OBJECTIVES: 1. 2. 3. 4. Discuss patients right and organizational ethics. Enumerate the patients’ rights. Define what is ethics. Explain what is organizational ethics.

Enumerate the ethical principles

INTRODUCTION Patients have a fundamental right to considerate care that safeguards their personal dignity and respects their cultural, psychosocial and spiritual values. These values often influence patients’ perceptions of care and illness. Understanding and respecting these values guide the provider in meeting the patient’s experience of and response to care. Thus, access, treatment, respect and conduct affect patient rights.

Patients' rights Formalized in 1948, the Universal Declaration of Human Rights recognizes “the inherent dignity” and the “equal and unaliena ble rights of all members of the human family”. And it is on the basis of this concept of the person, and the fundamental dignity and equality of all human beings, that the notion of patient rights was developed. In other words, what is owed to the patient as a human being, by physicians and by the state, took shape in large part thanks to this understanding of the basic rights of the person. Patients' rights vary in different countries and in different jurisdictions, often depending upon prevailing cultural and social norms. Different models of the patient -physician relationship —which can also represent the citizen -state relationship —have been developed, and these have informed the particular rights to which patients are entitled. In North America and Europe, for instance, there are at least four models which depict this relationship: the paternalistic model, the informative model, the interpretive model, and the deliberative model. Each of these suggests different professional obligations of the physician toward the patient. For instance, in the paternalistic model, the best interests of the patient as judged by the clinical expert are valued above the provision of comprehensive medical information and decision -making power to the patient. The informa tive model, by contrast, sees the patient as a consumer who is in the best position to judge what is in her own interest, and thus views the doctor as chiefly a provider of information. There continues to be enormous debate about how best to conceive of this relationship, but there is also growing international consensus that all patients have a fundamental right to privacy, to the confidentiality of their medical information, to consent to or to refuse treatment, and to be informed about relevant risk to them of medical procedures.

A patient's rights occur at many different levels, and in all specialties. The American Medical Association (AMA) outlines fundamental elements of the doctor-patient relationship in their Code of Medical Ethics. These rights include the following:
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The right to receive information from physicians and to discuss the benefits, risks, and costs of appropriate treatment alternatives The right to make decisions regarding the health care that is recommended by the physician The right to courtesy, respect, dignity, responsiveness, and timely attention to health needs The right to confidentiality The right to continuity of health care The basic right to have adequate health care

 CONSENT Consent, particularly informed consent, is the cornerstone of patients' rights. Consent is based on the inviolability of one's person. It means that doctors do not have the right to touch or treat a patient without that pati ent's approval because the patient is the one who must live with the consequences and deal with any dis -comfort caused by treatment. A doctor can be held liable for committing a Battery if the doctor touches the patient without first obtaining the patient's consent. Consent must be voluntary, competent, and informed. Voluntary means that, when the patient gives consent, he or she is free from extreme duress and is not intoxicated or under the influence of medication and that the doctor has not coerced the patient into giving consent. The law presumes that an adult is competent, but competency may be an issue in numerous instances. Competence is typically only challenged when a patient disa grees with a doctor's recommended treatment or refuses treatment altogether. If an individual understands the information presented regarding treatment, she or he is competent to consent to or refuse treatment.

 RIGHT TO TREATMENT In an emergency situation, a patient has a right to treatment, regardless of ability to pay. If a situation is likely to cause death, serious injury, or disability if not attended to promptly, it is an emergency. Cardiac arrest, heavy bleeding, profound shock, severe head injuries, and acute psychotic states are some examples of emergencies. Less obvious situations can also be emergencies: broken bones, fever, and cuts requiring stitches may also require immediate treatment. Both public and private hospitals have a duty to administe r medical care to a person experiencing an emergency. If a hospital has emergency facilities, it is legally required to provide appropriate treatment to a person experiencing an emergency. If the hospital is unable to provide emergency services, it must pr ovide a referral for appropriate treatment. Hospitals cannot refuse to treat prospective patients on the basis of race, religion, or national origin, or refuse to treat someone with HIV or AIDS.

 RESEARCH When involving people in research studies it is impo rtant that each patient or subject is fully informed as to the purpose of the trial, any possible dangers and the fact that it may not directly be of benefit to them before they are asked for consent. Double blind trials, where neither the researcher nor t he subject knows what treatment (usually drugs) the subject is receiving, need special vigilance, particularly if unforeseen and potentially dangerous side effects occur. Recent years have seen trials stopped before completion because of such ill effects o r because the benefit of one approach is obviously superior to another. It is obviously immoral to continue to put a patient at risk, even if extra knowledge regarding the treatment would be valuable for others. The Code emphasises the importance of truth and the absence of any form deception. All actions relating to patients or clients must be for their benefit in the long run. Some treatments, such as chemotherapy for cancer, may seem in the immediate future to be anything but beneficial but the patient must understand this and the intended eventual benefit prior to giving consent. Benjamin and Curtis (1981, p.62) say that deception is a form of manipulation, like coercion and rational persuasion; it is a way of inducing others to do what one wants them to do.

 ADVENCE MEDICAL DIRECTIVES In recent years it has become possible for an individual to make an Advanced Statement, often described as living will, in which the person express their desires with regard to medical treatment. The statement may cov er the type of treatment the person would find acceptable, particularly in the case of potentially terminal illness and whether resuscitation should be carried out. Although the legal status of such a document as ambiguous most healthcare professionals wo uld abide by its provisions. Every state has enacted advance medical directive legislation, but the laws vary widely. Advance medical directives are documents that are made at a time when a person has full decision-making capabilities and are used to direc t medical care in the future when this capacity is lost. Many statutes are narrowly drawn and specify that they apply only to illnesses when death is imminent rather than illnesses requiring long -term life support, such as in end-stage lung, heart, or kidn ey failure; multiple sclerosis; paraplegia; and persistent vegetative state. When advance medical directives function as intended and are honored by physicians, they free family members from making extremely difficult decisions. They may also protect physicians. Standard medical care typically requires that a doctor provide maximum care. In essence, a living will can change the standard of care upon which a physician will be judged and may protect a physician from legal or professional repercussions for wit hholding or withdrawing care.

 RIGHT TO DIE A number of cases have addressed the right to refuse life -sustaining medical treatment. Broadly speaking, under certain circumstances a person may have a right to refuse life sustaining medical treatment or to have life-sustaining treatment withdrawn. On the one side in these cases is the patient's interest in autonomy, privacy, and bodily integrity. This side must be balanced against the state's traditional interests in the preservation of life, prevention of suicide, protection of dependents, and the protection of the integrity of the medical profession.

 PRIVACY AND CONFIDENTIALITY Confidentiality between a doctor and patient means that a doctor has the express or implied duty not to disclose information receiv ed from the patient to anyone not directly involved with the patient's care. Confidentiality is important so that healthcare providers have knowledge of all facts, regardless of how personal or embarrassing, that might have a bearing on a patient's health. Patients must feel that it is safe to communicate such information freely. Although this theory drives doctor -patient confidentiality, the reality is that many people have routine and legitimate access to a patient's records. A hospital patient might have several doctors, nurses, and support personnel on every shift, and a patient might also see a therapist, nutritionist, or pharmacologist, to name a few. The law requires some confidential information to be reported to authorities. For example, birth and d eath certificates must be filed; Child Abuse cases must be reported; and infectious, contagious, or communicable diseases must be reported. In addition, confidential information may also be disclosed pursuant to a judicial proceeding or to notify a person to whom a patient may pose a danger.

ETHICS Since ethics govern right conduct, they deal with what “should” or “ought to” be done. Ethics are not unlike the law in that each deal s with the rules of conduct that reflect underlying principles of right and wrong and codes of mortality. Ethics are designed to protect the rights of human beings. In nursing, ethics provide professional standards for nursing activities; these


Organizational Ethics is the ethics of an organization , and it is how an organization ethically responds to an internal or external stimulus. Organizational ethics is interdependent with the organizational culture . Although, it is akin to both organizational behavior(OB) and business ethics on the micro and macro levels, organizational ethics is neither OB, nor is it solely business ethics (which includes corporate governance and corporate ethics ). Organizational ethics express the values of an organization to its employees and/or other entities irrespective of governmental and/or regulatory laws. Ethics has been consi dered to be a component of organizational culture sometim es referred to as t he moral clim ate of an organization (B artl ett, 2003).A ft er recent and on- going business scandal s (Enron, Worl dC om, etc.) where top managem ent did not m ake ethi cal and m oral choi ces t he organizati onal culture has result ed i n federa l government regul ati ons (Sarbanes -Oxley) stepping in to help regul ate and im pact t he m orale clim at e of the organization. Enforced regul ations are not a component of organizati onal et hics. The severe decli ne in publ i c t r u s t a n d i n v e s t o r c o n f i d e n c e h a s l e d e x e c u t i v e s t o r e t h i n k a n d r e - e v a l u a t e exactly what their responsibilities are when it comes to making ethical decisions. Ethics has been a topic of discussion since the time of Socrates and Plato. Scholars have debated and discussed ethics as doing what is right, having morals, or often referred to ethics being a set of values or principles that guide's one's behavior. Trevino and Nelson (2005) define ethics as "the principles, norms and standards of conduct governing an individual or group".

ETHICAL PRINCIPLES Health care has traditionally been based on the assumption that life is an important and essential good and that it should be preserved whenever possible. Prevention of premature or avoidable death is seen as part of the goal of health care. However, the principle or duty to prolong/preserve life does not provide an adequate basis for making decisions about when treatments may be withheld or withdrawn.

a. The principle of respect for persons’ autonomy Patients have the right to make decisions about the course of their life for themselves. This is often called the patient's right of self -determination or autonomy. Important aspects of respect for persons’ autonomy include: the concept of informed consent, the presumption that patients have the capacity to make decisions, the presumption that patients have a right to delegate decision -making authority, the patient's right to be adequately informed, and the right to authorize or refuse any medical treatment. b. The principle of "do no harm" (non-maleficence) One of the most established principles of health care ethics directs providers to avoid or minimize harm to patients. Providers are obligated to carefully weigh the burdens and risks associated with any proposed treatment. When treatment no lon ger provides reasonable benefits or becomes unacceptably burdensome from the patient's perspective, it should be stopped.

c. The principle of beneficence The obligation to promote the good of the patient is basic. Attempting to extend life usually promotes the good of the patient. However, the patient's life may, for example, be full of pain and suffering and the patient may prefer to forego the treatment even though it means an earlier death. The obligation to promote the patient's good involves identifyi ng the possible benefits from the patient's perspective. If the patient or surrogate judges that continuing to provide a treatment offers inadequate benefits, it should be stopped. d. The principle of justice as fairness Considerations of procedural justic e or fairness require that decisions about withholding and withdrawing treatment should involve shared decision -making by patients/surrogates and providers. The magnitude of such decisions requires that they should reflect the ideals of due process for decision-making including appropriate respect for all parties involved in the decision, open and sustained dialogue, careful consideration of all options, appropriate consultation and/or review, mechanisms for addressing differences of opinion, and the like.

e. The principle of equity (distributive justice) Serious problems regarding the just distribution of health care resources exist in the United States. The lack of guidance and support for withholding and withdrawing of inappropriate life sustaining trea tments, for example, may contribute to the unjust distribution of these resources.

LESSON LEARNED: Every patient has the right to be treated. They have the right to be respected. The rights of the patients are an important part of respecting and car ing for them as a whole person. As a nurse we should be committed in relating to the patient in a way that we respect their role in making decisions about their care. We should provide care in a manner that is sensitive to cultural, r acial, religious and other differences. In providing care, we should not discriminate on the basis of race, color, religion, age, sex, sexual preference, national origin, disability or source of payment. We should respond to their reasonable requests for treatment and to their health care needs.


Annas, George J.( 2003). The Rights of Patients . 3rd edition. Carbondale: Southern Illinois Univ. Press.

Burnard, Philip & Chapman, Christine M. (2004 ). Professional and Ethical Issues in rd Nursing.”Consent to Care” .3 Edition.United Kingdom. Baillière Tindall.pages 51 -53. Kozier, Barbara. (2007). Concepts and Issues in Nursing Practice . “Professional Accountability and Advocacy”. 2 nd Edition.USA. Pearson Education .pages 145-146.

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