Legal and Ethical Principles
Define at least 10 terms relating to legal and ethical principles.
Describe at least five examples of ethical behavior for the health care worker.
Identify at least five situations that show improper ethical or legal behavior.
Explain the importance of confidentiality in health care, including privacy issues resulting from advanced technology.
Describe at least two examples of rights of the health care patient.
Describe the role of the health care worker regarding current legal issues, including advanced directives and telemedicine.
Informed consent (in-FORMD kuhn-SENT) Agreement to surgical or medical treatment with knowledge of the facts and risks involved
Malpractice (mal-PRAK-tiss) Failure of professional skill or learning that results in injury, loss, or damage
Telehealth (TEL-uh-helth) Use of technology to deliver health-related services and information, including telemedicine
Professional Codes of Conduct
Ethical and legal responsibilities are a central part of all health care occupations. The worker must understand and follow ethical practices, including respect for cultural, social, and ethnic differences of the patients and other workers. Legal responsibilities include practicing within the guidelines of laws, policies, and regulations established for each type of employment (Box 4-1).
Health care workers must stay within a “scope of practice” or use the methods and procedures in which they are trained (Table 4-1). The Nurse Practice Acts (NPAs) are state laws that determine which tasks nurses may legally perform. Some common laws or traditional practices also influence nursing practice. Performing skills or tasks that are outside the health care worker’s scope of practice is illegal as well as unethical. The health care worker who is supervising others may delegate some tasks. For example, the registered nurse or licensed physician may ask a licensed practical nurse to assess the patient’s health by collecting, reporting, and charting data. The licensed practical nurse does not work independently. The nurse assistant works under the supervision of the registered nurse or licensed practical nurse (Fig. 4-1). The medical assistant works under the supervision of a licensed physician. The dental assistant works under the supervision of a licensed dentist. Dental hygienists may practice without the supervision of a dentist in some states.
Brain Byte
In some cases nurse assistants may assist a patient with medication in a home setting, but not in a hospital.
Health care has become an industry that involves many complex professions and technologies. The health care worker must make legal and ethical decisions daily. Ethics are the principles and values that determine appropriate behavior. An individual, community, or society adopts moral standards that distinguish right from wrong. Morals are based on the experience, religion, and philosophy of the individual and the society. The basis of ethical behavior in the health care field is the respect for the needs and rights of others.
Case Study 4-1
You enter a room and find the patient is gone. You look all over the floor and then alert the rest of the staff of the absence. As you are contacting security, the patient reappears and states she had gone to the chapel. What should you do?
Answers to Case Studies
are available on the Evolve website: http://evolve.elsevier.com/Gerdin
Ethical standards apply to relationships with fellow workers, patients, and the community. These are based on individual morals and society’s expectations. Some ethical standards are the same for all health occupations (Box 4-2). Each profession may have an oath or pledge that states the basic beliefs and goals of the group (Box 4-3).
BOX 4-2 Code of Ethics
The primary goals of the health care worker are to promote an optimal level of wellness, preserve life, and provide for a peaceful death when necessary.
The health care worker respects the religious beliefs and cultural values of all patients.
The health care worker provides adequate and continuous care for all patients regardless of age, gender, race, or nature of the illness or injury.
The health care worker knows the limits of practice for which he or she is competent and stays within those limits.
The health care worker maintains competence and current knowledge by pursuing continuing education.
The health care worker practices jurisprudent behavior at all times by avoiding unethical or illegal practices.
The health care worker respects the dignity and rights of each patient by maintaining confidentiality and a professional attitude regarding all information relating to the patient.
The health care worker asks for clarification and assistance when unsure of any aspect of care.
The health care worker participates in professional activities and organizations to provide better health care.
The health care worker maintains a high standard of ethical and legal behavior in his or her private and professional life.
The health care worker must be jurisprudent, or aware of the laws that influence the industry. Workers in all occupations are legally responsible (liable) for their behavior and the care given. The employer also may be liable for the actions of the worker that are not reasonably prudent (negligent) or that reflect bad practice (malpractice). Slander means to communicate verbally something that is untrue and harmful about another person, and libel means to put it in writing. Inadequate charting is the cause of many incidences of liability for the health care worker. Another common concern is the violation of a patient trust that could result in invasion of privacy or illegal restraint.
Hospitals and other health care facilities may have an institutional or internal review board that meets to oversee the agency’s guidelines for ethical conduct. The board also may decide issues relating to a worker’s conduct, responsibility, and scope of practice when necessary. Many health care occupations are regulated by state agencies. Some workers hold a license that determines which actions may be performed. Licensed professionals are legally responsible for their actions when performing as employees or in their own practice.
Malpractice and Liability
Health care workers are legally responsible or liable for the care that is given to their patients. There are several types of law that apply to health care. The health care worker is accountable for all of them (Table 4-2).
TABLE 4-2
Types of Law Affecting Health Care
| Type of Law | Description | Examples |
| Administrative | Enforce statutory law, code-regulating bureaucracies | OSHA, NPA |
| Civil | Dispute between individuals | Assault, false imprisonment (restraint) |
| Common | Decisions made by judges, based on earlier court decisions | Protect disoriented patient, exemptions from immunizations |
| Constitutional | Supreme law of the land | Freedom of speech |
| Criminal (penal) | Legal punishment for public concerns(Common or statutory)(Local, state, or federal)(Felony or misdemeanor) | Falsification of patient records, fraud, theft |
| Statutory | Rules passed by government(local, state, or federal) | DRG law, NPA |
DRG, diagnosis-related grouping; OSHA, Occupational Safety and Health Administration. NPA, Nurse Practice Act.
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