Domain 5 - Ethical, Legal, and Practice Standards Flashcards
Ethics
A universally accepted set of rules of behavior based on ideas of what is considered right and wrong that are adopted by a group of people
What are the 7 Ethical Principles for Case Managers?
- Autonomy: independence or freedom, as of the will or one’s actions
- Privacy/Confidentiality
- Veracity: truthfulness
- Beneficence: doing things to benefit others (duty to do good)
- Nonmaleficence: refraining from doing things that could harm others (avoid harm)
- Justice: fair treatment
- Fidelity: honor commitments
What is the difference between nonmaleficence and beneficence?
Beneficence means performing a deed that benefits someone, while nonmaleficence means refraining from doing something that harms or injures someone.
Feeding people at a soup kitchen is an example of beneficence. Preventing a patient from taking a harmful medication is an example of nonmaleficence.
What is the Ethical Decision-Making Model used for?
To help resolve ethical dilemmas. The model should be used to make sure you are informed of all the sides to the issue and you do not allow any personal feelings or biases to become involved.
Emergency Medical Treatment and Labor Act (EMTALA) (1986)
States that any person who presents themselves at an emergency department in need of treatment MUST be treated regardless of their ability to pay, hospitals cannot turn anyone away if they need treatment, and they must stabilize any person before they can be transferred to another facility
EMTALA
Emergency Medical Treatment and Labor Act (EMTALA) (1986)
HIPAA
Health Insurance Portability and Accountability Act (HIPAA)
PHI
Protected Health Information
Health Insurance Portability and Accountability Act (HIPAA)
HIPAA covers how medical information is used and disclosed. This information is
called protected health information (PHI).
Protects an individual’s personal and health information and it also covers the rights an individual has for obtaining access to their medical (or their children’s) information and for making corrections to that information.
HIPPA Privacy Rule
Limits use of individually identifiable personal health information
HIPPA Security Rule
Established national standards for securing client data that is stored or transferred electronically
There are exceptions to HIPPA where there is no authorization required, which includes:
- Public health
- Abuse, Neglect, domestic violence
- Court order signed by a judge
- Response to a HIPAA Investigation Subpoena (different from a state lawsuit subpoena)
The Patient Protection and Affordable Care Act of 2010 (PPACA) (also referred to as ACA), ensures:
Ensures that clients:
-Have autonomy, and can make their healthcare decisions without interference
-Are provided with the ability to give informed consent
-Receive respectful care and treatment
-Are able to complain about deviations from established care standards without fear of reprisal
Social Security Act
- Enacted in 1935 – provided benefits for the aged, blind, dependent, and crippled children, maternal/child health, and old-age benefits.
- Amendments to the act in 1965 gave us legislation in which the most important provisions resulted in creation of Medicare and Medicaid
Title XVIII
Title XVIII – Medicare
* Medical care for those over 65 and disabled persons entitled to Social Security benefits
Title XVIX
Title XVIX – Medicaid
* Provided for health care for the indigent and other designated groups
* Jointly funded by federal and state governments
* Criteria vary from state to state
Occupational Safety and Health Act 1970 (OSHA) primary goal is:
- Reduce workplace hazards
- Implement safety and health programs for employers and employees
Occupational Safety and Health Act 1970 (OSHA) Employee Rights
- Obtain clear information about workplace hazards
- Review documentation on work-related injuries and illnesses
- Make confidential complaint
- Freedom from retaliation for complaints or inquiries
Definition of Case Management
Case Management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote patient safety, quality of care, and cost-effective outcomes.
Patient Self-Determination Act 1990 (PSDA)
- Amendment to titles XVIII and XIX of the Social Security Act
- Requires hospitals, skilled nursing facilities, home health agencies, hospice programs, and health maintenance organizations (HMOs) to:
-Inform clients of their rights under State law to make decisions concerning their medical care
-Periodically inquire as to whether a client executed and advanced directive and document the client’s wishes regarding their medical care
-Not discriminate against persons who have executed an advance directive
-Ensure that legally valid advance directives and documented medical care wishes are implemented to the extent permitted by State law
-Provide educational programs for staff, clients, and the community on ethical issues concerning client self-determination and advance directives
What is the difference between Self-Determination and Autonomy?
- Autonomy – freedom from external control or influence; personal liberty
-Can refuse or terminate care - Self-determination – the process by which one controls their own life and make treatment decisions including:
-Designate healthcare proxy
-Establish advance directives
-Refuse or discontinue care, life support, nutritional support
Informed Consent
A person’s agreement to allow something to happen, made with full knowledge of the risks involved and the alternatives.
Advance Directive
A written statement of a person’s wishes regarding medical treatment, often including a living will, made to ensure those wishes are carried out should the person be unable to communicate them to a doctor
Living Will
Health care declaration of what the individual wants, or does not want done, medically if they become too ill or injured to direct care
