ethical decision making Flashcards
Define ethics; give an example of a code
what does a code of ethics recognize
- ethics is a branch of philospophy that deals with thinking about morality, moral problems, and moral judgments; American Dental Hygienists Association Code of Ethics
- professional and clients; professional and professional; professional and society
define accountability
how to maintain it between: self (4), client (4), profession (3), employment situation (2), society (2)
- the ability to answer for ones actions
- Self: report any conduct that endangers patients, seek lifelong learning opportunities, make judgements and evaluate based on evidence, maintain current licensure and CE
Client: provide clients with thorough and accurate info, ensure client safety and well being, encourage respectful communication, be knowledgeable of state and federal laws
Profession: maintain ethical standards, encourage colleagues to do the same, report colleagues with unethical behavior
Employment: remain current on state rules and regulations, follow the employment setting policy and procedures
Society: maintain ethical conduct in the care of all clients in all settings, integrate sensitivity to diversity and cultural competency in pt care
FUNDAMENTAL ETHICAL PRINCIPLES OF HEALTHCARE: define the following
autonomy, beneficence, nonmaleficence, justice, veracity, fidelity, societal trust, confidentiality
autonomy: individual right to self determination; involving client in decision making and obtaining informed consent
beneficence: benefit, or promoting good; taking only necessary rads, maintaining equipment, volunteering
nonmaleficence: above all, do no harm
justice: fairness and equality
veracity: truth telling or integrity
fidelity: obligation to keep implied or explicit promises
societal trust: value pts trust and understand that public trust in our profession is based on our actions and behavior
confidentiality: we respect the confidentiality of pt info (HIPPA)
ADHA code of ethics: assists _______ in achieving high levels of _______, decision making, and practice
the code contains categories of ________________
- The ADHA Code of Ethics assists
dental hygienists in achieving
high levels of ethical consciousness, decision making, and practice - the Code contains categories of Standards of Professional Responsibilities
4 specific objectives of the code of ethics
- to increase our professional and ethical consciousness and sense of ethical responsibility.
- to lead us to recognize ethical issues and choices and to guide us in making more informed ethical decisions.
- to establish a standard for professional judgment and conduct.
- to provide a statement of the ethical behavior the public can expect from us
what 7 basic beliefs guide our practice and provide context for our ethics
- The services we provide contribute to the health and well-being of society.
- Our education and licensure qualify us to serve the public by preventing and treating oral disease and helping individuals achieve and maintain optimal health.
- Individuals have intrinsic worth, are responsible for their own health, and are entitled to
make choices regarding their health. - Dental hygiene care is an essential component of overall health care and we function interdependently with other health care providers.
- All people should have access to health care, including oral health care.
- We are individually responsible for our actions and the quality of care we provide.
- We are obliged to be inclusive, diverse and to promote equity for access to our services and career opportunities.
list and define the 5 fundamental principles
Universality: if one individual judges an action to be right or wrong
in a given situation, other people considering the same action in the same situation would make the same judgment.
Complementarity: recognizes the existence of an obligation to justice and basic human rights. In all relationships, it requires considering the values and perspectives of others before making decisions or taking actions affecting them.
Ethics: the general standards of right and wrong that guide behavior within society. As generally accepted actions, they can be judged by determining the extent to which they promote good and minimize harm. Ethics compel us to engage in health promotion/disease
prevention activities
Community: expresses our concern for the bond between individuals, the community, and society in general. It leads us to preserve natural resources and inspires us to show concern for the global environment.
Responsibility: central to our ethics; there are guidelines for making ethical choices and accept responsibility for knowing and applying them. We accept the
consequences of our actions or the failure to act and are willing to make ethical choices and
publicly affirm them.
what are the 7 core values
Individual autonomy and respect for human beings: treat ppl with respect, give informed consent prior to treatment, give full disclosure with relevant info for them to make informed decisions
Confidentiality: respect the confidentiality of pt info, our obligation to justify any violation of confidence
Societal Trust: value client trust and understand that public trust in our profession is based on our actions
and behavior.
Non-maleficence: provide services in a manner that protects all clients
and minimizes harm to them
Beneficence: promoting the well-being of individuals and the public by engaging in health promotion/disease prevention activities.
Justice and Fairness: fair and equitable distribution of health care resources; all people should have access to high-quality, affordable oral healthcare.
Veracity: our obligation to tell the truth and expect that others will do the same. We value self-knowledge and seek truth and honesty in all relationships
what is an ethical dilemma
a situation in which two ethical principles are in conflict, regardless of the decision, one will be violated
areas in which ethical dilemmas occur:
public health:
administration:
research:
DH-DDS-client relationships:
DH-DH relationships:
employer-employee relationship:
– Public health hygienists: Allocating limited resources and maximizing benefits for a large population
– Administration: Maintaining balance between client and employee (or student clinician in educational settings) needs and rights
– Research: Surveys, compiling data, evaluating products or drugs
(bias, falsifying data, misuse of funds)
– Dental hygienist–dentist-client relationships: Disagreements about
oral care (most difficult & common)
– Dental hygienist–dental hygienist relationships: Colleagues
compromising client care
– Employer-employee relationships: Misuse of power or corruption
what is the ethical decision making framework (7 steps)
define the problem/conflict by ones sense of professionalism/moral code
identify ethical issues
gather info including all relevant subjective and objective info including research
identify ethical alternatives and their implications
establish an ethical position which may just be the least negative
select, justify, and defend alternatives after reviewing to make sure decisions are supported and consider the client, DDS, DH, and coworkers
act on the ethical choice (implement the alternative)
EX of ethical conflict:
– Client refuses to be premedicated with an antibiotic before an
appointment
– If the dental hygienist honors the client’s request, the ethical principle of autonomy is followed
– Ethically, the dental hygienist who treats a client without appropriate premedication would potentially harm the client, violating the ethical principles of nonmaleficence.
EEK!
Jurisprudence: ________
– Oral health professionals are governed by _______ laws enacted by legislators, ________ laws (regulations) disseminated by regulatory boards, and
_______ law or ____ law determined by judicial decisions in court cases.
– A dental hygienist must be aware of the rules and regulations governing the practice of dental hygiene in the _______ where licensing is maintained.
jurisprudence: Oral Health
Professionals at Risk
– Oral health professionals are governed by statutory laws enacted by legislators, administrative laws (regulations) disseminated by regulatory boards, and common law or case law determined by judicial decisions in court cases.
– A dental hygienist must be aware of the rules and regulations governing the practice of dental hygiene in the jurisdiction where licensing is maintained.
what is the difference between civil and criminal law
Civil law: offenses for violating private or contractual rights; a breach of legal duty against a person; requires less strict level of proof, called a preponderance of evidence
Criminal law: established for preventing harm against society and describes a criminal act as well as the appropriate punishment; level of proof required is that beyond a reasonable doubt
what 6 governing bodies affect the practice of DH
- federal laws
- state or provincial statues
- regulatory boards
- state/provincial public health and safety codes
- case law from medical and dental malpractice lawsuits
- local/regional laws and codes
– Each governing body affects the ____ of dental hygiene
– The professional is presumed to be ______ of all the rules and regulations influencing practice and can’t claim ______ of the law
– ________ for violations exist, and a practitioner who violates a particular rule may be judged under _______ governing bodies
– Each governing body affects the practice of dental hygiene
– The professional is presumed to be aware of all the rules and regulations influencing practice and can’t claim ignorance of the law
– Sanctions for violations exist, and a practitioner who violates a particular rule may be judged under multiple governing bodies
legal vulnerability in dental practice can be ____ or ____
civil can be _____ or _______
tort can be _______ or _______
if tort is unintentional, that is ______
if tort is intentional what 4 laws could be broken
legal vulnerability in dental practice can be criminal or civil
civil can be contract or tort
tort can be intentional or unintentional
if tort is unintentional, that is negligence (professional or malpractice)
if tort is intentional what 4 laws could be broken: assault and battery, misrepresentation/deceit, defamation/slander, breach of confidentiality
malpractice lawsuits are ____ in nature
civil
BREACH OF CONTRACT
– Failure to perform a ____
A legal definition states that a contract is:
– Agreement between ___ or more ______ and _______ parties
– To do or not to do a ____ ____ for which there is sufficient consideration
– Consideration is an exchange of something of _____, such as money, between two people
– Failure to perform a promise
A legal definition states that a contract is:
– Agreement between two or more consenting and competent parties
– To do or not to do a legal act for which there is sufficient consideration
– Consideration is an exchange of something of value, such as money, between two people
define:
implied contract
express contract
duty
Implied contract: no written document of the agreement, a contractual relationship just exists
Express contract: One in which the terms are expressed and includes either a verbal or a written agreement
Duty: Obligatory conduct or service, or conducting oneself in a particular manner
what are the client contractual duties (4)
if a breach in a contract occurs, what can the client do
Cooperating in care, providing accurate information, paying fees, and keeping appointments
client can use the contract
concept to remedy the situation and obtain damages
what are the contractual duties of the oral healthcare provider (18)
Be licensed and registered legally
Use reasonable care in providing services
Never exceed scope of practice
Not use experimental procedures or medications
Complete care in a reasonable time
Never abruptly stop care
Obtain informed consent
Arrange for care when absent or in emergencies
Make referrals and request consultations when necessary
Maintain privacy and confidentiality
Maintain up-to-date knowledge in field
Inform clients of treatment progress
Inform client of unanticipated occurrences
Keep accurate records
Comply with all laws
Practice within code of ethics
Charge a reasonable fee based on community standards
Never attempt a procedure for which practitioner is unqualified
the relationship between a professional and client may end without charges of abandonment IF the following conditions are met: (6)
- both parties agree to end it
- death of the client or DH occurs
- the client ends the relationship by act or statement
- the client is cured/treatment is complete, as with a specialist
- the practitioner unilaterally decides to terminate care
- the client refuses necessary oral radiographs or premed for preventing infective endocarditis
if the PRACTITIONER seeks to terminate care, what steps must be taken? (6)
The law states that a practitioner may refuse to treat an individual for any reason except for: (5)
notify the client by WRITTEN communication; include reason for termination; state termination date and emergency care procedure; suggest the client seek another DH; offer to provide copies of the client record; send the letter by certified or registered mail
race, creed, color, national origin, or a certain condition, such as a disability
does the DH rely on the dentist for DH care
NO, Dental hygienists are accountable for dental hygiene care and do not rely on others to assume this responsibility.
what is a tort
intentional tort:
unintentional tort:
negligence:
> what 4 things must occur
tort: interference with another persons right to enjoy person, property, or privacy
intentional tort: committed with intent on the part of the person
unintentional tort: not intended by the person accused of committing tort
> Negligence: failure of one owing a duty to another to do what a reasonable and prudent person would ordinarily have done under the circumstances (falls under unintentional tort)
A duty or standard exists; a breach or failure to exercise necessary care occurs; a harm results; and the harm is directly caused by the breach of duty
STANDARD OF CARE
– Degree of ____ a reasonably prudent professional would exercise under the _____ or ______ circumstances
– Is determined by members of the ______, not the ______
– Failure to meet standard of care can include:
– An act of _______ (not doing something)
– An act of ________ (performing act inappropriately)
– Although the ______ is ultimately responsible for the actions of the dental hygienist, the dental hygienist still may be found _______ in a court of law if a required duty is not met
– Degree of CARE a reasonably prudent professional would exercise under the same or similar
circumstances
– Is determined by members of the profession, not the courts
– Failure to meet standard of care can include:
– An act of omission (not doing something)
– An act of commission (performing act inappropriately)
– Although the dentist is ultimately responsible for the actions of the dental hygienist, the dental hygienist still may be found negligent in a court of law if a required duty is not met
INFORMED CONSENT
– Informed consent is a person’s _____ to allow something to happen based on full ______ of facts required to make an intelligent decision
– Consent is the individual’s right to __________
– Patient must be informed of _______
– what is a material risk
– The _____ has the final say in his or her care, the client must be of _____ mind when giving consent, and the consent must be ______ to be valid
– Informed consent is a person’s agreement to allow something to happen based on full disclosure of facts required to make an intelligent decision
– Consent is the individual’s right to self-determination
– Patient must be informed of material risk
– A material risk is one that a “reasonable person” would consider in determining whether to proceed with the proposed treatment
– The client has the final say in his or her care, the client must be of sound mind when giving consent, and the consent must be informed to be valid
INFORMED CONSENT
what 8 things must be included in the informed consent
- diagnosis of the condition
- recommended procedure
- nature and reasons for procedure
- benefits AND material risks of procedure
- prognosis if procedure is preformed or not performed
- alternative procedures
- risks and benefits to alternatives
- potential consequences if not completed
INFORMED CONSENT
– In lawsuits that focus on informed consent, clients often claim: (2)
– DH should explain any ______ terms and make sure that the client ______ the information
– Consent must be obtained for minors from _________
– It is suggested that the office policy be developed so that informed consent is obtained in a _______ manner from all clients
– In lawsuits that focus on informed consent, clients claim: a lack of understanding of the risks involved, and that alternatives to treatment were not presented
– DH should explain any technical terms and make sure that the client comprehends the information
– Consent must be obtained for minors from parents or guardians
– It is suggested that office policy be developed so that informed consent is obtained in a consistent manner from all clients
INFORMED REFUSAL
Risk of a lawsuit occurs when
the client ________ to follow the
advice of the treating dentist or
dental hygienist when the patient has injury or consequences as a
result of ________
Always inform the client of: (3)
There must be discussion about
the refusal and the _____, as well as an opportunity to discuss the _______
Risk of a lawsuit occurs when
the client refuses to follow the
advice of the treating dentist or
dental hygienist; if patient has
injury or consequences as a
result of refusing the treatment
Always inform the client of
recommendation, reasons for
recommendation, possible
consequences of refusal=
informed refusal
There must be discussion about
the refusal and the effects, as
well as an opportunity to
discuss the recommendation
the informed refusal should include: (4)
if the client refuses to sign the informed refusal, this should be _____ and the form signed by the _____ and the _______
a copy of the form should be given to the _____ and another copy kept in their _____
recommendation, list of consequences of refusal, documentation that the client understood the risk of refusal, and the date and signature of the dentist, client, and witness
if the client refuses to sign the informed refusal, this should be noted and the form signed by the provider and the witness
a copy of the form should be given to the client and another copy kept in the chart
STATUTE OF LIMITATIONS
– Length of time an ______ person has to enter ______ against another for an alleged injury
– Starts either at the _________ occurs or at the __________ or reasonably should have discovered the injury
– Ability to ___ when an injury is discovered _____ the length of time in which someone can file a lawsuit
– Practitioners must be aware of the __________ and rules within their state to assist in planning for record keeping and record storage
– Length of time an aggrieved person has to enter lawsuits against another for an alleged injury
– Starts either at the time an injury occurs or at the time the plaintiff discovers the injury or reasonably should have discovered the injury
– Ability to sue when an injury is discovered expands the length of time in which someone can file a lawsuit
– Practitioners must be aware of the statute of limitations and rules within their state to assist in planning for record keeping and record storage
VA statute of limitations (yrs in jail)
assault and battery
contract in writing
contract w/o writing
false imprisonment
fraud
legal malpractice
libel
medical malpractice
personal injury
product liability
property damage
slander
trespassing
wrongful death
2yrs
5yrs
3yrs
2yrs
2yrs
2-5yrs
1yr
2yrs
2yrs
2yrs
5yrs
1yr
5yrs
2yrs
DH and client relationship
define confidentiality
- maintain confidentiality in all _____
- a person can waive confidentiality through _____ or _____
- information about a clients care is not to be shared without a clients permission
- maintain confidentiality in all settings
- a person can waive confidentiality through words or actions
how can confidentiality be waived? (2)
- referral to a specialist
- by action of law, such as a requirement to report specific communicable diseases or the suspicion of child abuse to the state or provincial agency
define defamation
define libel
define slander
– If an individual’s _____ is not harmed by the defamatory comment, there is no ___ or ____
– In certain defamation cases, _____ (intent to inflict an injury) must be shown
a communication that injures an individual’s reputation; must be FALSE
written defamation
verbal defamation
– If an individual’s reputation is not harmed by the defamatory
comment, there is no libel or slander
– In certain defamation cases, malice (intent to inflict an
injury) must be shown
DH AND DENTIST RELATIONSHIP
– Individual is protected against unlawful _________ in employment; Includes discrimination based on: (3)
– Americans with Disabilities Act (ADA): If an individual satisfies the position requirements, the employer is required to provide reasonable accommodations such as modifying: (4)
– Equal ___ Act
– _____ harassment
– Termination of employment: “__ ___” : termination for little or no ___
– Individual is protected against unlawful discrimination in employment; Includes discrimination based on pregnancy, childbirth and related medical conditions
– Americans with Disabilities Act (ADA): If an individual satisfies the position requirements, the employer is required to provide reasonable accommodations such as modifying equipment, facilities, schedules, or job routine
– Equal Pay Act
– Sexual harassment
– Termination of employment: “At will” : termination for little or no reason
SEXUAL HARASSMENT
sexual harassment is sexual _______ because it forces a person to work under ____ ______ ______
what is quid pro quo
what is hostile environment
– Sexual discrimination because it forces a person to work under adverse employment conditions
– Quid pro quo: involves a superior-subordinate relationship in which the offender has control
over the working conditions of the victim
– Hostile environment includes unwelcome, demeaning verbal or physical conduct of a sexual
nature that creates a hostile, intimidating, or offensive work environment
what are the steps to take when facing sexual harassment (6)
- directly inform the harasser that the conduct in unwelcome and to stop
- review office policies and protocols
- notify a supervisor or superior
- talk to co workers to determine if it has happened before
- inform: if refusal of advances may affect the job, inform a coowner of the practice or other supervisory pannel
- document precisely the content, date, time, and witnesses
what can an employer not ask you about during an interview (11)
- maiden name /birth name
- birth place
- religion
- color of skin
- disability status
- photograph
- height/weight
- marital status/children
- arrest record
- national origin/ancestry/descent
- society/club memberships or affiliations
Between the employer and the employee, the DH rarely has a ________. The lack of _______ may leave the DH in a risky situation.
the __ should assist an employer with developing a ____
in most jurisdictions the DH works as an employee of the _______
Independent contractors (2)
Between the employer and the employee, the DH rarely has a written employment contract. The lack of a written agreement may leave the DH in a risky situation.
the DH should assist an employer with developing a contract
in most jurisdictions the DH works as an employee of the dentist
Independent contractors: increased liability and total responsibility for income and social security taxes
a _______ program is recommended to identify risks in the ____________
a risk management program is recommended to identify risks in the delivery of oral care
how can communication be a risk managment tool (3)
- open communication between the DH and client minimizes misunderstandings
- educate employers about potential liabilities for DH and their prevention
- best resources for the development of a risk managment philosophy are the personnel within the employment setting
what should the client record include? (7)
*this is the providers best defense or worst enemy in a malpractice action
-health and dental status at the time of initial exam
- treatment provided
- legal documentation for corpse identification or insurance claims or fraud
- legal documentation for defense of litigious claims
- record required as part of state regulatory practice
- tool for quality assessment and assurance
- communication tool among health professionals for the clients care
what is a dependent practitioner
dependent as a result of the licensing and regulation laws of the state; however, the individual is not dependent on the employer to assume legal responsibility for his or her own actions
a DH may be charged with _____ if a breach of duty occurs and ____ results
EX: not assessing a clients BP, not performing and recording a perio assessment
a DH may be charged with negligence if a breach of duty occurs and harm results
what is an independent practitioner
– Also is an ____ and is responsible for knowledge of labor and employment laws, _____ issues, tax laws, and related business obligations
– Protecting ________, as well as keeping personal and professional ______ separate, is essential
a DH is responsible for all the legal principles that influence client care
– Also is an employer and is responsible for knowledge of labor
and employment laws, discrimination issues, tax laws, and
related business obligations
– Protecting personal assets, as well as keeping personal and
professional expenses separate, is essential
legal issues with an independent contractor:
– The _________ is contracting to provide services:
– Dental hygienist assumes that the contracting party will pay a
____ and provide certain facilities and support staff
– Must approach practice with a strong __________ philosophy
– During the interview process, should evaluate the employer in terms of potentially _____ activities, ________ philosophies, _____ control, and _____ keeping, to name a few considerations
– Requires careful scrutiny of ___ laws and definitions of the _______ ___________ ______
– The dental hygienist is contracting to provide services:
– Dental hygienist assumes that the contracting party will pay a
salary and provide certain facilities and support staff
– Must approach practice with a strong risk management
philosophy
– During the interview process, should evaluate the employer in terms of potentially negligent activities, referral philosophies, infection control, and record keeping, to name a few considerations
– Requires careful scrutiny of tax laws and definitions of the independent contracting status
legal issues with the EDUCATOR:
- Contract with both ______ and _____
- _______ is one aspect of the relationships developed in an educational setting
- _______ may also be an issue
- the educator who serves as a clinical _______ must recognize that the legal principles apply to clinical _______
- may be involved in supervision of clerical and clinical staff or work with administrators
- Contract with both colleagues and students
- confidentiality is one aspect of the relationships developed in an educational setting
- discrimination may also be an issue
- the educator who serves as a clinical instructor must recognize that the legal principles apply to clinical education
- may be involved in supervision of clerical and clinical staff or work with administrators
Administrator or Manager: Legal
Issues
- Involved in _____, _____, and possibly _______ students,
colleagues, or employees - All parties involved require a clear understanding of the ___ and
______ delineated in the contract - May be responsible for ensuring the ____ of an employee from
wrongful acts of another - ____ laws and related legal concepts may dictate what
_______ is important and also appropriate
- Involved in hiring, evaluating, and possibly dismissing students,
colleagues, or employees - All parties involved require a clear understanding of the rights and
responsibilities delineated in the contract - May be responsible for ensuring the safety of an employee from
wrongful acts of another - Labor laws and related legal concepts may dictate what
documentation is important and also appropriate
Consumer Advocate: Legal Issues
– The consumer rights advocate should be aware of legislation on: (5)
– Focus on areas that best meet personal needs and the needs of the population group(s) they represent
– The consumer rights advocate should be aware of legislation on legal issues, civil rights, healthcare, labor issues in employment of the disabled, geriatrics, and issues regarding children and adolescents
– Focus on areas that best meet personal needs and the needs of the population group(s) they represent
legal issues for a researcher
– Be familiar with issues such as _________, ________, rights of human and ______ subjects, informed consent, record keeping, data management, and abandonment
– Must also consider legal issue such as product liability, fund management, and tax issues
– Be familiar with issues such as institutional review boards, confidentiality, rights of human and animal subjects, informed consent, record keeping, data management, and abandonment
– Must also consider legal issue such as product liability, fund management, and tax issues
