WGU C426 Healthcare Values and Ethics Rated A+

WGU C426 Healthcare Values and Ethics Rated A+ Normative Ethics Attempt to determine what moral standards should be followed so that human behavior and conduct may be morally right. Consequential Ethics Theory of ethics emphasizes that the morally right action is whatever action leads to the maximum balance of good over evil. - What will be the effects of each course of action? - Will they be positive or negative? - Who will benefit? - What will do the least harm? Utilitarian Ethics The concept that the moral worth of an action is determined solely by its contribution to overall usefulness. Deontological Ethics Immanuel Kant () Doing the right thing is good, but it might not always lead to or increase the good and right thing sought after. Nonconsequential Ethics An ethical theory that denies the consequences of an action or rule are the only criteria for determining the morality of an action or rule. The rightness or wrongness of an action is based on properties intrinsic to the action, not on its consequences. Ethical Relativism Morality is relative to the norms of one's culture in which one lives. Actions can be considered right or wrong depending on the accepted norms of the society in which they are practiced 4 principles of ethics 1. Beneficence 2. Nonmaleficence 3. Autonomy 4. Justice Beneficence Doing good or causing good to be done; kindly action. Nonmaleficence Duty to do no harm Autonomy The right of a person to make one's own decision. Justice obligation to be fair in the distribution of benefits and risks Ethics Committee Composition A multidisciplinary group of people consisting of ethicists, educators, clinicians, legal advisers, and political leaders, clergy, QI managers, and corporate leaders. Ethics Committee Function Development of policy and procedure guidelines to resolve ethical dilemmas; staff and community education; conflict resolution; case reviews, support, and consultation; and political advocacy. Laws Impact On Healthcare ... Common Law The body of principles that has evolved and expanded from judicial decisions that arise during the trial of court cases. "Reason and justice for all" Statutory Law Written law emanating from federal and state legislative bodies. Administrative Law The extensive body of public law issued by administrative agencies to direct the enacted laws of the federal and state governments. The branch of law that controls the administrative operations of governments. Elements of Negligence 1. Duty to care 2. Breach of duty 3. Injury/Actual Damages 4. Causation/Proximate Cause Duty to Care Duty is defined as a legal obligation of care, performance, or observance imposed on one to safeguard the rights of others. This duty may arise from a special relationship such as that between a physician and a patient. Breach of Duty Failure to use the degree of care required under the circumstances. Injury/Actual Damages Actual damages must be established. Without injury damages cannot be awarded. Causation/Proximate Cause The fourth element necessary to establish negligence, requires that there be a reasonable, close, and causal connection or relationship between the defendant's negligent conduct and the resulting damages suffered by the plaintiff. Negligence Failure to take proper care in doing something. Tort Law A civil wrong, other than a breach of contract, committed against a person or property (real or personal) for which a court provides a remedy in the form of an action for damages ______ actions touch an individual on both a personal and a professional level. Criminal Law Society's expression of the limits of acceptable human and institutional behavior. Objective: - to maintain public order and safety, protect individuals, use punishment as a deterrent to crime, and to rehabilitate the criminal for return to society. Contract A special kind of agreement, either written or oral, that involves legally binding obligations two or more parties. Purpose: To specify, limit, and define the agreements that are legally enforceable. Contract Elements 1. Offer/Communication 2. Consideration (a promise to/not to) 3. Acceptance Trial Procedures Opening statements, burden of proof, evidence, examination of witnesses, defense of one's actions, closing arguments, jury instructions (judges charge), deliberation and verdict, damages, and appeals. Privacy Act of 1974 Enacted to safeguard individual privacy from the misuse of federal records, to give individuals access to records concerning themselves that are maintained by federal agencies, and to establish a Privacy Protection Safety Commission. Health Insurance Portability and Accountability Act (HIPAA) Designed to protect the privacy, confidentiality, and security of patient information. ________ standards are applicable to all health information in all of its formats (e.g., electronic, paper, verbal). How do privacy laws differ from state to state? They differ in what records are available to be accesses as well as amended. Emergency Medical Treatment and Active Labor Act (EMTALA) Designed to forbid Medicare-participating hospitals from "dumping" patients out of emergency departments that are seeking treatment for a medical condition. Healthcare Quality Improvement Act (HCQIA) Enacted in 1986 to provide those persons giving information to professional review bodies and those assisting in review activities limited immunity from damages that may arise as a result of adverse decisions that affect a physician's medical staff privileges. ________ was enacted by congress to "facilitate the frank exchange of information among professionals conducting peer review inquiries without the fear of reprisals in civil lawsuites. Patient Self-Determination Act (PSDA) 1990 Was enacted to ensure that patients are informed of their rights to execute advance directives and accept or refuse medical care. Ethics in Patient Referral Act Prohibits physicians who have ownership interest or compensation arrangements with clinical lab from referring Medicare patients to that lab. Requires Medicare providers to report names & provider numbers of all physicians or their immediate relatives with ownership interests in a provider entity. Patient Protection and Affordable Care Act (PPACA) 2010 Federal legislation designed for comprehensive health reform, with an intent to expand coverage (for preexisting conditions), improve prescription drug coverage in Medicare, and extending the life of the Medicare trust fund by at least 12 years. Sarbanes-Oxley Act (2002) A law passed by Congress that requires the CEO and CFO to certify that their firm's financial statements are accurate. This act encourages self-regulation and the need to promote due diligence, select a leader with morals and core values, the courage to speak out, etc. Patient's Bill of Rights 1. Right to know their rights. 2. Right to explanation of their rights. 3. Right to know hospital's adverse events. 4. Right to admission (to the hospital). 5. Right to quality care. 6. Right to Informed consent. 7. Right to ask questions. 8. Right to privacy and confidentiality. Ethical Codes A system of principles governing morality and acceptable conduct Informed Consent A legal concept that provides that a patient has a right to know the potential risks, benefits, and alternatives of a proposed procedure. Consent and Ethical Codes The physician has a responsibility to ensure the patient has informed consent and treats the patient without bias as to whether or not the patient selects the advised treatment. Oral Consent More difficult to corroborate, but if proved, is as binding as written consent, for there is, in general, no legal requirement that a patient's consent be in writing. Written Consent A visible proof of a patient's wishes. Should include: - Nature of illness/injury. - Name of proposed procedure. - Purpose of Tx. - Risks/benefits of treatment. - Probability of success. - Alternatives. - Risks of prognosis of not Tx. - Understanding of informed consent. - Signatures & dates. Centers for Disease Control and Prevention (CDC) - Health Literacy The degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions. Organizational Health Literacy Organizational health literacy is what organizations and professionals do to help people: - Find - Process - Understand - Decide on health information and services. Health Literacy Universal Precautions (AHRQ) The steps that practices take when they assume that all patients may have difficulty comprehending health information and accessing health services. Health literacy universal precautions are aimed at: - Simplifying communication with and confirming comprehension for all patients, so that the risk of miscommunication is minimized. - Making the office environment and health care system easier to navigate. - Supporting patients' efforts to improve their health. Successful Health Literacy Communication (NIH) - The provider offers a clear understanding of what to do to improve one's health, why is it being done, and, precisely, how to do it. -- "This medicine will lower your blood pressure, which will help your heart. You need to take the green tablets, with food. That's one green tablet every day when you wake up with your breakfast, and one green tablet after dinner and before you go to sleep." - The provider needs to confirm the individual has a fundamental understanding of the information exchange, i.e. more than a nod of the head or an uh huh. - Remember in school the teachers who said, "Any questions?," gave the class no time to think of a question to ask, and moved on? - You will probably remember more warmly the teacher who took the time to probe the question, "What do you think your risk is of having the complications I mentioned? What are you going to do with that information?" - Using the "teach back" method , having the patient repeat the information back to the provider, can help in ensuring there has been understanding. - Ideally, skills related to "teach to goal" help the patient improve his or her own self management. - Health care systems can also address limited literacy. Institutional Review Boards (IRBs) - Primary Responsibilities - Protecting the rights and welfare of human subjects - Ensuring protocols are presented by the sponsor(s) - Ensuring sponsor(s) of a protocol discloses --- Areas of concern that might give the impression of a conflict of interest in the outcome of the clinical research --- Financial interests that might occur should the clinical trials prove to be successful or give the impression of success, including stock options and cash payouts - Reviewing, monitoring, and approving clinical protocols for investigations of drugs and medical devices involving human subjects - Ensuring that the rights, including the privacy and confidentiality, of each individual, are protected - Ensuring that all research is conducted within appropriate state and federal guidelines (e.g., FDA guidelines) Experimental Subject's Bill of Rights • Be informed of the nature and purpose of the experiment • Be given an explanation of the procedures to be followed in the medical experiment and any drug or device to be used • Be given a description of any attendant discomforts and risks reasonably to be expected • Be given an explanation of any benefits to the subject reasonably to be expected, if applicable • Be given a disclosure of any appropriate alternatives, drugs, or devices that might be advantageous to the subject, their relative risks, and benefits • Be informed of the avenues of medical treatment, if any, available to the subject after the experiment if complications should arise • Be given an opportunity to ask questions concerning the experiment or the procedures involved • Be instructed that consent to participate in the medical experiment may be withdrawn at any time and the subject may discontinue participation without prejudice • Be given a copy of the signed and dated consent form • Be given the opportunity to decide to consent or not to consent to a medical experiment without the intervention of any element of force, fraud, deceit, duress, coercion, or undue influence on the subject's decision Centers for Medicare and Medicaid Services (CMS) - Patient's Bill of Rights • Help children (eventually all americans) with pre-existing conditions gain coverage and keep it. • Protect all Americans' choice of doctors. • End lifetime limits on the care consumers may receive. Protecting Clinical Research Patients - FDA Investigators are responsible for protecting the rights, safety, and welfare of subjects under their care during a clinical trial This responsibility should include: • Providing reasonable medical care for study subjects for medical problems arising during participation in the trial that is, or could be, related to the study intervention • Providing reasonable access to needed medical care, either by the investigator or by another identified, qualified individual (e.g., when the investigator is unavailable when specialized care is needed) • Adhering to the protocol so that study subjects are not exposed to unreasonable risks Woman's Right to Privacy: Roe v. Wade (1973) The court legalized abortion by ruling that state laws could not restrict it during the first three months of pregnancy. Based on 4th Amendment rights of a person to be secure in their persons. Conditional Restrictions Unconstitutional: Doe v. Bolton (1973) The court struck down four pre-abortion procedural requirements commonly imposed by state statutes: • Residency (of the state) • Performance of the abortion in a hospital accredited by the JCAH • Approval by an appropriate committee of the medical staff • Consultations Parental Consent Requirement Unconstitutional: Danforth v. Planned Parenthood (1976) It is unconstitutional to require parental consent for minors under age 18. The statute failed to provide any definite guidelines (lacks a reasonable exception) States May Deny Medicaid Benefits: Maher v. Roe (1977) Ruled that the states may refuse to spend public funds to provide nontherapeutic (medically necessary) abortions for women. States May Protect Fetus: Colautti v. Franklin (1979) The states may seek to protect a fetus that a physician has determined could survive outside the womb. Parental Consent Requirement Unconstitutional: Bellotti v. Baird (1979) Massachusetts statute requiring parental consent before an abortion could be performed on an unmarried woman younger than the age of 18 years was unconstitutional. States May Deny Medicaid Benefits: Harris v. McRae (1980) Upheld the Hyde Amendment, which restricts the use of federal funds for medicaid abortions. If the states in question are not compelled to fund Medicaid recipients' medically necessary abortions for which federal reimbursement is unavailable, but may choose to do so. Notification of Parents Permitted: H. L. v. Matheson (1981) Requires a physician to "notify, if possible" the parents or guardian of a minor on whom an abortion is to be performed. Conditional Restrictions Unconstitutional: City of Akron v. Akron Center for Reproductive Health (1983) Decided that the different states cannot: • Mandate what info providers give abortion patients. • Require that abortions for woman more than 3 months pregnant be performed in a hospital. Abortion Rights Narrowed: Webster v. Reproductive Health Services (1989) Upheld a Missouri statute providing that no public facilities or employees should be used to perform abortions and that physicians should conduct viability tests before performing abortions. Refusal to Fund Abortion Counseling Not Unconstitutional: Rust v. Sullivan (1991) Doctors working in government-sponsored clinics were prevented from providing women with information about abortion, even if the life of the mother were in danger Abortion Restrictions-Undue Burden Rule: Planned Parenthood v. Casey (1992) States can regulate abortion, but not with regulations that impose "undue burden" upon women; did not overturn Roe v. Wade, but gave states more leeway in regulating abortion (e.g., 24-hour waiting period, parental consent for minors) Women's Medical Professional Corp. v. Voinovich (1998) The statute banning any use of Dilation and extraction (D&X) procedure was unconstitutionally vague. Partial Birth Abortion Ban Struck Down: Stenberg v. Carhart (2000) States may not ban partial birth abortions if they fail to allow an exception to protect the health of the mother Partial Birth Abortion Ban Act of 2003 -(PBABA) -Passed by congress under Bush after being vetoed twice by Clinton -This Act basically bans the dilation and extraction procedure -3 States challenged this act because it lacked a health exception clause -Appellate courts declared this law unconstitutional and it was sent to supreme court Spousal Consent • Husband's Interest Insufficient • Husband's Required Consent Unconstitutional Incompetent Persons' Consent The record had supported a finding that if the woman had been able to do so she would have requested the abortion. Parental Consent A legal requirement, in some states, that minors must obtain their parents' permission to have an abortion. Parental Notification: Planned Parenthood v. Owens Passed the Parental Notification Act, which requires a physician to notify the parents of a minor prior to performing an abortion for the minor. Euthanasia The painless killing of someone dying from a painful disease. Active Euthanasia The intentional commission of an act, such as giving a patient a lethal drug that results in death. The act, if committed by the patient, is thought of as suicide. Passive Euthanasia The intentional commission of an act, such as giving a patient a lethal drug that results in death. The act, if committed by the patient, is thought of as suicide. Involuntary Euthanasia Occurs when the decision to terminate the life of an incurable person (i.e., an incompetent or unconsenting competent) is made by someone other than that incurable person. Voluntary Euthanasia Occurs when the decision to terminate the life of an incurable person (i.e., an incompetent or unconsenting competent) is made by someone other than that incurable person. Physician-Assisted Suicide An action in which a physician voluntarily aids a patient in bringing about his or her own death. Criminalizing Assisted Suicide: Quill v. Vacco • The Supreme Court found that neither the assisted suicide ban nor the law permitting patients to refuse medical treatment treats anyone differently from anyone else or draws any distinctions between persons. • There is a distinction between letting a patient die and making one die. Most legislatures have allowed the former but have prohibited the latter. Oregon's Death with Dignity Act (1994) Allows a terminally ill Oregon resident to obtain a lethal dose of medication from his or her physician. Organ Transplant Determination Methods In the case of a 70-year-old patient with multiple life-threatening health problems, the patient may not be considered a suitable candidate for a transplant, whereas a 15-year-old patient with few health issues would be considered a more appropriate candidate. Mayo Clinic's Liver Transplant Eligibility Requirements A comprehensive evaluation includes blood tests, imaging studies and other tests. Doctors will check your heart-lung function. And they'll test you for other serious conditions, including chronic infections, cancer, and heart and blood vessel (cardiovascular) disease. Corporate Duties and Responsibilities The duty to supervise and manage is applicable to the trustees as it is to the managers of any other business corporation. In both instances, there is a duty to act as a reasonably prudent person would act under similar circumstances. The governing body must act prudently in administering the affairs of the organization and exercise its powers in good faith. CEO Challenges and Responsibilities • Show support and respect to all physicians and staff, knowing that as a team they are the ones who provide bedside care. • Make daily rounds in the organization. Fix the things they can and find a way to fix the things they think they cannot. • Develop friendships and supporters who can help the organization to meet those extraordinary goals. • Implement community caring programs. Reach out, teach, and educate all members of the community on preventative care. • Not be influenced by power brokers simply because of their position. CEOs and managers must do the right thing, all the time—not in a vacuum, but as a team. • Show respect to all persons. Treat consultants, accreditation representatives, and inspectors on all levels (e.g., federal, state, local, and private) with respect, knowing that they are all there to help the organization become better in its delivery of patient care. CEO Code of Ethics • To maintain or enhance the overall quality of life, dignity, and well-being of every individual needing health care service; and to create a more equitable, accessible, effective, and efficient health care system. • Have an obligation to act in ways that will merit the trust, confidence, and respect of health care professionals and the general public. • Acting as a moral advocate by promoting such rights, interests, and prerogatives. • Acting as a model, meaning that decisions and actions will reflect personal integrity and ethical leadership that others will seek to emulate. Employee Rights • Equal pay for equal work. • Refuse to participate in care. • Question a patient's care. • Freedom from sexual harassment. • Suggest changing physician. • Be treated with dignity and respect. • Employment-at-will and fair treatment. • Public policy exception. • Freedom from intimidation. • Privacy and confidentiality. Employee Responsibilities • Advocate for patients. • Show compassion. • Honor patient wishes. • Maintain confidentiality. • Maintain employee privacy and confidentiality. • Adhere to safe practices. • Comply with sterile technique protocols. Exercise judgement. • Adhere to professional standards. • Maintain professional Relationships. • Report unethical behavior. • Protect patients from harm. • Report patient abuse. Refusal to Participate in Care • Right to refuse to participate in certain aspects of patient care and treatment. • Conflict with cultural, ethical, and/or religious beliefs. Employee Privacy and Confidentiality Like patients, employees have this right, such as information about their health status. Safe Practices Procedures used to keep one safe from danger or harm National Patient ______ Goals: • Handwashing • Patient identification. • Verification of operative site. Professional Standards Guidelines of acceptable behavior and performance established by professional associations. Caregivers have a responsibility to maintain a professional attitude in the performance of their work. Pillars of Moral Strength (Patient Centered Care) Courage, wisdom, commitment, compassion, fairness, honesty, integrity, and respect are examples of the pillars that have value when addressing difficult healthcare dilemmas.