Legal and Ethical Principles

Chapter 4


Legal and Ethical Principles



Learning Objectives



image Define at least 10 terms relating to legal and ethical principles.


image Describe at least five examples of ethical behavior for the health care worker.


image Identify at least five situations that show improper ethical or legal behavior.


image Explain the importance of confidentiality in health care, including privacy issues resulting from advanced technology.


image Describe at least two examples of rights of the health care patient.


image Describe the role of the health care worker regarding current legal issues, including advanced directives and telemedicine.



Key Terms

















Legal and Ethical Terminology



Which Term Best Fits with this Example?


Wanda Roberts was run over by a truck in 1992. After 6 weeks of treatment at a hospital, she was transferred to another facility. In Roberts v. Galen (1999), the U.S. Supreme Court considered her claim of “patient dumping.” This practice was described as moving a patient without insurance to a publicly funded facility for care regardless of condition.


























Term Definition
Abandonment Neglecting a patient or client under and in need of immediate professional care, without making reasonable arrangements for the continuation of such care
Assault A threat or an attempt to injure another person in an illegal manner
Battery Unlawful touching of another person without consent, with or without injury
Breach Breaking the law, an obligation, or the terms of a contract
Civil law Defines the legal relationships between individuals
Common law Unwritten law; customs that may have authority or have been established by prior court decisions



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).



BOX 4-1   Legal Issues in Health Care




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.



image
FIGURE 4-1 The nursing assistant may use handwritten notes to report to the supervising nurse to be charted electronically. (From Sorrentino SA: Mosby’s textbook for nursing assistants, ed 7, St. Louis, 2008, Mosby.)


image 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.



image 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 codes are guidelines for the actions of people in a profession. They are established by the professionals to whom they apply, and they may not be legally binding. What is ethical in one society or profession might not apply to another and may change over time. In most health care professions, the rules of ethics are preserved in an oath or code of standards. Physicians established the first code of ethics for a profession. Lawyers followed them. The third and fourth professions to establish codes were pharmacists and veterinarians.


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




image 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.


image The health care worker respects the religious beliefs and cultural values of all patients.


image The health care worker provides adequate and continuous care for all patients regardless of age, gender, race, or nature of the illness or injury.


image The health care worker knows the limits of practice for which he or she is competent and stays within those limits.


image The health care worker maintains competence and current knowledge by pursuing continuing education.


image The health care worker practices jurisprudent behavior at all times by avoiding unethical or illegal practices.


image 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.


image The health care worker asks for clarification and assistance when unsure of any aspect of care.


image The health care worker participates in professional activities and organizations to provide better health care.


image The health care worker maintains a high standard of ethical and legal behavior in his or her private and professional life.



BOX 4-3   Nightingale Pledge




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.



Legal and Ethical Terminology



Which Term Best Fits with this Example?


In Hunter v. Mann (1974), a doctor treated a man and a girl for injuries from a traffic accident. The doctor refused to disclose their identity to the police who were looking for a man and girl who had earlier run away from an accident.





























Term Definition
Conduct Behavior or a person’s actions
Consent Permission granted by a person voluntarily and in sound mind; written consent is most easily proved
Crime Performing an act that is forbidden or omitting a duty required by public law, making the offender liable for the action
Criminal law Defines the legal obligation between an individual and the state or society
Custom An accepted behavior or common practice
Duty of care By law, health care workers must perform services in a manner that meets common standards of practice
Ethics Standards of behavior and practice that are established by a professional organization for its members


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).


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Apr 15, 2017 | Posted by in MEDICAL ASSISSTANT | Comments Off on Legal and Ethical Principles

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