WEEK-3-HEALTH-CARE-ETHICS (AUTONOMY)pptx

health care ethics

1. C. ETHICAL PRINCIPLES 1. Autonomy -from Greek word ” autos” meaning self and “nomos” meaning governance or law (Morrison, E and Furlong, B.2019 p.44) Refers to freedom from external control. It is the right to accept or refuse treatment. Patient autonomy- the right of the patient to make decisions about their medical care without their health care provider trying to influence the decision. It allows the health care providers to educate the patient but does not allow the health care provider to decide for the patient.

2. Con’t… ETHICAL PRINCIPLES .. The health care formulation of this principle can be as follows: Presence of informed consent or their lawful surrogate except in extreme emergencies. Clarifies the meaning respect for person and their freedom in the context of health care. Seeks to encourage rational decision making by the patient who must live with the consequences of medical treatment or lack of it. (Bailelie,H et al. 2013,p33-34)

3. PATIENT’S RIGHTS Basic rule of conduct between patients and medical caregivers as well the institutions and people that supports them. The right to be treated with respect – regardless of their means or health care challenges without discrimination by their providers, practitioners, and payers. The right to obtain medical records – including doctors notes, medical test results, and other documentation related to their care. The right to privacy of medical records – who else, besides the patient, may obtain patient’s records, and for what purposes/s.

4. Con’t… PATIENT’S RIGHTS The right to make treatment choice – as long as the patient are considered to be of sound mind, it is both their right and responsibility to know what are the options available for treatments and then make the choice they feel is right for them. The right to informed consent – no reputable practitioner or facility that performs tests, procedures, or treatments will do so without asking the patient or his guardian to sign a consent. The practitioner is expected to provide clear explanations of the risk and benefits prior to the patient’s participation .

5. Con’t.. Patient’s Rights The right to refuse treatment – as long as he/she is considered to be: capable of making sound decisions, or he/she made that choice when he/she was of sound mind through written expressions (as is often in end-of-life-care) This includes surgery, use of ventilator machine, CPR, and other invasive procedures or extraordinary means. The right to make decisions about end-of-life-care - patient may make or legally record his/her decisions about how their lives will end, including life preserving measures ( ventilators, feeding tubes)This information may be found in the patient’s “Advance Directives”

6. In a capsule: the patient’s rights are as follows: P-rivacy A-utonomy T- reatment refusal I- nformation E- ducation N –ot to be restrained T- o be treated with confidentiality S- ervices

7. PATIENT’S BILL OF RIGHTS (Patient Care Partnership) A document that provide patients with information on how they can reasonably expect to be treated during the course of their treatment or hospital stay. They provide goals and expectations for patient treatment. Considerate and respectful care Complete current information Receive from his doctor information necessary to give informed consent Refuse treatment to the extent permitted by law Consideration of his privacy Confidentiality

8. con’t…PATIENT’S BILL OF RIGHTS (Patient Care Partnership) 7. Reasonable response to the request of the patient for services 8. Obtain information as to any relationship of his hospital to other health care and educational institutions 9. Refuse to participate if hospital proposes to perform human experimentation 10. Continuity of care 11. Examine and receive an explanation of his bills 12. Hospital rules and regulations that apply to his conduct

9. INFORMED CONSENT Consent – a patient’s signed consent form is necessary for: admission to a health care agency Invasive procedures – central line insertion, surgery, treatments like chemo Participation in research studies A patient or his representative needs to sign a separate special consent or treatment forms before the performance of a specialized procedure.

10. Con’t ..INFORMED CONSENT When a competent patient refuses care or treatment, this act is legally his or her right… assess the reason for refusal Inform the physician/health care provider Document this in the medical record

11. Principle of Informed Consent It is the right and responsibility of every individual to advance his/her welfare by freely and voluntarily giving consent . Designating agreement or refusal to undergo any procedures, treatments based on sufficient knowledge of the benefits, burdens, and the risks involved. 4 requirements: Decision- making capacity Documentation of consent Disclosure of information Comprehension of the information

12. Con’t .... Principle of Informed Consent Upon fulfilment of the 4 requirements of informed consent , three essential conditions are fulfilled: That the individual’s decision is voluntary That he decision is made with appropriate understanding of the circumstances That the patient’s choice is deliberate in so far as the patient has carefully considered all of the benefits, burdens, risks, and reasonable alternatives

13. In health care, informed consent is a patient’s agreement to have a medical procedure after receiving full disclosure of risks, benefits, alternatives, and consequences of refusal (Westrick, 2014) Failure to obtain such can result to a claim of battery. Must be obtained when patient is not under the influence of medication such as opioids/ narcotic analgesics. THE PERSON RESPONSIBLE FOR PERFORMING THE PROCEDURE IS RESPONSIBLE FOR OBTAINING THE INFORMED CONSENT i.e. physician, surgeon.

14. Parents are usually the legal guardians of pediatric patients Occasionally a parent/guardian refuses, in tis case the court intervenes. The courts generally considers to the child’s ultimate safety and well – being. In emergency cases , if it is impossible to obtain consent from the patient or an authorized person , a health care provider may perform a procedure required to benefit the patient or save a life without a liability for failure to obtain consent. In such cases, the law assumes that the patient would wish to be cured. 2 physicians will sign the consent and document the emergency nature of the situation

15. For there be emergency justifying treatment without informed consent, 3 conditions must be present (Rosoff, 1981. Cited in Baillie, H et al., 2013) Patient must be incapable of giving consent and no lawful surrogate is available to give the consent There is danger to life or danger of serious impairment of health Immediate treatment is necessary to avert these dangers.

16. Patients with mental illness must also give consent in the patient’s Bill of Rights. They retain the right to refuse treatment until a court has determined legally that they are incompetent. The primary function of informed consent is the protection of the patient’s right to self-determination to accept the proposed treatment. The patient is free to decide what will be done to their body.

17. PROXY CONSENT (Legally Acceptable Representative) The process by which people with legal right to consent to medical treatment for themselves or a minor or ward, delegate that right to another person. Three fundamental constraints on this delegation : The person making the delegation must have the right to consent . The person must be legally and medically competent to delegate the right to consent. The right to consent must be delegated to a legally and medically competent adult.

18. 2 Types of Proxy Consent for adults 1.Durable –power- of- attorney (power of attorney), healthcare proxy The patient who wants medical care, uses the power of attorney to delegate the right to consent to a specific person, if they are rendered temporarily incompetent by the medical care. It is an authorization that enables any competent individual to name someone to exercise decision- making in the event of the person’s incapacitation, unable to make decisions personally. As in end-of-life-care

19. 2. Living will – is a written, legal document prepared by a competent adult that spells out medical treatments a patient would or would not want to be used to keep him /her alive, as well as his/her preferences for other medical decisions such as: Pain management or Organ donation An expression of the person’s wishes regarding end-of-life-care ..where he/she thinks of her values ( www.mayoclinic.org , living wills, art-2004603 AUG.22, 2020)

20. 2. CONFIDENTIALITY In health care, refers to the obligation of the professionals who have access to patient records or communication to hold that information in confidence. Confidence means trust. The information will be kept secret from the reach of unauthorized people until the parties agree to uncover the information. It prevents the access of sensitive information from being public. Confidentiality implies: Information about the patient be kept private Information in the patient’s record is accessible only to those providing care to the patient

21. 3 . No one else is entitled unless the patient signed a “ Consent for Release of Information” that identifies with whom the information may be shared and for what purpose. 4 . Discussing about the patient outside clinical setting violates patient confidentiality. Like: Telling friends or family Discussing patients in elevator, cafeteria Any area outside nursing unit The patient has the right to review records pertaining to his/her medical care

22. To have the information explained or interpreted as necessary except when restricted by law. Maintaining confidentiality may be observed by: Not discussing patient issues with other patients or uninvolved staff Not sharing health information to others without patient’s permission Not publishing information, embarrassing facts about the patient Not accessing medical records when unauthorized to do so Sharing patient information only in private and scheduled areas Protecting the medical record from all unauthorized recorders

23. PRIVACY An individual is free from public interruption and intrusion The person is apart from the public attention, and observation It is a tendency to hide certain facts about himself or else people will use them against him (Surbhi, S.,2018) “ Privacy is a necessary condition, the necessary atmosphere for maintaining intimate relationships of respect, love, friendship, and trust. Without privacy, these relationships are inconceivable” (Fried, 1990). The patient grants the nurse and the physician access to his/her body and mind in order to protect his/her health. Rightly or wrongly , many diseases and treatments are considered shameful.

24. Examples of violations and invasion of patient’s privacy: Taking photograph of the patient Use of patient’s name or picture for the sole advantage of the health care agency Leaving curtains or doors open while treatment or procedure is being performed Allowing individuals to observe a treatment or procedure without the patient’s consent Leaving a confused or agitated patient sitting in the nursing unit hallway

25. Interviewing a patient in a room with only a curtain between patients or where conversations can be overheard. Surbhi (2018) states the differences between privacy and confidentiality Privacy –state of being secluded; free from public interference Confidentiality –situation when information is kept secret from any other person Privacy- talks about a person Confidentiality – talks about information

26. Privacy- everyone is disallowed from interfering personal matters Confidentiality –some specified and trustworthy people are allowed to have access to the information Privacy is voluntary; confidentiality is compulsory if the relationship between parties is fudiciary (involving trust) Privacy is a right; confidentiality is an agreement In the Phil 1987 Constitution art. 3 sec. 3 . Right to privacy and confidentiality

27. 3. VERACITY Truth telling and the Right to Information To respect veracity in relationships is to deal honestly with patients and colleagues as they are. The ordinary ethics of truthfulness is summed up in 2 commands: 1. do not lie- “if you communicate, do not lie” 2. You must communicate to those who have a right to the truth. “ you communicate if the other person has the right to communication” Neither says you must everyone everything you know or everything they want to know.

28. Veracity in the Health Care Setting – refers to comprehensive, accurate, and objective transmission of information as well as to the way professional fosters the patient’s understanding. This is connected to respect of autonomy. Veracity in Nursing – where do we stand? Truth telling is important because it shows respect for people and allows them the right to autonomy-giving them all the information they need to make their own choices.

29. In certain circumstances withholding the truth from a patient is the compassionate and moral choice- to protect them from mental and emotional distress. Veracity is necessary for 3 reasons: Respect owed to others. Obligation of fidelity and promise-keeping. Successful intervention and cooperation. This is supported by the Patient’s Bill of Rights – right to information

30. Violations of Veracity : 1. omission of relevant facts 2. Commission – telling a lie 3. Cloak the truth in so much medical jargon – unable to understand.(Thompson, L., 2018). TRUTH TELLING ( Baillie, H., et al 2013) asserts the following: Every competent person has the right to information Truth telling is the right of every individual to have insight into the situation. When truth telling will harm the patient or others due to unpreparedness to accept the dreadful diagnosis or situation.

31. In the Filipino culture, traits of family orientation to illness and the non-confrontational attitude affect truth telling. This depicts that family members are often informed before the patient, on serious diagnosis because this may: bring more harm, like hopelessness, depression, refusal to undergo treatments. The nonconfrontational attitude prevents us from disclosing unpleasant views, may be traceable to Filipino value system as shame or “hiya”. We subscribe to death denial culture.

32. 4. FIDELITY Keeping of promises Remaining faithful to the professional promises made to provide quality , competent care to patients. The obligation to: act in good faith and to keep vows and promises, fulfill agreements, maintain relationships and fiduciary responsibilities. Fiduciary responsibilities – nurse and physician becomes the trustees of patients health and welfare. They can not withdraw care without giving notice to the patient and family.

33. The model of Fidelity is : keeping one’s word of honor, loyalty to commitments and oaths, and reliability. Standing true to one’s word “palabra de honor” Encompasses traits of maturity and commitment Fidelity is the most important ethical principles. It requires that all patients are treated with respect regardless of the circumstances.

34. 5. JUSTICE Morrison and Furlong (2019) assert the following statements on justice: Governs social fairness –determines who should receive or is entitled to receive a resource. Giving each one his/her due, entitlements, benefits one has a right to Fairness – care must be equitably , fairly and justly to each individual In health care the benefits must be balanced with the burdens to determine who is eligible to receive some type of care.

35. 2 Major Categories of Justice Procedural – due process. In legal system, we speak of being equal before the law. You receive the same treatment as everyone else. In health care, did you receive the same attention and care as the person who preceded you? 2. Distributive – determining how to divide burdens and benefits. This refers to fair, equitable, and appropriate distribution/ allocation of responsibilities, or share of rights and roles. Ex. Busy nurses have to decide how quickly to respond to call button relative to the task in which they are currently engaged.

36. 6. BENEFICENCE Latin word “bene” for “well” or “good”. Action done for the good of others Associated with the acts of mercy, kindness, charity, humanity, altruism, love at times are also considered forms of beneficence Benevolence refers to virtue of being inclined to do good and act for the benefit of others. There are instances when one is obliged to do emergency care to one who is hovering between life and death.

37. Beneficence and a higher moral burden- we are morally obliged to take positive and direct steps to help others. Relative to ethical theories, consequentialism, the greatest good for the greatest number. Acts of kindness and courtesy, compassion and understanding even under extremely stressful circumstances is part of professionalism Requires the ability to see every patient as a unique person who has worth. (Morison, E. and Furlong, B., 2019)