ETHICS AND LEGAL PRACTICE IN

PATIENT CARE MANAGEMENT

JONAH LYDIA G. LANGGA, RN, MN, DPA

ETHICS
 DEFINITION OF ETHICS
 ETHICS – is the systematic study of what a person’s conduct
and actions should be with regard to self, other human beings,
and the environment; it is the justification of what is right or
good and the study of what a person’s life and relationships
should be, not necessarily what they are.

 It is a system of moral conduct and principles that guide a

person’s actions in regards to right and wrong and in regard to
oneself and society at large.
 ETHICS AND PRACTICE
 Healthcare workers (e.g. nursing service staff) are often placed
in situations where they are expected to be agents for
patients, physicians and the organization simultaneously, all
of which may have conflicting needs, wants and goals.

 To make appropriate ethical decisions, healthcare workers

must have knowledge of ethical principles and frameworks,
use of a professional approach that eliminates trial and error,
and use of available organizational processes resulting to
sound decisions.
 ETHICAL FRAMEWORKS
FRAMEWORK BASIC PREMISE
Utilitarianism Provide the greatest good for the greatest number
of people.
Rights-Based Individuals have basic inherent rights that should
Reasoning not be interfered with.
Duty-Based A duty to do something or to refrain from doing
Reasoning something.
Intuitionism Each case is weighed on a case-by-case basis to
determine relative goals, duties and rights.
 ETHICAL PRINCIPLES
PRINCIPLES DEFINITION
Autonomy Promotes self-determination and freedom of choices.
Beneficence Actions are taken in an effort to promote good.
Nonmaleficence Actions are taken in an effort to avoid harm.
Paternalism One individual assumes the right to make decisions for another.
Utility The good of the many outweighs the wants/ needs of the individual.
Justice Seek fairness; treat “equals” equally and treat “unequals” according to
their differences.
Veracity Obligation to tell the truth.
Fidelity Need to keep promises.
Confidentiality Keep privileged information private.
LEGAL PRACTICE
 LAW AND LEGISLATION
 The primary purpose of law and legislation is to protect the
patient and the healthcare worker. Laws and legislation define
the scope of acceptable practice and protect individual rights.

 Those who are aware of their rights and duties in legal

matters are able to protect themselves against liability or loss
of professional licensure.
 NEGLIGENCE AND MALPRACTICE
 NEGLIGENCE – is the omission to do something that a
reasonable person, guided by the considerations that
ordinarily regulate human affairs, would do – or as doing
something that a reasonable and prudent person would not do.

 MALPRACTICE – the failure of a person with professional

training to act in a reasonable and prudent manner – also is
called professional negligence.
 COMPONENTS OF MALPRACTICE
(PROFESSIONAL NEGLIGENCE)
ELEMENTS OF LIABILITY EXPLANATION
1. Duty to use due care The care that should be given under the circumstances
(defined by standard of care) (what the reasonably prudent HCW would have done).
2. Failure to meet standard Not giving the care that should be given under the
of care (breach of duty) circumstances.
3. Foreseeability of harm The HCW must have reasonable access to information
about whether the possibility of harm exists.
4. A direct relationship Patient is harmed because proper care is not given.
between failure to meet the
standard of care (breach) and
injury can be proven.
5. Injury Actual harm results to the patient.
 LIABILITIES
 RESPONDEAT SUPERIOR – One form of vicarious liability which
means “the master is responsible for the acts of his servants.” The
theory behind the doctrine is that an employer should be held legally
liable for the conduct of employees whose actions he or she has a
right to direct or control.

 The purpose of respondeat superior is not to shift the burden of blame

from the employee to the organization but rather to share the blame,
increasing the probability of larger financial compensation of the
injured party. In return, the employer may have the legal right to
recover or be reimbursed from the negligent employee.
 LIABILITIES

 PERSONAL LIABILITY – Every person is liable for his or her

own conduct. The law does not permit a wrongdoer to avoid
legal liability for his or her own wrongdoing, even though
someone else also may be sued and held legally liable. In the
end, each healthcare worker is always held liable for his or her
own negligent practice.
 INCIDENT REPORTS

 INCIDENT REPORTS – are records of unusual or unexpected

incidents that occur in the course of a client’s treatment.
Incident reports are use to defend the health agency against
lawsuits brought by clients, the reports are generally
considered confidential communications.

 Thus, a copy of the incident report should not be left in the

chart. The chart should, however, must contain enough
information about the incident or occurrence so that
appropriate treatment can be given.
 INFORMED CONSENT

 Many healthcare workers erroneously believe that they have

obtained informed consent when they witness a patient’s
signature on a consent form for surgery or procedure.

 Strictly speaking, informed consent is obtained only after the

patient receives full disclosure of all pertinent information
regarding the surgery or procedure and only if the patient
understands the potential benefits and risks associated with
doing so.
PATIENT’S BILL
OF RIGHTS
1. The patient has the right to considerate & respectful care, irrespective of
socio-economic status.

2. The patient has the right to obtain from his physician complete current
information concerning his diagnosis, treatment and prognosis in terms
the patient can reasonably be expected to understand. When it is not
medically advisable to give such information to the patient. The
information should be made available to an appropriate person in his
behalf. He has the right to know by name or in person, the medical team
responsible in coordinating his care.
3. The patient has the right to receive from his physician information necessary to
give informed consent prior to start of any procedure and or treatment. Except in
emergencies, such information for informed consent should include but not
necessarily limited to the specific procedure and or treatment, the medically
significant risks involved, and the probable duration of incapacitation. Where
medically significant alternatives for care or treatment exist, or when the patient
requests information concerning medical alternatives, the patient has the right for
such information. The patient has also the right to know the name of the person
responsible for the procedure and/or treatment.
4. The patient has the right to refuse treatment / life-giving measures, to
the extent permitted by law and to be informed of the medical
consequence of his action.

5. The patient has the right to every consideration of his privacy

concerning his own medical care program. Case discussion, consultation,
examination and treatment are confidential and should be conducted
discreetly. Those not directly involved in his care must have the
permission of the patient to be present.
6. The patient has the right to expect that all communication and records
pertaining to his care should be treated as confidential.

7. The patient has the right that within its capacity, a hospital must make
reasonable response to the request of patient for services. The hospital must
provide evaluation, service and or referral as indicated by the urgency of care.
When medically permissible a patient may be transferred to another facility
only after he has received complete information concerning the needs and
alternatives to such transfer. The institution to which the patient is to be
transferred must first have accepted the patient for transfer.
8. The patient has the right to obtain information as to any relationship
of the hospital to other health care and to other health care and
educational institutions in so far as his care is concerned. The patient has
the right to obtain as to the existence of any professional relationship
among individuals, by name who are treating him.

9. The patient has the right to be advised if the hospital proposes to

engage on or perform human experimentation affecting his care or
treatment. The patient has the right to refuse or participate in such
research projects.
10. The patient has the right to expect reasonable continuity of care; he has the right
to know in advance what appointment times the physicians are available and where.
The patient has the right to expect that the hospital will provide a mechanism
whereby he is informed by his physician or a delegate of the physician of the patient’s
continuing health care requirements following discharge.

11. The patient has the right to examine and receive an explanation of his bill
regardless of source of payment.

12. The patient has the right to know what hospital rules and regulations apply to his
conduct as a patient.