Health Law & Ethics Legal and Ethical Issues in Health Care: Basic Health Skills Ii (Gru1251)

Week 5
Topic: HEALTH LAW & ETHICS
HEALTH LAW & ETHICS

Legal and Ethical Issues in Health Care
BASIC HEALTH SKILLS II (GRU1251)
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Objectives
By the end of this lecture, you will be able to:
 Define and Contrast laws, morals, and ethics.
 Explain the purpose of professional codes of ethics.
 Define the term standard of care.
 Describe informed consent.
 Discuss the importance of confidentiality for healthcare professionals.

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Objectives
 Explain what an advance directive is.
 Compare a living will, a durable power of attorney, and a

healthcare proxy.
 Describe patients’ rights and responsibilities.
 Name the qualities of a successful healthcare worker.
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Lecture Learning Outcomes
• Recognize ethical issues and their implications related to

healthcare.
• State the legal and ethical regulations that apply to healthcare

delivery, and outline the moral basis of patient confidentiality.
• Identify patient’s rights and responsibilities in health care.
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LAW & ETHICS
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Legal and Ethical Responsibilities
 How Will Legal and Ethical

Considerations Affect How You Make
Decisions As a Healthcare Professional?
 What is the difference between law and

ethics?
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INTRODUCTION
• Healthcare professionals must understand and act according
to the accepted morals, laws, and ethics related to their
occupation in all aspects of their work, including working with
clients, procedures, or records.
• He alt h car e p r of e ssion als AND

St ud e n t s ar e le g ally r e sp on sib le
f or t h e ir act ion s
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INTRODUCTION
Why is it important to understand the legal issues that impact

your practice?
 Healthcare Professionals have a responsibility to:

• Understand the legal obligations when caring for clients
• Understand the legal limits influencing daily practice
• Protect the client’s rights
• Protect themselves from liability (legal responsibility)
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Understanding Laws, Morals, and Ethics
• Laws – a law, or statute, is a rule of conduct or

action.
• It is a system of rules of action or conduct that governs the

behavior of people in respect to relationships with others and
with government.
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Understanding Laws, Morals, and Ethics (cont.)

• Morals and Ethics
• Morals are formed from your personal values – your concept of right
and wrong.
• You develop moral values through the influence of family culture and
society.
• Acting morally toward others involves treating them the way you
would like to be treated.
• Ethics are standards of behavior developed as a result of your moral

values.
 An unethical act is not necessarily illegal.
 An illegal act is always unethical.
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• Morals and Ethics

Morals define personal character, while ethics stress a social
system in which those morals are applied.
In other words, ethics point to standards or codes of behavior

expected by the group to which the individual belongs.
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The Difference between Laws, Morals, and Ethics

Law Ethics Moral Values
Definition Set of governing rules Standards of behavior Concept of right and
that reflect moral wrong formed through
values influence of family,
culture, and society
Main purpose To protect the public To raise standard of To serve as a guide for
competence personal conduct
Purpose To promote smooth To build values and To serve as a basis for
functioning of society ideals forming personal code
of ethics
Penalties or Upon conviction in civil or Suspension or eviction Difficulty in getting along
consequences criminal court: fines, from professional with others
imprisonment, loss of society membership, as
professional license, or other decided by peers
penalty determined by courts
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Code of Ethics
For further guidance, most
healthcare organizations have
established codes of ethics to help
their professional members with
difficult decisions.
The first known code of ethics was

developed around 400 B.C.E. by
Hippocrates, a Greek physician
known as the father of Western
medicine. It was called the
Hippocratic Oath.
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Understanding Laws, Morals, and Ethics

What are the Functions of Law?
define rules of behavior for members of society

determine which actions are and are not permissible in
society and what punishments enforce the rules
protect public safety and property
promote non-discrimination
regulate professions
provide the distribution of goods and services
protect the interests of society
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Why Should Healthcare Professionals Know the Law?
 In 1999, an American report, “To Err is Human”, revealed that between

44,000 – 98,000 people died due to preventable medical errors (Kohn,
Corrigan, & Donaldson, 2000).
 Healthcare Professionals must have a basic knowledge of the law because

it:
authorizes boundaries of practice

protects us against liability
protects the rights of patients
protects patients from poor practice and harm
is a component of ethical decision-making
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• Criminal Laws – protect members of society from
certain harmful acts of others.
• A criminal act may be one of:
Commission, if there is a law forbidding a certain act.
Omission, in violation of a law requiring a certain act.
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• Civil Laws – are concerned with private rights and
remedies.
• Examples of the causes of civil disputes include:
Contract violation.
Slander or libel.
Trespassing.
Product liability.
Automobile accidents.
Family matters such as divorce, child support, and child
custody.
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Torts (illegal acts)
• A tort is broadly defined as a civil wrong committed
against a person or property, excluding a breach of
contract.
• Torts may be intentional (willful) or unintentional
(accidental) and, if intentional, may also be crimes.
Examples of intentional torts:
1. Assault
2. Battery
3. Fraud
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Intentional Torts
Example:
1. Assault - an attempt or purposeful threat to touch a person without
consent; no actual physical contact is necessary. OR an attempt to
threaten or harm another person (Ex: force feeding)
If a nurse threatens to use restraints on a patient for an X-ray

procedure against his consent, this is assault.
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Intentional Torts
Example:
2. Battery - unwarranted or harmful touching without consent.
The touching may cause physical harm or it may insult the
dignity of the person. Angry, violent or wilful touching is
battery.
If a nurse gives an injection without the patient’s consent,

even if the intention is beneficent and the outcome positive,
this is battery.
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Intentional Torts
Example:
4. Fraud - deliberate deception to gain something unfairly or
illegally.
A nurse who falsifies credentials to gain employment, or who

changes documentation in a medical record to cover up an error
or avoid legal action, is committing fraud.
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Unintentional torts are acts that were not intended to
cause harm. However, they are committed without regard for
consequences.
An unintentional tort is caused by negligence. Negligence is
also called medical malpractice.
Example:
Negligence
an omission to do something which a reasonable person
guided by ordinary considerations would do
or doing something that a reasonable person would not do.
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Malpractice
The 3 Ds must be present for negligence to occur:

• Duty – healthcare practitioner/patient relationship
exists.
• Derelict – healthcare practitioner did not live up to
the obligation of caring for a patient.
• Damage – the breach of duty results in damages to
the patient or plaintiff.
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Direct Causation
The patient must establish that the medical professional’s breach of the duty of care was the direct cause of the patient’s damages. Although
establishing this is often fairly straightforward, it can be another area where the arguments on both sides become heated.
Damages
Finally, the patient must show that they have actually suffered harm, either physically, mentally or both. This is often shown through medical records,
prescriptions and/or testimony.
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Malpractice
• According to the legal principles of negligence, the “three Ds” of negligence
listed above—duty, derelict, damage—must be present for a lawsuit to
have merit.
For example:
 a healthcare practitioner is not necessarily liable (legally responsible) for a
poor outcome when delivering healthcare. Many clients do not recover, but
this does not mean that they were the victims of malpractice.
 A healthcare practitioner is liable only if it can be established that they
were negligent in the delivery of professional services and caused injury to
a client through that negligence.
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Noncompliance
• Noncompliant healthcare workers may face fines
or prison sentences and can lose their licenses to
practice their profession.
• Unethical conduct may result in expulsion or
censure from your professional organization, but
only the state can revoke a license.
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Medical practice acts are state statutes that govern
medical practices. They do the following:
Cover requirements and methods for licensing
healthcare providers.
Establish medical licensing boards.
List grounds for revoking (cancelling) licenses.
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Licensure, Registration, and Certification

Licensure – is required for certain professions
within a country.
 All states require that all healthcare workers have licenses to
practice in that state.
 Persons who do not meet state standards for a license may not
legally practice
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Licensure, Registration, and Certification (cont.)

Registration
• Adding one’s name in an official registry or record as having
satisfied the requirements for a certain healthcare
occupation.
• Fulfilling certain education requirements and/or paying a
registration fee.
Certification – usually voluntary

• Reciprocity – when state licensing authorities accept a
person’s valid license from another state.
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Standard of Care and Scope of Practice
• Standard of care is the level of performance

expected of a healthcare worker in carrying out his or
her professional duties.
It is: the minimal acceptable level of practice.

Based on laws as well as best (researched)
practices.
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Standard of Care and Scope of Practice (cont.)

• Working outside your scope of practice can make
you liable.
• Working within your scope of practice ensures that
you:
• Do not injure patients or put them at risk by performing
procedures that are beyond your ability.
• Will not be held liable for a standard of care that is
beyond your training, experience, and job description if
a legal situation arises.
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Informed Consent
is basically a legal document derived from the doctor’s duty to tell the
patient information about:
• The proposed methods of treatment.
• Why the treatment is necessary.
• The risks involved in the proposed treatment.
• All available alternative types of treatment.
• The risks of any alternative methods of treatment.
• The risks involved if treatment is refused.
• It will assist the patient to make a rational and informed choice
about undergoing such care
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Informed Consent
A SAMPLE CONSENT FORM
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Informed Consent (cont.)
• People who cannot give informed consent

include:
• Minors – individuals under 18 years of age (21 in
some states). Exceptions include those deemed
mature minors by the court.
• Mentally incompetent individuals – persons
judged by the court to be insane, senile, mentally
retarded, or under the influence of drugs or alcohol.
• People who only speak a foreign language.
(Language Barriers)
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Confidentiality
• It is illegal and unethical for a

healthcare worker not to
observe confidentiality.
• Privileged communication
refers to information held
confidential within a
protected relationship.
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Confidentiality (cont.)
• Keeping client medical information confidential
means:
• Not informing any unauthorized person about the
information contained in a patient’s medical records.
• Not showing written information to an unauthorized third
party.
• Taking proper precautions when communicating such
information over a computer, telephone, or fax machine.
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• Guidelines to follow if you have access to a patient’s
information:
• Do not decide if information is confidential based on your
approval or agreement.
• Do not reveal financial information about a patient.
• Do not use the patient’s name or other information if
others in the room might overhear.
• Use caution in giving the results of medical tests to patients
over the telephone.
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• Guidelines to follow if you have access to a patient’s
information: (cont.)
• Do not leave medical charts or insurance reports where
patients or others can see them.
• If the patient has not given written permission to release
information, do not release it.
• Do not discuss patients in public places where others may
overhear, such as the cafeteria or elevator.
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• Confidentiality for patient medical records may be
waived under the following circumstances:
• When a third party requests a medical examination, such
as a pre-employment examination, and that third party
pays the patient’s bill.
• When a patient sues a physician or other healthcare
practitioner for malpractice.
• When the patient signs a waiver allowing the release of
information.
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CONSENT TO RELEASE INFORMATION
• Written consent
must be obtained
before releasing
information to a
third party.
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Medical Records
Facilities providing healthcare
services are required by
licensing authorities to keep
and maintain healthcare
records of patients.
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Medical Records (cont.)

Medical records provide:
1. A format for tracking, documenting, and maintaining a client’s health
data
2. Documentation of a client’s lifelong healthcare.
3. A basis for managing a client’s healthcare.
4. Background information in the event of a lawsuit.
5. Clinical data for education, research, statistical tracking, and
assessing the quality of healthcare.
6. Medical records may be kept electronically or on paper. They belong
to the owners of the facility, even though the client owns the
information contained in them.
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Health Insurance Portability and Accountability Act

On August 21, 1996, the U.S. Congress passed the Health Insurance
Portability and Accountability Act (HIPAA).
The purposes of the act are to:
• Improve the efficiency and effectiveness of health-care delivery by
creating a national framework for health privacy protection
• Protect and enhance the rights of patients by providing them access to
their health information and controlling the inappropriate use or
disclosure of that information
• Improve the quality of health care by restoring trust in the health-care
system among consumers, health-care professionals, and the
multitude of organizations and individuals committed to the delivery of
care
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Health Insurance Portability and Accountability Act
• This law states that all patients have rights regarding
their health information, which is known as protected
health information (PHI).
• Clients have the following rights under HIPAA law:
• The right to notice of privacy practices.
• The right to limit or request restriction on their PHI and its use
and disclosure.
• The right to confidential communications.
• The right to inspect and obtain a copy of their PHI.
• The right to request an amendment to their PHI.
• The right to know if their PHI has been disclosed and why.
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An advance directive is a set of instructions someone prepares in advance of ill health that determines his
healthcare wishes. A living will is one type of advance directive that becomes effective when a person is
terminally ill.
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Advance Directives
 Advance directives are legal documents that make
known a person’s wishes about life-support measures.
Living Will
 provides instructions directly to physicians, hospitals,
and other healthcare providers involved in a client’s
medical treatment.
Durable Power of Attorney
 not specifically a medical document, but it may serve that
purpose. It gives a person, called a designee, the authority
to make a variety of legal decisions on behalf of another
person, called the grantor.
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Healthcare Proxy
 or healthcare power of attorney, is also an end-of-life
document. With it, clients specify an agent to make
medical decisions for them in the event that they lose the
ability to reason or communicate.
Organ Donor Directives
 a document that indicates client’s wish to donate organs
for transplantation or medical research when patient
dies.
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Advance Directives
SAMPLE LIVING WILL
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SAMPLE HEALTHCARE PROXY
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Client Autonomy
Clients’ Rights
Patient’s Bill of Rights guarantees the client’s right to:
• Receive considerate and respectful care.
• Receive complete and current information concerning
his or her diagnosis, treatment, and prognosis.
• Know the identity of physicians, nurses, and others
involved with his or her care, as well as when those
involved are students, residents, or trainees.
• Know the immediate and long-term costs of treatment
choices.
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Client Autonomy (cont.)

Clients’ Rights (cont.)
• Receive information necessary to give informed consent
prior to the start of any procedure or treatment.
• Have an advance directive concerning treatment or be
able to choose a representative to make decisions.
• Refuse treatment to the extent permitted by law.
• Receive every consideration of his or her privacy.
• Be assured of confidentiality.
• Obtain reasonable responses to requests for services.
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Client Autonomy (cont.)
Clients’ Rights (cont.)

• Obtain information about his or her healthcare and be
allowed to review his or her medical record and to have
any information explained or interpreted.
• Know whether treatment is experimental and be able to
consent or decline to participate in proposed research
studies or human experimentation.
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Clients’ Responsibilities
Clients are responsible for:
• Providing information about past illnesses, hospitalizations,
medications, and other matters related to their health
status.
• Participating in decision making by asking for additional
information about their health status or treatment.
• Providing healthcare agencies with a copy of their written
advance directive if they have one.
• Informing physicians and other caregivers if they anticipate
problems in following a prescribed treatment.
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Clients’ Responsibilities (cont.)

• Following a physician’s orders for treatment. The client has
the right to refuse treatment to the extent permitted by
law.
• Providing healthcare agencies with necessary information
for insurance claims and working with the healthcare
facility to make arrangements to pay fees when necessary.
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Qualities for Success
• Successful healthcare providers use the 3

Cs:
• Courtesy
• Compassion
• Common sense
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Qualities for Success Week 5
Qualities for Success (cont.)

• A relaxed attitude when meeting new people.
• A willingness to learn new skills and techniques.
• An aptitude for working with the hands.
• Empathy for others.
• Good communication and listening skills.
• Patience in dealing with others.
• The ability to work as a member of a healthcare team.
• Proficiency in English, science, and mathematics.
• The ability to keep information confidential.
• The ability to leave private concerns at home.
• Trustworthiness .
• A sense of responsibility.
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References
 Booth, A. (2013).Healthcare science technology : A complete

online learning system. Chapter 12. McGraw -Hill: USA.
 Simmers, L., Simmers, K., & Simmers, S. (2009). Introduction to

Health Science Technology. Chapter 5. DELMAR. USA.
 Burkhardt, M. & Nathaniel, A. (2008) Ethics and issues in

contemporary nursing. (3rd edition) USA: Delmar Cengage
Learning. Chapter 7.
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Questions?
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Week 5

Topic: HEALTH LAW & ETHICS

HEALTH LAW & ETHICS

BASIC HEALTH SKILLS II (GRU1251)

 Define and Contrast laws, morals, and ethics.

 Explain the purpose of professional codes of ethics.

 Define the term standard of care.

 Describe informed consent.

 Discuss the importance of confidentiality for healthcare professionals.

 Compare a living will, a durable power of attorney, and a

 Describe patients’ rights and responsibilities.

 Name the qualities of a successful healthcare worker.

Lecture Learning Outcomes

• Recognize ethical issues and their implications related to

• State the legal and ethical regulations that apply to healthcare

• Identify patient’s rights and responsibilities in health care.

LAW & ETHICS

Legal and Ethical Responsibilities

 How Will Legal and Ethical

 What is the difference between law and

• He alt h car e p r of e ssion als AND

Why is it important to understand the legal issues that impact

 Healthcare Professionals have a responsibility to:

Understanding Laws, Morals, and Ethics

• Laws – a law, or statute, is a rule of conduct or

• It is a system of rules of action or conduct that governs the

Understanding Laws, Morals, and Ethics (cont.)

• Ethics are standards of behavior developed as a result of your moral

Understanding Laws, Morals, and Ethics (cont.)

• Morals and Ethics

In other words, ethics point to standards or codes of behavior

The Difference between Laws, Morals, and Ethics

The first known code of ethics was

Understanding Laws, Morals, and Ethics

define rules of behavior for members of society

Why Should Healthcare Professionals Know the Law?

 In 1999, an American report, “To Err is Human”, revealed that between

 Healthcare Professionals must have a basic knowledge of the law because

authorizes boundaries of practice

Understanding Laws, Morals, and Ethics (cont.)

Understanding Laws, Morals, and Ethics (cont.)

Understanding Laws, Morals, and Ethics (cont.)

If a nurse threatens to use restraints on a patient for an X-ray

If a nurse gives an injection without the patient’s consent,

A nurse who falsifies credentials to gain employment, or who

Understanding Laws, Morals, and Ethics (cont.)

Understanding Laws, Morals, and Ethics (cont.)

The 3 Ds must be present for negligence to occur:

Understanding Laws, Morals, and Ethics (cont.)

Understanding Laws, Morals, and Ethics (cont.)

Licensure, Registration, and Certification

Licensure, Registration, and Certification (cont.)

Certification – usually voluntary

Standard of Care and Scope of Practice

• Standard of care is the level of performance

It is: the minimal acceptable level of practice.

Standard of Care and Scope of Practice (cont.)

Informed Consent (cont.)

• People who cannot give informed consent

• It is illegal and unethical for a

CONSENT TO RELEASE INFORMATION

Medical Records (cont.)