English Legal aspect & Legislation in Healthcare- Assignment 2
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LegalAspectHIM_5e_Ch05_PowerPoint.pptxLegal and Ethical Aspects of Health Information Management, 5th edition
Dana W. McWay, JD, RHIA
McWay, Legal and Ethical Aspects of Health Information Management 5th edition, © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Unit 2
An Overview of Ethics
McWay, Legal and Ethical Aspects of Health Information Management 5th edition, © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Chapter 5
Ethical Standards
McWay, Legal and Ethical Aspects of Health Information Management 5th edition, © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Introduction
Literacy in the field of ethics will impact
Decision making in everyday life
Navigation of complex dilemmas
Ethics is comprised of various
Models
Concepts
Theories
McWay, Legal and Ethical Aspects of Health Information Management 5th edition, © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
4
Ethical Models (1 of 4)
Definition of ethics
The formal study of moral choices that conform to standards of conduct
Listening to ones’ conscience
Making judgments between right and wrong
Sometimes confused with other areas of study
Morals
Values
Etiquette
Law
McWay, Legal and Ethical Aspects of Health Information Management 5th edition, © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
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Ethical Models (2 of 4)
Ethics is the formal study of moral choices
Basis is in philosophy
Morals
The principles of right conduct that individuals internalize
Based in religious belief and personal choice
Related to ethics
Ethics put moral principles into practice
Etiquette
The social code of customs and rituals
Based in society
McWay, Legal and Ethical Aspects of Health Information Management 5th edition, © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
6
Ethical Models (3 of 4)
Law
Body of rules with legal force
Choice is external: based in a controlling authority (legislature)
Law: minimum level of expectations for right and wrong
Ethical choice is internal: based in one’s conscience
Look to ethics when:
No obvious right or wrong
Enforcement of law does not bring justice
Right behavior brings wrong effect
Personal sacrifice is consequence for following ideals
McWay, Legal and Ethical Aspects of Health Information Management 5th edition, © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
7
Ethical Models (4 of 4)
Values
All four concepts—ethics, morals, etiquette, and law based on values
Concepts that give meaning to a person’s life
Based on societal norms, religion, and family orientation
Conflict may arise when values of different countries or groups differ
McWay, Legal and Ethical Aspects of Health Information Management 5th edition, © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
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Ethical Concepts (1 of 11)
Ethical concepts: abstract ideas are part of the values that form the basis for decisions
Multiple approaches to ethical reasoning
Autonomy
Beneficence/nonmaleficence
Best-interest standard
Fidelity
Justice
Rights
Veracity
McWay, Legal and Ethical Aspects of Health Information Management 5th edition, © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
9
Ethical Concepts (2 of 11)
Autonomy
Independence, self-determination, freedom
Three main elements
Ability to decide
Power to actualize or implement a decision
Respect for the autonomy of others
Concept of informed consent: Power rests with patient to make decisions about health
Dilemma: Balance between rights of individual and rights of others
McWay, Legal and Ethical Aspects of Health Information Management 5th edition, © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
10
Ethical Concepts (3 of 11)
Beneficence and Nonmaleficence
Two interlocking concepts
Beneficence: Qualities of kindness, mercy, and charity, duty to always do good
Nonmaleficence: Prohibition against doing harm, duty to prevent evil
Hippocratic oath
I swear . . . that . . . I will apply measures that benefit the sick . . . keep them from harm and injustice
McWay, Legal and Ethical Aspects of Health Information Management 5th edition, © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
11
Ethical Concepts (4 of 11)
Beneficence and Nonmaleficence (cont.)
Double-effect principle
Recognizes that ethical choices may result in untoward outcomes
Harm versus benefits analysis
Is the untoward outcome secondary or unintended?
Is that outcome outweighed by an intended positive outcome?
Example: If adverse drug reaction occurs as an unexpected outcome of administering a treatment
McWay, Legal and Ethical Aspects of Health Information Management 5th edition, © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
12
Ethical Concepts (5 of 11)
Best-Interest Standard
Determining what is in the best interest of a person when that person cannot decide for himself or herself
Patient cannot give consent
Incompetent due to age (a child), mental limitations (Alzheimer’s or retardation), or coma
Another decides whether there will be benefit or harm
May base decision on past evidence of person’s wishes (advanced directive, previous statements)
Legal application: famous cases
Quinlan, Cruzan, and Schiavo
McWay, Legal and Ethical Aspects of Health Information Management 5th edition, © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
13
Ethical Concepts (6 of 11)
Fidelity
Faithfulness, loyalty, and devotion to one’s obligations
Related to accountability
Working in health care requires providers to exercise fidelity to the role of caring for the patient
It is the physician’s duty to the patient to be the first one to inform him or her of the diagnosis
McWay, Legal and Ethical Aspects of Health Information Management 5th edition, © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
14
Ethical Concepts (7 of 11)
Justice
An obligation to be fair to all
Fairness, honesty, and impartiality
Requires that no one be favored over another
Does not require that each one be treated the same
What one considers fair may conflict with another’s opinion
McWay, Legal and Ethical Aspects of Health Information Management 5th edition, © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
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Ethical Concepts (8 of 11)
Justice (cont.)
Comparative justice
Group with greater need or interest may receive more resources than those with lesser need
Distributive justice
Fair distribution of burdens and benefits
Requires one in position of authority to provide service due to others
McWay, Legal and Ethical Aspects of Health Information Management 5th edition, © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
16
Ethical Concepts (9 of 11)
McWay, Legal and Ethical Aspects of Health Information Management 5th edition, © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Figure 5.2 Access and Distributive Justice
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Ethical Concepts (10 of 11)
Rights
A just claim or entitlement that others are obliged to respect
Rights may vary with the moral values of a culture
Patient rights
Right to confidentiality
Obligation of health care provider to maintain patient information in a manner that will not permit dissemination beyond the health care provider
Right to privacy
Right to be left alone or to control personal information
McWay, Legal and Ethical Aspects of Health Information Management 5th edition, © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
18
Ethical Concepts (11 of 11)
Veracity
Habitual truthfulness and honesty
One may argue that there are situations in which not telling the truth may be justified
Person not strong enough to handle or understand truth, too much anxiety or grief
Patients must truthfully inform health care provider of all relevant information
Health care provider must disclose facts to patient to enable patient to decide care
Medical research issues: use of placebos
McWay, Legal and Ethical Aspects of Health Information Management 5th edition, © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
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Ethical Theories (1 of 6)
Systematic statements or plans used to deal with ethical dilemmas
Theories enable consistent and coherent process when making ethical decisions
Utilitarianism
Deontology
McWay, Legal and Ethical Aspects of Health Information Management 5th edition, © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
20
Ethical Theories (2 of 6)
Utilitarianism
Consequentialism
Everyone should make choices that promote the greatest balance of good over harm for everyone
An act is right when it is useful in bringing about a good end
Consideration of the effects of action on everyone involved is encouraged
McWay, Legal and Ethical Aspects of Health Information Management 5th edition, © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
21
Ethical Theories (3 of 6)
Utilitarianism (cont.)
Application
Used when preparing cost–benefit analysis
All possible options are considered
Utility or value of each option determined
Option with highest total utility chosen
Group benefit is valued
Weakness
End justifies the means
Difficulty identifying and measuring all of the possible benefits; requires some prediction into the future
McWay, Legal and Ethical Aspects of Health Information Management 5th edition, © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
22
Ethical Theories (4 of 6)
Deontology
Formalism or duty orientation
Decision making is based on moral rules and unchanging principles
Derived from reason and applied universally
Look at the intrinsic nature of act
Determine its basic rightness or wrongness
Consequences of the act are irrelevant
McWay, Legal and Ethical Aspects of Health Information Management 5th edition, © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
23
Ethical Theories (5 of 6)
Deontology (cont.)
Categorical imperative
A command derived from a principle that does not allow exceptions
Application of unconditional commands in a similar manner in all situations
Examples:
Life is sacred. Killing is never justified.
Medical research: Value on freedom of choice. No subject should ever be tricked into participating.
McWay, Legal and Ethical Aspects of Health Information Management 5th edition, © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
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Ethical Theories (6 of 6)
Deontology (cont.)
Weaknesses
Does not consider the variety in real-life situations
Overly rigid
Disregard for consequences of action may lead to absurd results
Disagreement as to whether motivation is derived from universal values
One may be motivated by changing values instead
McWay, Legal and Ethical Aspects of Health Information Management 5th edition, © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
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