CH.5 Ethical and Legal Implications of Practice

Question 1

The force behind Civil Law

Answer 1

–state statues regulate individual conducts
–state statutes and professional boards regulate the practice of therapists and set minimum standards for competent practice as well as requirements for continuing education
–the common law of civil liability for negligent and intentional acts imposes a duty to pay compensation to individuals who are injured

Question 2

The Distinction

Answer 2

–Punishment for ethical misconduct ranges from a loss of professional standing to expulsion from the profession or professional societies
–Punishment by the state board in one state will usually result in reciprocal discipline in any other state where a practitioner holds a license to practice
–if there is patient injury, may also have legal consequences, in the form of criminal penalties or civil judgments
–an illegal act violates the standards of conduct set down for all citizens
–ethical misconduct usually relates to violations of professional and ethical norms established by the profession as a whole

Question 3

Philosophical Foundations of Ethics

Answer 3

–Philosophy: the love of wisdom and the pursuit of knowledge concerning humankind, nature, and reality
–Ethics: one of the disciplines of philosophy which is primarily concerned with the question of how we should act
–” Respect the humanity in persons”

Question 4

Early Ethical Dilemmas

Answer 4

–RTs faces ethical dilemmas and legal issues associated with patient expectations. staffing, and quality of care

Question 5

Ethical Dilemmas now

Answer 5

–the rationing of care, dealing with conflicts associated with third party, imposed standards of care, and delivery of the appropriate standard of care in the face of cost constraints and corporate influence. Staffing issues continue to be a problem and contribute to many of the ethical and legal concerns.

Question 6

Code of Ethics

Answer 6

–Essential part of any profession claiming to be self-regulating
–AARC Statement of Ethics and Professional Conduct: this code seeks to establish parameters of behavior for members of profession
–Moral obligations impose ethical duties on therapists: tools of cross -examination cited in legal proceedings

Question 7

Ethical Theories and Principles

Answer 7

–Provides the foundations for all ethical behavior
–Two components: a professional duty and a patient right

Question 8

Autonomy

Answer 8

–principle acknowledges patients’ personal liberty and their right to decide their own course of treatment
–Basis for “ informed consent”
–Under this principle, the use by an RT of deception or coercion to get a patient to give is unethical

Question 9

Veracity

Answer 9

–principle binds health care provider and patient to be truthful
–requires that the health care provider tell the consenting individual the whole truth about the choices inherent in medical care
–problems with veracity center around issues with benevolent deception (withholding truth from patient for his or her own good)
–in most cases, telling truth is best policy

Question 10

Non-maleficence

Answer 10

–Requires health care providers to avoid harming patient
–It is sometimes difficult to uphold this principle in modern medicine
–Drugs and procedures have secondary effects that may be perceived as harmful
–Procedures carry risks of side-effects and complications
–not all can be predicted

Question 11

Beneficence

Answer 11

–raises “do-no-harm” requirement to higher level
–requires health care workers to contribute to health and well-being of their patients
–dilemmas in this domain have led to development of “advanced directives”

Question 12

Confidentiality

Answer 12

–requires health care workers to respect patient’s right to privacy
–qualified rather than absolute ethical principle
–in certain situations, health care workers are permitted to share patient’s medical history with others
–risks of inadvertent disclosure of patient’s *protected health information (PHI) *has increased exponentially with advent of social media

Question 13

Justice

Answer 13

– involves fair distribution of care
–balance must be found between health care expenses and ability to pay
–Distributive Justice: rationing of health care services
–Compensatory justice: calls for recovery of damages incurred from medical malpractice
–costs represent little, if any, impact on cost of health care services

Question 14

Role Duty

Answer 14

–practitioners must understand limits of role and practice with fidelity
–RT must not perform duties outside defined role

Question 15

Formalism

Answer 15

–the viewpoint relies on rules and principles
–Rules function apart from consequences of a particular act
–Act: justifiable if it upholds applied rules or principles

Question 16

Consequentialism

Answer 16

–the viewpoint in which decisions are based on the assessment of consequences
–Act: judged to be right or wrong based on consequences
–commonly uses principle of utility, aims to promote greatest general good

Question 17

Virtue Ethics

Answer 17

–the viewpoint that asks what a virtuous person would do in a similar circumstance
–allows established practices of profession to give guidance
–Ask, “How should I carry out my life if I am to live well?”
–calls for behavior based on what “good practitioners” would do in similar circumstances

Question 18

Intuitionism

Answer 18

–when intuition is involved in the decision making process
–ethical viewpoint holds there are certain self-evident truths, usually based on moral maxims
–“Treat others fairly”
– when decision making tool is unhelpful in certain situations, it will depend on intuitional abilities of any specific caregiver

Question 19

Mixed Approaches

Answer 19

–Tries to take advantage of the strengths of two major lines of ethical thought
–Rule utilitarianism approach: variation of consequentialism
–concerned with which “rule” would promote greatest good, instead of which “act”
–differences in values, educational levels
–risk of inconsistent ethical decision making
–Disadvantage: variability between caregivers

Question 20

Virtue Ethics

Answer 20

–is founded not in rules or consequences but in personal attributes of character or virtue
–The first question is not, “How do I act in this situation?” but rather, “ How should I carry out my life if I am to live well?” or “How would the good RT act?”

Question 21

Legal Issues Affecting Respiratory Care

Answer 21

–when errors in practice cause patient injury or death, the possibility of professional liability results
–Health care organizations have adopted processes to lessen the risk of being sued- quality review processes
–professional liability may contribute to increasing health care costs
–most cases never go to court

Question 22

Public Law

Answer 22

–Criminal Law: deals with acts against welfare and safety of public
–Administrative Law: consists of regulations set by government agencies

Question 23

Civil Law

Answer 23

–protects citizens from others who might seek to take unfair advantage
–civil courts decide if plaintiff has been wronged and degree of reparation required

Question 24

Tort Law

Answer 24

–civil wrong committed against individual or property for which court provides remedy
–The basic functions of Tort: keep the peace between individuals, and replace vengeance between individuals with a settlement

Question 25

3 Basic forms of Torts

Answer 25

--Negligent torts: is failure to perform one's duties competently --Intentional torts: involves willful act violating another's interest --Torts in which liability regardless of fault (as in the case of manufacturers of defective products)

Question 26

Causation

Answer 26

--revolves around whether acts of negligence were cause, in fact, and legal cause of damages --Proximate Causation or Legal Causation: turns on foreseen ability; determines fairness to impose damages on defendant, tends to be retrospective analysis

Question 27

Damages

Answer 27

-- another factor in negligence law --Economic: awarded for economic loss --Noneconomic damages: pain, suffering, disability, disfigurement, and loss of enjoyment of life --Punitive Damages: awarded to punish wrongful conduct and determine future unlawful conduct

Question 28

*Elements of Negligence*

Answer 28

-- the practitioner owes a duty to the patient --the practitioner breaches that duty --the breach of duty was the cause of damages --damage or harm came to the patient

Question 29

3 Classifications of malpractice

Answer 29

--Criminal malpractice: assault and battery --Civil malpractice: negligence --Ethical malpractice: violations of professional ethics, possibly resulting in censure

Question 30

2 defenses against intentional torts

Answer 30

-- no intent to do harm --patient gave consent to action, knowing risks involved

Question 31

Helping Avoid Lawsuits

Answer 31

--be aware of and conform to all legal aspects of licensure and standards of care --institutional risk management processes should be an ongoing component of hospital operation and professional development --every therapist should have malpractice insurance --active risk management practices and appropriate guest relations policies two most effective tools in preventing malpractice litigation

Question 32

HIPAA

Answer 32

--Health Insurance Portability and Accountability Act: congressional act to establish standards for privacy of individually identifiable health information --Basic goals: strike a balance ----protecting individuals health information, and not impeding exchange of information needed to provide quality health care

Question 33

Medical Supervision

Answer 33

--RTs required by "scope of practice" to work under competent medical supervision --RT's employer, either physician or hospital, is liable for RT's actions --In some states, supervising physician may still be liable even if therapist is employed by hospital --Legal theory of "failure to supervise" --Respondeant superior

Question 34

Basic Elements of a Practice Act

Answer 34

--scope of professional practice --requirements and qualifications for licensure --exemptions --grounds for administrative action --creation of examination board and processes --penalties and sanctions for unauthorized practice

Question 35

Providing Emergency Care

Answer 35

--Rendering emergency medical care to injured person: unique area that allows practice without the direction of a competent physician --Good Samaritan Law: to encourage individuals to give needed emergency medical assistance

Question 36

Interaction of Ethics and Law

Answer 36

--growth of field into home care and DME --Corporate Compliance officer (CCO) ----oversees hospital's business practices and ensures conformity to law ----available to discuss legal or ethical issues arising in course of care

Question 37

Licensure Statute

Answer 37

-- all RTs should know in detail the requirements of their respiratory care practice act --purchase an insurance policy that covers professional discipline

Question 38

Understanding the Causes of discipline

Answer 38

--substance abuse --domestic violence --sexual abuse --gross incompetence --engaging counsel

Question 39

The Patient Protection and Affordable Care Act

Answer 39

--PPACA --passed by congress in 2010 --improved whistleblower protections for hospital workers

Question 40

National Labor Relations Act

Answer 40

--provides protection to hospital workers, even if they do not belong to a union --protects worker when he or she engages in an act that would benefit of all employees

Question 41

False Claims Act

Answer 41

--forbids making false claims against government --provides sever sanctions against violators, including monetary

Question 42

Health care and Change

Answer 42

--rapidly changing relating to how services are funded and how patients and health care workers interact --managed care affects the ethical decision making process --health care practitioners must consider not only the best services to deliver to patients but also the best managed care outcome