people, it's a good act; if it hurts, it's a bad act.

Deontological (Duty-Oriented) Theories -

Associated with duties and rights that encourages the judgements on the rightness of actions based on the duty of those involved, irrespective of any real or predicted consequences or outcomes.

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The rightness or wrongness of an act is essentially independent of its consequences , what matters is that the actor acts out of moral duty. - Immanuel Kant who is, generally considered the first proponent of duty-based ethics. - He proposed these rational agents: - The agent should act only on a principle or a maxim that can be regarded as a universal law and agreed by everyone. - No one should be treated merely as ‘means’ but always an end.

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Utilitarianism is where the good resides in the promotion of happiness or the greatest net increase of pleasure over pain. Act Utilitarianism - The decision is based on listing the possible alternatives for action, weighing each in regard to the amount of pleasure or utility it provides, and selecting the course of action that maximizes pleasure. Rule Utilitarianism - An action can be deemed to be right if it conforms to a rule that has been validated by the principle of utility. Virtue Ethics -

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Aristotle The heart of the moral agent making the decision rather than the reasoning to a right action. Primarily about personal character and moral habit development rather than a particular action.

Teleological (Consequence-oriented) Theories -

More concerned consequences of judgements on Examples of it are

with the goals and actions when making their appropriateness. consequentialism and a 5

NCM 108: Health Care Ethics

Private Law -

Concerned with the recognition and enforcement of the rights and duties of private citizens and organizations. Torts and contract law are basic types of private law. Basic objectives of tort law are: ● Preservation of peace between individuals ● Determining of fault ● Compensation of injury Torts are classified into 3 broad categories: ● Negligent torts ● Intentional torts ● Tort in which liability assessed irrespective of fault (strict liability) Negligent Torts ● Negligence is the unintentional commission of an act that a reasonably prudent person would or would not do under the same circumstances. ○ Malfeasance - the execution of an unlawful act ○ Misfeasance - improper performance of an act that lead to injury ○ Nonfeasance - the failure to perform an act when there is duty to act. ● 4D’s of negligence: duty, dereliction of duty, direct cause, and damage. ● Res ipsa loquitur - the thing speaks for itself. ● Respondeat superior - let the master answer. Intentional Torts ● Willful act that violates another’s interest. ● Assault and battery, defamation of character, false imprisonment, invasion of privacy. ○ Assault and battery: unlawful touching without justification. ■ Assault - verbally ■ Battery - physical contact (bodily injury or offensive touching. ○ Defamation of Character: occurs when one person communicates to a second person about someone in such a manner that the reputation of the person is harmed. ■ Libel - written ■ Slander - verbal ○ False Imprisonment - illegal confinement of an individual against their will by another individual in a manner that

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violates the right to be free from restraint of movement. Invasion of privacy Breach of contract - there is failure, without legal excuse, to perform any promise that comprises the whole or part of the contract. Contractual duty can occur as the result of signing documents or can arise out of implication.

CORE BIOETHICAL PRINCIPLES • •

Bio –– life. Ethos –– customs or norms.

❶ STEWARDSHIP ● A principle in Christian ethics. ● A human life comes from God, and no individual is the master of her own body. ● Take care of our life and to the life of other people. ○ Nurses are responsible to someone’s life ○ Avoid harm in human body ❷ TOTALITY ● Refers to the whole body. ● Every person has the duty to develop, use, care for and preserve all body parts. ○ You should not disregard any part of the body ○ Suggest also that an individual has the right to cut off body parts that is no longer functioning ○ Example: diabetic foot ❸ SOLIDARITY ● Being one with the other. ● In practice, we should always be with our patients if they are incapable of doing things. ❹ RESPECT FOR PERSON ● Every person has the responsibility to treat a person always as an end and never as a means. ● Unique, worthy, rational, self-determining creature, and having the capacity to decide what is best for him. ● Respect every decision they have: but nurses have the responsibility to explain the pros and cons of the decision. 6

NCM 108: Health Care Ethics

❺ NON-MALEFICENCE ● The non-infliction of evil, harm, or injury to others and of course, to one’s self. ○ Do no harm ○ Reason why nurses put handrails in the hospital

THREE BASIC ELEMENTS OF AUTONOMY

❻ BENEFICENCE ● Is the practice of doing acts of goodness, kindness and charity. ○ To do good ○ Think always of what is best for patient

PATIENT’S RIGHTS

1. 2. 3. others

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❼ JUSTICE ● The act of giving one what she deserves or what is due to her. ○ Fairness or equality. Example: patient has right for decision making; the nurse has the role to provide the right of patient ❽ AUTONOMY ● It is the right of every person to have control over their lives and decisions regarding their care.

AUTONOMY

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One of the most important of health care ethics. The word comes from the Greek words autos and nomos, which means self and governance, respectively. It is a form of personal liberty, where the person is free to select and implement her own decisions, free from deceit, pressure, constraint, or coercion. Involves the right of self-determination, independence, and freedom. Other words often associated with autonomy: dignity, inherent worth, self-reliance, and individualism.

EXAMPLE: The nurse having difficulty supporting the decision of a new mother, who is a Jehovah's Witness and whose life is in danger because of blood loss, refuses to have a blood transfusion.

Ability to decide Power to act on your decisions Respect for the individual autonomy of

It is another consideration and decision making. Greater attention was paid to the rights of the patient. Patients may expect to be informed of all alternatives for treatment and often want to participate in selecting a type of treatment, weighing the possible benefits and risks of the treatment methods presented.

THE PATIENT’S BILL OF RIGHTS 1. ● ● ●

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Right to Appropriate Medical Care and Humane Treatment. Without any discrimination and within the limits of resources. Good quality. Human dignity, convictions, integrity, individual needs and culture shall be respected. Be informed of the reason for delay. Patients in emergency shall be extended immediate medical care and treatment without any deposit, pledge, mortgage or any form of advance payment for treatment. Right to Informed Consent. Right to a clear, truthful and substantial explanation in a manner and language understood to the patient. Written agreement between patient and health care provider. Exemption: Emergency cases When health population is at risk (epidemic) When law makes it compulsory for everyone to submit a procedure When patient is either a minor, or legally incompetent, in which case, a third party consent is required When the patient waives his right in writing

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NCM 108: Health Care Ethics

Emancipated: They can already make their own decision because they are financially independent or capable of doing actions ● In case a person is incapable of giving consent and a third party consent is required. ○ Spouse ○ Son or daughter of legal age ○ Either parent ○ Brother or sister of legal age ○ Guardian ○

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Right to Privacy and Confidentiality. Be free from unwarranted public exposure, except when his mental or physical condition is in controversy and the appropriate court orders him to submit to a physical or mental examination by physician. Right to Information. Result of evaluation of the nature and extent of disease. Other additional or further contemplated medical treatment on surgical procedures. Itemized bill of the hospital and medical services rendered in the facility. The benefits and of the procedure and others options in which the patient must be informed.

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Right to choose health care provider and facility.

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Except when he is under the care of a service facility or when public health and safety so demands or when the patient expressly waives this right in writing. Right to seek 2nd opinion and subsequent opinions. Patient has the right to choose his or her health practitioner.

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Right to Self-determination Right to avail of any recommended diagnostic and treatment procedures. ● Advance written directive –– advance directions (e.g. DNR waiver) ○ Informed of the medical consequences of his choice. ○ Releases those involved in his care from any obligation relative to the consequences of his decision.

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His decision will not prejudice public health and safety.

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Right to Religious Belief. Shall not be imposed by parents upon their children who have not reached legal age in life threatening situations.

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Right to Medical Records. Summary of medical history and condition. Has the right to view contents of his medical records, except psychiatric notes and other incriminatory information obtained about 3rd parties. Medical certificate and other documents Within 45 days from request

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Right to Leave. Right to leave the hospital. No patient shall be detained against his or her will. ○ Only allowed to leave the hospital provided appropriate arrangements have been made to settle the unpaid bills.

10. Right to Refuse Participation In Medical Research. ● Right to be advised if the health care provider plans to involve him in the medical research. 11. Right to Correspondence and to Receive Visitors. ● Subject to reasonable limits prescribed by the rules and regulations of the health care institution. ● Limitations: ○ If the patient is immunocompromised. ● General rule: ○ Children below 12 years old are not allowed in the hospital. ○ Patient visitors should visit during visiting hours. 12. Right to Express Grievances. ● Right to express complaints and grievances about the care and service received.

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NCM 108: Health Care Ethics

13. Right to be Informed of His Rights and Obligations as a Patient. ● It shall be the duty of the health care institution to inform of their rights as well as of the institution’s rules and regulations that apply to the conduct of the patient while in the care of such institution. ○ Upon admission, patients and relatives are informed of their rights and obligations. ○ To know all their rights. ○ Shall be posted on a bulletin board but some are posted in the patient room.

GUIDELINES FOR INFORMED CONSENT ●

The person(s) giving consent must fully comprehend: 1. The procedure to be pe...