TITLE : BUSI 302- LEGAL AND ETHICAL ISSUES IN HEALTHCARE
Introduction
Professional legal and ethical are the elementary components that describe the relationships
between healthcare shareholders, including clients and the providers of healthcare facilities or
managers of the healthcare organization. The professional sphere acts by the provisions of the
constitutions of the federal and the state, the municipal ordinances, regulations, executive orders,
judicial precedents, and agency orders insofar as they pertain to the standard of care, treatment,
and handling of the patient, the patient’s privacy and the code of ethics. In health care, by
profession, one engages in what is best for their patient and upholds the patient’s right to decide
for themselves. Medical principles generally comprise autonomy, beneficence, non-maleficence,
and justice.
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Evolution of Healthcare Laws and Ethics
The first recorded version of the professional medical code, the Hippocratic Oath, was
formulated in ancient Greece around the 5th century BCE and provided the basis of ethical
practice for physicians. It outlined principles like ‘do no harm’ and patient confidentiality.
"The twentieth century saw some developments in the codification of laws governing the practice
of healthcare and its ethics. The Nuremberg Trials that took place after the Second World War
paved the way for the formulation of the Nuremberg Code meant for ethical issues in medical
research, specifically stressing the principle of informed consent. Another important aspect of the
period was that focus on bioethics directed the formation of an independent branch, the Hastings
Center in 1969, as well as the books published which can be considered as a bioethical
framework, namely “Principles of Biomedical Ethics’ by Beauchamp and Childress in 1979. All
these advancements have shaped the contemporary healthcare systems, and the rights of a
patient, and aspects of ethical practices, are accorded due consideration in any management of a
patient’s healthcare.
Historical Milestones' Impact on Modern Healthcare Practices
Today, numerous ways define the present day health care and are attributed to the following
events that have shaped the healthcare systems. The released Flexner Report of 1910 acted as a
pivotal point to reform the medical education in the United States and proceed to pioneer and
elevate new teaching standards besides shutting down undesirable medical schools. This report
also demanded the scientific approaches and ethical standards of medical profession which
formed the foundation of medical professionalism today.
"The passing of Medicare and Medicaid in 1965 was one of the miscellaneous strides made in the
advancement of health care in America, through it, millions were empowered to afford care and
obtain the services of their preference; it was a proclamation, a cry for health care equity was
being made in America. The more enhancement of the patients’ right was made later on by the
HIPAA of 1996 which protected the privacy and security of health information.
"This train has been kept up into the 21st century with the passage of the Affordable care Act of
2010 aimed at improving on health care access and reduction of inequalities. It means that ethical
matters have developed with time and it still fosters debates and evolution because of feature
enhancements in human genetics, machine science, and data protection.
Legal Issues in Healthcare
Patient Rights and Confidentiality
HIPAA and Patient Privacy
The first and strongest law that has been put in place concerning patients’ information security is
the Health Insurance Portability and Accountability Act of 1996 also referred as the HIPAA.
HIPAA established the national standard of privacy and security on the health information that
are required concerning the rules in engaging with the data of patients. HIPAA Privacy Rule
gives the patients the general right on records: of the right of access, right to amendment, and
right to an accounting of disclosures. The Security Rule builds on this by defining the standard of
the security of the electronic health information to ensure that no healthcare provider lacks
enough control measures that will cause loss of data or information breach.
Informed Consent
The Doctrine of informed consent is a legal and ethical doctrine in the health sector where the
patient is made aware of the procedures to be carried out on him or her and agree with it. In this
process the patient is informed about all the hazards of the treatment or any procedure that is to
be carried out, the advantages of undergoing the treatment, the available alternatives as well as
the likely outcomes or effects of the procedure. In trauma critically, the legal concept of
informed consent impacts a patient’s autonomy by eliminating any coercion or deceit. When
informed consent is not properly attained, the healthcare providers are liable to face certain
lawful punitive actions such as malpractice suits. In ethically, informed consent is done to uphold
the patient’s dignity and ensure patient provider relationship is built on trust.
Malpractice and Negligence
Medical malpractice is a claim that can be filed against a healthcare worker that has not worked
according to the acceptable level of care and the patient suffers as a result. Negligence is a
primary component of malpractice, meaning a member’s failure to meet the expected level of
care due to his decision makers and other like individuals in similar circumstances. They are the
mistakes due to misconduct, which include surgical errors, wrong diagnosis of ailment and
premature prescription of drugs and not seeking permission from the patient. These actions or no
actions may result in a severe patient’s adverse event, appeared law suits and monetary damages.
Legal Consequences for Healthcare Professionals
Cases involving litigation and actions brought against them for acts of medical negligence and
malpractice are not the best for the health care facilities. Demerits include, being charged or
fined heavily, losing their licenses, risking losing their jobs and in some extreme cases being
sued for the things they do or fail to do. Medical negligence case studies normally have many
processes and because of the nature of the particular case require many proofs moreover contain
professional-witnesses. On a larger scale, in addition to the consequences on the individual
involved in malpractice litigation, include increased insurance costs, changes in the delivery
system of healthcare that is subsequently followed by increased costs.
Healthcare Regulations and Compliance
FDA Regulations
FDA is doing a good job of providing assurance of the safety, quality, and efficacy of drugs,
biologic, vaccines, and medical devices and other healthcare products. Some of the FDA rules
includes the pre-marketing process relating to new drugs or medical devices and the post-
marketing supervision of the drugs and medical devices once approved for the market and the
reporting of adverse/affect events. The stated FDA regulations should be followed to the latter so
that the public is protected from loss of confidence in the various health organizations,
manufacturers and to avert the law. Thus executing its structure of regulation the FDA helps the
patients to be saved from receiving a medical product that may be dangerous or one that doesn’t
function in a manner expected.
Occupational Safety and Health Administration (OSHA)
The Occupational Safety and Health Administration or OSHA is the organization that has the
duty of establishing and implementing recommended standards relative to healthcare institutions
and facilities. The specific areas within the general scope of OSHA regulation in workplaces
include toxic substances, ergonomics, and infectious diseases. Failure to adhere to OSHA
standards is legal and financially costly due to workplace related injuries or illnesses in health
facilities. The awareness of the standards set by the OSHA helps create safety for both the
healthcare facility’s workforce and the patients by limiting the accidents risks in a workplace.
Insurance and Reimbursement
Legal Aspects of Health Insurance
The problem with health insurance is another area of healthcare law that is rather detailed and
requires compliance with numerous regulations. Legal dimensions of health insurance relate to
setting coverage determinations, safeguarding patient’s rights, as well as overseeing the
insurance pertinent market. Reforms such as the ACA have brought important changes to health
insurance among them being; prohibition of pre-existing health conditions,Medicaid expansion
and health insurance market place. These legal frameworks have the purpose of opening up
access to the services, lower the costs and enhance the quality of the same.
Issues Related to Reimbursement and Billing Practices
Other areas containing reimbursement and billing entails a crucial constituent of the healthcare
financial system. Concerning legal issues in this area, upcoding, billing for services not
delivered, and kickbacks are common fraud and abuse aspects. The FCA and AKS are two main
federal statutes in this regard that deter fraudulent behaviors by imposing steep penalties.
Reimbursement regulations should be followed to the later to avoid legal actions against
providers, besides being able to provide accurate and fair billing to patients. Ethical and
unprocedural billing not only shield healthcare organizations from the possible litigations but
also ensure that the health delivery system is more responsible.
Ethical Issues in Healthcare
Bioethics
Bioethics is a branch of knowledge that crosses over between several disciplines that deal with
moral questions emerging from biological and medical science. It covers issues relating to health
care, utmost principles, clinical and research ethics. Bioethics theory is a conceptual system
covering a wide range of procedures to analyze and determine ethical practices in the sphere of
healthcare. This involves patients’ right to self-determination, beneficence, non-malefication or
doing no harm, and justice through fair distribution of resources and medical care.
End-of-Life Care
Ethical Dilemmas in Palliative Care
End-of-life care brings many questions of ethicss, particularly in the sphere of palliative care,
which is that branch of medicine thnly focused on giving a peacepatient a peaceful death and
lessening the sufferingted to severe disease. First, it would be pertinent to define the quality of
life and the quotient between the quality and quantity of life. Regarding the issues regarding the
decision on removing or not administering life-sustaining treatments that include the use of
ventilators or feeding tubes, the decisions of a fiduciary shifts the patient’s rights between the
beneficent and non-maleficent principles. The following are some of them; Such decisions
preserve the patients’ wishes, spiritual and ethical work views that healthcare providers consider
while making options.
Euthanasia and Physician-Assisted Suicide
Two major concerns in the provision of palliative care that have so much controversy with
reference to ethically correct are euthanasia and PIPAS. Euthanasia is also called mercy killing;
euthanasia is when a doctor makes a decision to end a patient’s life as with the intention of
alleviating the patient’s pains while physician-assisted suicide means assisting a patient to
commit suicide. Measures of this sort may evoke simple tenets of ethics in the preservation of
life, autonomy and roles of a patient’s care and the use of healthcare interventions for the
purpose of alleviating pain. These are some of the basic distinctions that are found in different
countries and states, hence depicting that somehow, legal framing of such issues is not the same
all over the world because of pneumatological as well as ethical variations.
Resource Allocation
Ethical Considerations in Allocating Limited Resources
There is always the issue of rationing, which can be regarded as an ethical dilemma as it
concerns the selection of proper healthcare provision for a particular individual. These are the
ethical principle of justice and equity in decisions made on rights of women. When there are
limited resources available such as during times of heightened epidemics or in LMICs, there is
need to ration them thereby giving priorities to patients with their severeness of their ill-health,
type of illness, the likely hood of recovery among other factors. Triage is the process designed in
order to optimize the utility of existing resources; however, this concept implies a variety of
ethical issues regarding equality and prejudice.
Triage and Prioritization in Emergencies
Triage is one of the largest crucial clinical processes of acute care because givers are forced to
sort out the patients on the basis of their urgency. Some of the ethical dilemmas that come with
this area are some of the following; In certain cases the available resource are often minimal to
cater for all the patients then decisions will have to be made which patients will be attended to
first and those have to wait longer. Such decisions entail the use of analysis and integration of the
principles of beneficence and non-maleficence and the principle of justice especially as it relates
to matters of distribution of care.
Research Ethics
Ethical Issues in Clinical Trials and Medical Research
Any clinical trial and medical research is crucial for building up the medical information and
treating patients efficiently but they bring major ethical issues. Ethical concerns in research have
to do with features such as consent, participants, and, integrity in the actual work that is being
done in the research. Every human participant involved in research is protected by the
Institutional Review Boards (IRBs), but constant monitoring is vital to deal with new unethical
events such as conflicts of self-interest and the application of placebo treatments.
Informed Consent in Research
The concept of informed consent is an important model in ethical research where the researcher
ensures that the subject is fully informed on the rationale, processes, risks and probable gains of
the study. It has to be voluntary where the participant has to freely agree with his/her consent not
enforced or coerced. Obtaining informed consent is most difficult in the groups of children or
individuals with depressed cognitive capacity, and for this reason, special precautions are
required to preserve their elementary rights and freedoms.
Legal and Ethical Issues in Specific Contexts
Reproductive Rights
Abortion Laws and Ethics
Abortion is very sensitive topic that touches on legal, ethical, and moral issues for some reasons.
On the legal level, abortion remains a sensitive topic that admits numerous types of regulation
depending on the country and state, general humanitarian and political orientation. In ethical
terms, the conflict mainly focuses on the rights of the pregnant woman and the rights of an
unborn child. Those who support reproductive rights claim the right of people to control their
own bodies and decisions about reproductive practices, whereas the opponents will refer to the
human life status of the fetus and the issue of the sanctity of life.
Assisted Reproductive Technologies (ART)
In legal sense ART receives different legal regulation concerning the rights of the donors,
surrogates and Intended Parents. Socioethical issues that are worth discussing include buying and
selling of people, offspring produced through AR, rights of the provider and surrogates. On the
other hand, such matters as ones referring to ART and the probability of being compelled
involved exploitation, have to be taken into consideration regarding justice, autonomy, and
beneficence rules.
Mental Health
Legal and Ethical Issues in Psychiatric Care
Psychiatric rehabilitation is believed to be one of the most problematic fields of medicine
regarding the legal rules and ethical questions concerning the severe mental health patient
population. These included issues like commitment and treatment against the patient’s wish,
patient’s rights and the matter of patient’s privacy. The conflict is always had in identifying the
appropriate course of action when the patient is either aggressive or likely to be aggressive again
if not restrained, because patients have rights and also have liberty interests in their bodies and in
the treatment they receive. In legal aspects, mental health providers are engaged in aspects of
such issues in advocating for rights of their patients, the patients’ interests and their welfare with
due regard to the legal and ethical benchmarks.
Patient Autonomy vs. Involuntary Treatment
The patient self-determination is an ethical norm that is hard to maintain in psychiatric practice
because of conflicted patients’ capability to decide cause by mental disorders. Sometimes, the
treatment of a patient may be forced in the form of admission to the hospital or administration of
drugs in cases that may pose threats to the patient or his or her surroundings, and this has some
ethical dilemmas especially concerning the patient’s rights and autonomy. Sophisticating the
contestation of these divergent claims presents rigorous ethical reasoning and compliance with
the legal frameworks that patients deserve humane and dignity.
Technology and Healthcare
Legal and Ethical Implications of Telemedicine
Telemedicine has established itself in the delivery of healthcare covering it up in terms of
convenience, access and more so wherever there may be a shortage of medical facilities. The
issue is that it also creates major questions, such as legal and ethical – patients’ confidentiality,
record privacy, and the quality of service. Licensure and reimbursement are legal issues because
site providers of telemedicine care have to address the different laws concerning the states and
countries they operate in.
Data Security and Privacy in Electronic Health Records (EHRs)
The integration of EHRs help in the ways it helps in organizing the treatment and brings
conjunction across the interdisciplinary workforce and interprofessional teams; nevertheless, it
entails legal and ethically associated issues with data protection and confidentiality. In this
context, HIPAA can be described as legal frames of references in the protection of the health
information because the incidence of computer crime is rising. As for ethics, the health care any
providers and the organizations possessing such information have to agree on behaving
responsibly not only to maintain patients’ rights on the privacy but to prevent situations when
this information will be disclosed to people who have no right to read it. The most critical issue
that is associated with current use of electronic records pertains to how the use can be made
useful and at the same time, ensure that the details recorded are secure.
Case Studies
The U. S Supreme Court of America, this case legally confirmed women’s ability to gain an
abortion asserting that it was her constitutional freedom upon medical aspects of privacy. The
said case remains in the heart of the ongoing debates of reproductive rights and has influenced
numerous countries’ legislation on abortion.
"Terri Schiavo Case (1990-2005)
"The extended time law took to determine the right of withdrawal of a feeding tube for Terri
Schiavo, a patient in the Persistent Vegetative State was an identification of major issues in end
of life care. The case is related to raising questions on who else should make those decisions if
the patients lack the decision-making capacity through stressing the importance of advance
directives and presenting the background on patients with no decision-making power.
"Tuskegee Syphilis Study (1932-1972)
Addendum to the National Institute of Health’s Guides for the Basic Research and Moral
Concerns Stemming from Human Subject Research occurred, which in turn led to the creation of
the Belmont Report on the ethical principles and guidelines for the use of human beings in
experimentation.
The ethical dilemma is evidently present in the case whereby the Jehovah’s Witnesses are
unwilling to accept blood transfusion due to their religious stand on patient autonomy against
patient rights accorded to them. Indeed, most healthcare providers coordinate with patients to
have other acceptable prohibitions in order to honor the patient’s belief system but, at the same
time, so that the patient’s lives will not be threatened.
Conclusion
Legal and ethical issues are important to understand to guarantee that patient service delivery is
fair and safe and respects patients’ rights. The evolution of contemporary practices can be
attributed to other significant events in the past, including the evolution of bioethics and
important legal cases. Not surprisingly, the discussion of current challenges and controversies,
such as the problem of resource allocation and new technologies, in the context of a critical
discussion of foundations indicates the need to constantly reflect on them.
Solving all the legal and ethical issues is possibly the most basic requirement to preserving
confidence in the healthcare system. The healthcare service organisations are required to
understand and work through a number of paradoxes in a more gentle manner and whilst
following the principles and rules. Thus, focusing on patients, their rights, and safety along with
equal access to healthcare, this branch can progress ethically and legally.
Because of the active advances in healthcare, an effort to sustain discourse among the authorities,
practitioners, patients, and ethicists is mandatory for legal and ethical norms to remain up to par.
Focusing on education and research and developing sound frameworks and requirements will
tackle current issues and be ready for future ones. In the end, espousing ethical and legal
principles will guarantee that health care remains a noble profession that would always be in the
side of the best interest of all the patients.
