Ethico-moral and Legal

Foundations of Client
Education
Differentiated View of Ethics, Morality and Law

1. Natural law (basis)

2. Deontological (Golden Rule)
3. Teleological (greatest good for the greatest number)
Evolution of Ethical/Legal Principles in
Health Care
• Charitable Immunity
• Cardozo Decision of 1914
A. Informed consent
B. Right to self-determination
Cardozo Decision

A. Informed Consent: the right to full disclosure; the right to make

one’s own decisions
B. Right to self-determination: the right to protect one’s own body
and to determine how it shall be treated
Application of Ethical and Legal Principles to Patient
Education
1. Autonomy
2. Veracity
3.Confidentiality
4. Nonmalfeasance
• Negligence
• Malpractice
• Duty
5. Beneficence
6. Justice
1. Autonomy: the right of a client to self-determination

• Although health education per se is not an interpretive part of the

principle of autonomy, it certainly lends credence to the ethical
notion of assisting the public to attain greater autonomy when it
comes to matters of health promotion and high-level wellness.

• The use of patient decision aids such as printed materials, videos,

and interactive web-based tutorials are designed to assist patients in
making informed treatment choices.
2. Veracity: truth telling; the honesty by a professional in providing full
disclosure to a client of the risks and benefits of any invasive medical
procedure.
• Professional radiologic technologists who are recognized for their
skill or expertise in a specific area may be called on to testify in court
on behalf of either the plaintiff or the defendant. Regardless of the
situation, the RT must always tell the truth and the patient is always
entitled to the truth.
3. Confidentiality: a binding social contract or covenant to protect
another’s privacy; a professional obligation to respect privileged
information between health professional and client.

• Only under special circumstances may secrecy be ethically broken

such as when a patient has been a victim or subject of a crime to
which the health care provider is a witness.

• Other exceptions to confidentiality occur when health care

providers suspect or are aware of child or elder abuse, narcotic use,
legally reportable communicable diseases, gunshot or knife wounds,
or the threat of violence toward someone.
4. Nonmalfeasance: the principle of doing no harm

A. Negligence: the doing or non-doing of an act, pursuant to a duty, that

a reasonable person in the same circumstances would or would not
do, with these actions or nonactions leading to injury of another
person or his/her property.

B. Malpractice: refers to a limited class of negligent activities that fall

within the scope of performance by those pursuing a particular
profession involving highly skilled and technical services.
 Common causes for malpractice claims:
1.Failure to follow standards of care
2.Failure to use equipment in a responsible manner
3.Failure to communicate
4.Failure to document
5.Failure to assess and monitor
6.Failure to act as patient advocate
7.Failure to advocate tasks properly

C. Duty: a standard of behavior; a behavioral expectation

relevant to one’s personal or professional status in life.
 Definition of Ethical Principles (cont’d)
5. Beneficence: The principle of doing good; acting in the best interest
of a client through adherence to professional performance
standards and procedural protocols.
• Adherence to these various professional performance criteria and
principles, including adequate and current patient education,
speaks to the RT’s commitment to act in the best interest of the
patient.

6. Justice: Equal distribution of goods, services, benefits, and burdens

regardless of client diagnosis, culture, national origin, religious
orientation, sexual preference and the like.
• The patient regardless of age, gender, physical disability, sexual
orientation, or race has a right to proper instruction regarding self-
care activities.
 The Ethics of Education in Classroom and Practice Settings

• The potential blurring of professional-personal boundaries is of

ethical import inherent in student-teacher relationships.

• These criteria can be used to distinguish between interactions that

are appropriate in the context of educational process and those that
less appropriate or even frankly inappropriate:
1. Risk of harm to the student or to the student-teacher
relationship
2. Presence of coercion or exploitation
3. Potential benefit to the student or to the student-teacher
relationship
4. Balance of student’s interests and teacher’s interests
5. Presence of professional ideals.
Legality of Patient Education and
Information
1. Patients’ Bill of Rights spells out the patient’s right to adequate information

2. The Joint Commission puts as accreditation standards the patient’s rights

to education and information.

3. National Regulations and professional practice laws for nursing, medicine,

and other health professions
Documentation of Patient Education...
“…probably the most undocumented skilled service….”
(Casey, 1995)
Documentation is required by:
• The Joint Commission
• Third-Party Reimbursement: insurance companies,
Medicare and Medicaid programs, or “private pay”
• Respondeat Superior: The employer may be held liable
for the negligence or other unlawful acts of the
employee during the performance of his or her job-
related responsibilities.
Economic Factors of Patient Education:
Justice and Duty Revisited
Challenge for health care providers:
• efficient & cost-effective patient education
• legal responsibility of all health professionals
• little preparation on pre-licensure level