Legal and Ethical Issues a Healthcare Provider May Face

• EMMYLOU GAY J. DOLOTINA

6. ETHICAL ISSUES AND CONFLICTS

6.1 MALPRACTICE

This pertains to careless acts and/or not doing what needs to be done in accordance with the standards of practice of health care. For example the nurse cannot perform indwelling catheterization unless she was trained to do so, and without the doctor’s order for it. This works the same way as when doctors prescribe medications to the elderly without prior laboratory tests made.

On the other hand, a caregiver who fails to put the bed down, lock the brake and put the sensor mat on after doing the turning to sides of the resident is also an act of malpractice as this will lead to injury or even death of a resident.

MANAGEMENT:

1. Provide information materials in the staff room and the nurses’ station about the risks and possible outcomes including the lawsuit that can be filled when proven guilty
2. Provide a seminar with open forum about the professional practice – what’s new and what not to do in the healthcare setting.
3. Reorientation of the staff on the policies and standards to be followed though meetings and written communications.

6.2 CONFIDENTIALITY

The healthcare team members of Kindly Residential facility are obliged to follow strict safekeeping of the resident’s information among the team members which include the medical history, past treatments, even the address and phone numbers relevant to the care of the patient. For example, if somebody calls the nurses station and asks for some information about the resident, the nurse/ healthcare assistant has to refuse to release any information to the caller.

If in turn, the caller asks for mobile phone number of the attending physician, still the nurse/caregiver should not give the information. This is also applicable to the rest of the members of the team. The mobile numbers, addresses should not be given without permission from the particular person.

MANAGEMENT:

1. Formulate a protocol with regard to information releasing over the phone. The family may sign up an agreement of having a code when acquiring information on present condition of the elderly member in the facility.
2. Implement a colour coding of the folders in order for the staff to recognize the types of files, so as not to accidentally open confidential files of other people.
3. Implementation of disciplinary actions of whoever breaks confidentiality rules leading to mistrust of the older people and their families.

6.3 CONSENT

Consent is an agreement between the person, allowing the healthcare professional to perform care, medical intervention and obtain history of the elderly person after being properly explained on the steps and risks of the procedures. This is usually put into writing or recorded for the protection of both parties.

The issue arises when the elderly person is assessed to be incapable of making decisions for his care due to dementia and other geriatric conditions. The immediate family is given the power of authority by the elderly to execute actions for the resident’s care and treatment.

In some cases, the authorised person readily decides for the elderly without consulting the older person on his/her preference of care. An example is when the doctor prescribes medications for palliative care for the patient after thorough assessment. The family decided to sign the consent for the induction of the medication, but then the elderly refused to be given the medication. Still, the elderly has the right to refuse even with the consent signed.

MANAGEMENT:

1. Ensure acquisition of consent forms with signature prior to implementing care such as catheterization, intravenous tubing, etc. including admission forms.
2. Upon admission, approval for authorised person is to be assigned for clearance from the legal counsel of the facility. Any queries regarding the matter will be addressed by the legal counsel office.

7. ETHICAL APPROACHES

7.1 PRINCIPLISM

The following are parts of the ideologies of Principlism:

a. AUTONOMY

This is said to be the free will of man, to choose and decide things that affect his life. Elderly people suffering from dementia and other health conditions of the elderly have diminished autonomy. These people are given protection.

APPLICATION: Informed Consent for the following reasons

1. Information – provides knowledge of the whole process: procedure, steps, risks and benefits, other alternative actions, answer questions and give an opportunity to withdraw
2. Comprehension- for understanding
3. Voluntariness- the freedom

b. BENEFICENCE and NON MALEFICENCE

Beneficence is to do good, while non maleficence is the practice to do no harm. In some instances, a caregiver has to choose between two actions which both give a benefit to the elderly, but in another way has a negative side.

For instance, the patient is on liquid restriction, however, the patient is crying a lot because she wanted to drink more water. The caregiver can safely wipe her mouth with wet cotton from time to time. In this way she is giving the patient comfort, at the same time, avoiding the practice to do harm by keeping the restriction of fluid even with the constant calling of the resident.

APPLICATION: Assessment in the risks and benefits

1. The avoidance of adding up to the nature of the problem
2. The system of assessment of these risks and benefits is made clear

c. JUSTICE

This refers to the balance between the reason for performing the procedure or treatment of an elderly person and its impact towards the totality of his well-being. The positive impact must outweigh the painful process that the elderly patient may undergo.

For instance, a 90 year old resident is complaining of knee pains and is tired of taking the pain killers. The only long term treatment that the doctor sees in order to alleviate the pain for the patient is to undergo knee cap replacement surgery. The doctor has to assess the patient’s condition if he can still endure the process, and if he can still recover properly from the operation. It is not justifiable to put the elderly for surgery for the reason that the resident can afford it and just wanted to do it if he will end up without pain but bedridden.

APPLICATION: Procedures

1. Decision making guide in performing the procedures
2. Weighing positive outcomes of treatment versus pain along the process of doing it.

7.2 VIRTUE ETHICS

In the field of healthcare, the healthcare team undeniably possess the character of patience and good virtues. This is one of the reasons why these people are able to endure the stressful environment of caring for the elderly with dementia and other medical conditions that the older people suffer.

Virtue ethics refers to the positive inner aspects that a healthcare team member holds naturally, that radiates in the workplace. This helps in keeping the job well done.

For instance, a person may say that he/she will not commit murder because he/she can’t bear to do it.

7.3 DUTY ETHICS

In the principle of deontology, the team member does the job well by adhering to the rules of the facility and the standards of practice. Therefore there is a higher authority that is being based upon in order to fulfil a task. Obedience is the key to doing the tasks.

For example, a person may say he/she will not commit murder because it is against the law of the country.

7.4 CONSEQUENTIALISM

The judgement of whether the job is properly done lies in the consequences and the outcomes of the effort done. Therefore, a person must not perform the action if the outcome is perceived to be negative.

For example, a person may say he/she will not commit murder because it will bring me to jail.

REFERENCES:

1. Greenwood, B. (2015).Legal and ethical issues that health care professionals face. Retrieved from http://work.chron.com/legal-ethical-issues-health-care-professionals-face-5648.html

2. Wikipedia (2014). Principlism. Retrieved from http://en.wikipedia.org/wiki/Principlism
3. Wikipedia (2014). Virtue Ethics. Retrieved from http://en.wikipedia.org/wiki/Virtue_ethics