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Identifiers: LCCN2018040864 | ISBN 9781284144185 (pbk.)

Subjects: | MESH: Legislation, Medical | Ethics, Clinical | HealthPersonnel–ethics | Patient Rights | United States

Classification: LCC KF3821 | NLM W 33 AA1 | DDC 174.2—dc23

LC record available at https://lccn.loc.gov/2018040864

6048

Printed inthe United States of America 23 22 21 20 19 10 9 8 7 6 5 4 3 2

I dedicate this book to healthcare professionals who have chosen to serve in the noblest of professions, the healing ministry

You stood by the bedsides of many patients during times of loneliness and frustration. When they wanted to give up, you gave them hope and the strength to fight on.

You watched over them while they slept, eased their pain with words of kindness, and gave them sips of water when they could not drink.

You stood by their bedside when fears arose within their souls.

Thank you, treasured caregivers, for you have been their light during the darkest of nights.

It has been my honor to have stood by your side as you provided care to so many patients as I surveyed your hospitals and ambulatory care sites

It has been my privilege to have stood by those who I have taught, and those who have taught me.

Forever Thankful

Epigraph

He has achieved success who has lived well, laughed often, and loved much; who has gained the respect of intelligent men and the love of little children; who has filled his niche and accomplished his task; who has left the world better than he found it, whether by an improved poppy, a perfect poem, or a rescued soul; who has never lacked appreciation of earth’s beauty or failed to express it; who has always looked for the best in others and given them the best he [or she] had; whose life was an inspiration; whose memory a benediction.

Anderson Stanley

Every mistake brings a teaching moment, an opportunity to learn.

—Nina Santucci

Each life is like a novel. Filled with moments of happiness, sadness, crisis, defeat, and triumph. When the last page has been written, will you be happy or saddened by what you read?

—Author Unknown

Brief Contents

Epigraph

Foreword

Preface

Acknowledgments

Chapter 1 Introduction to Ethics

Chapter 2 Contemporary Ethical Dilemmas

Chapter 3 End-of-Life Dilemmas

Chapter 4 Healthcare Ethics Committee

Chapter 5 Development of Law

Chapter 6 Introduction to Law

Chapter 7 Government Ethics and the Law

Chapter 8 Organizational Ethics and the Law

Chapter 9 Healthcare Professional LegalEthical Issues

Chapter 10 Physicians’ Ethical and Legal Issues

Chapter 11 Employee Rights and Responsibilities

Chapter 12 Patient Consent

Chapter 13 Patient Abuse

Chapter 14 Patient Rights and Responsibilities

Chapter 15 Summary Case: Search for Truth

Glossary Index

Contents

Epigraph

Foreword

Preface

Acknowledgments

Chapter 1 Introductionto Ethics

Learning Objectives

Introduction

Ethics

Why Study Ethics

Morality

Code of Conduct

Moral Judgments

Morality Legislated

Moral Dilemmas

Ethical Theories

Meta-Ethics

Normative Ethics

Descriptive Ethics

Applied Ethics

Consequential Ethics

Utilitarian Ethics

Deontological Ethics

Nonconsequential Ethics

Ethical Relativism

Principles of Ethics

Autonomy

Beneficence

Nonmaleficence

Justice

Virtue Ethics and Values

Courage as a Virtue

Wisdomas a Virtue

Temperance as a Virtue

Commitment

Compassion and Empathy

Conscientiousness

Discernment

Fairness

Fidelity

Freedom

Honesty/Trustworthiness/Truth Telling

Integrity

Kindness

Respect

Hopefulness

Tolerance

Cooperation and Teamwork

Forgiveness

Religious Ethics

Judaism

Hinduism

Buddhism

Taoism

Christianity

Islam

Religious Beliefs and Duty Conflict

Secular Ethics

Atheism

Situational Ethics

Reasoning and the Decision-Making Process

Absence of a Moral Compass

Creating a Culture of Ethics

Summary Thoughts

Chapter 2 Contemporary EthicalDilemmas

Learning Objectives

Introduction

Noteworthy Historical Events

68,000–58,000 BC AD 1932–1972 1933–1945 1946 1949 1954 1960s 1964 1968

Undue Burden Rule

Funding

Refusal to Fund Abortion Counseling Not Unconstitutional

Spousal Consent

Parental Consent

Informed Consent

States May Protect Fetus

State Abortion Statutes

Law and Morality of Abortion—

Conflicting Beliefs

Sterilization

Elective Sterilization

Therapeutic Sterilization

Eugenic Sterilization

Wrongful Birth, Life, and Conception

Wrongful Birth

Wrongful Life

Wrongful Conception

Artificial Insemination

Consent

Confidentiality

Surrogacy

Organ Donations

Who Lives? Who Dies? Who Decides?

UniformAnatomical Gift Act

Failure to Obtain Consent

Altruismvs. Sale of Organs

Research, Experimentation, and Clinical Trials

Right to Try Experimental Drugs

Office of Research Integrity

Food and Drug Administration

Institutional Review Board

Informed Consent

Experimental Subject’s Bill of Rights

Patient Responsibilities

The Cures Act

Human Genetics

Genetic Markers

Genetic Information Nondiscrimination

Act of 2008 (HR493)

StemCell Research

Acquired Immune Deficiency Syndrome

Spread of AIDS

Confidentiality

The Right to Treatment

AIDS Education

Chapter 3 End-of-Life Dilemmas

Learning Objectives

Introduction

Where Do Americans Die?

Euthanasia

Active or Passive Euthanasia

Voluntary or Involuntary Euthanasia

Right to Self-Determination

Defining Death

Legislative Response

Assisted Suicide

Physician-Assisted Suicide

Assisted Suicide Versus Refusal or Withdrawal of Treatment

Oregon’s Death with Dignity Act (1994)

Patient Self-Determination Act of 1990

Advance Directives

Living Will

Right to Die Without a Living Will Durable Power of At torney

Surrogate Decision Making

Futility of Treatment

Withholding and Withdrawal of Treatment

Patient Not in a Persistent Vegetative State

Removal of Life-Support Equipment

Feeding Tubes

Do-Not-Resuscitate Orders

Competent Patients Make Their Own Decisions

ANew Beginning and a Better Ending

Chapter 4 Healthcare Ethics Committee

Learning Objectives

Introduction

Committee Structure

Committee Goals

Committee Functions

Policy and Procedure Development

Expanding Role of the Ethics

Committee

Internal Ethical Issues

External Ethical Issues

Resolution of Ethical Dilemmas

Making Better Decisions

Chapter 5 Development of Law

Learning Objectives

Introduction

Public Law

Private Law

Sources of Law

Common Law

Statutory Law

Administrative Law

U.S. Government Organization

Separation of Powers

Conflict of Laws

Legislative Branch

Judicial Branch

Executive Branch

Department of Health and Human

Services

Administration on Aging

Centers for Medicare and Medicaid

Services

Public Health Service

Chapter 6 IntroductiontoLaw

Learning Objectives

Introduction

Tort Law

Negligence

Intentional Torts

Assault and Battery

False Imprisonment

Defamation of Character

Invasion of Privacy

Infliction of Mental Distress

Criminal Law

Criminal Procedure

Healthcare Fraud

Manslaughter

Murder

Theft

Contracts

Elements of a Contract

Employment Contracts

Exclusive Contracts

Trial Procedure and the Courtroom

Pleadings

Discovery

Preparation of Witnesses

The Court

The Jury

Subpoenas

Opening Statements

Burden of Proof

Evidence

Examination of Witnesses

Defense of One’s Actions

Closing Statements

Judge’s Charge to the Jury

Jury Deliberation

Damages

Appeals

Chapter 7 Government Ethics andthe Law

Learning Objectives

Introduction

U.S. Office of Government Ethics

House of Representatives Committee On Ethics

Senate Select Committee On Ethics

Office of Congressional Ethics

U.S. Judicial Code of Conduct

State Ethics Committees

Public Policy

Veterans Administration

Fourteenth Amendment to the Constitution

Title VI: Civil Rights Act

Sherman Antitrust Act

Privacy Act

Health Insurance Portability and Accountability Act (HIPAA)

Emergency Medical Treatment and Active Labor Act (EMTALA)

Health Care Quality Improvement Act

Agency for Healthcare Research and Quality

Ethics in Patient Referral Act

Patient Self-Determination Act

Sarbanes-Oxley Act

Patient Protection and Affordable Care Act (2010)

Political Malpractice

Oath of Office

Ethics in Public Service

Chapter 8 Organizational Ethics andthe Law

Learning Objectives

Introduction

Corporate Authority

Fiduciary Responsibility

Express Corporate Authority

Implied Corporate Authority

Ultra Vires Acts

Corporate Ethics

Code of Ethics for Organizations

Corporate Compliance Program

Unprofessional Conduct

Trust and Integrity

False Advertising

Concealing Mistakes

Corporate Negligence

Doctrine of Respondeat Superior

Independent Contractor

Corporate Duties and Responsibilities

Appointment of a CEO

CEO Licensure

CEO Responsibilities and Challenges

CEO Code of Ethics

Screen Job Applicants

Credentialing, Appointment, Privileging, and Discipline

Ensure Competency

Discipline of Physicians

Provide Adequate Staff

Provide Adequate Supplies and Equipment

Allocate Scarce Resources

Provide Quality Patient Care

Comply with Rules and Regulations

Provide Timely Treatment

Avoid Conflicts of Interest

Provide a Safe Environment

Prevention of Falls

Protect Patients and Staff fromSexual Harassment and Assault

Decisions that Collide with Professional Ethics

ALife Needlessly Shortened

Financial Incentive Schemes

Restoring Trust

Effective Communication Builds Trust

Improving Organizational

Performance and Ethics

Board Education

Policies and Procedures

Search for Best Practices

Reduce Variation

Assure Continuity of Care

Partner with the Community

Develop a Culture of Compassion and Kindness

Chapter 9 Healthcare

Issues

Learning Objectives

Introduction

Paramedics and First Responders

Emergency Medical Responder

Emergency Medical Technician

Advanced Emergency Medical Technician

Paramedic

Nurses:Ethics and Legal Issues

Registered Nurse

Advanced Practice Nurse

Nurse Practitioner

Clinical Nurse Specialist

Nurse Anesthetist

Nurse Midwife

Special Duty Nurse

Float Nurse

Agency Personnel

Nursing Assistants

Student Nurses

Negligent Acts in Nursing

Chiropractor

Dentistry

Dental Hygienist

Dietary

Incidence and Recognition of Malnutrition

Emergency Department

Timely Response May Require a Phone

Call

Laboratory

Ethics and Inaccurate Lab Results

Refusal to PerformHIV Testing

Medical Assistant

Medical Records

Pharmacy

Dispensing and Administration of Drugs

Drug Substitution

Expanding Role of the Pharmacist

Duty to Monitor Patient’s Medications

Warning Patients About Potential for Overdose

Refusal to Honor a Questionable Prescription

Reducing Medication Errors

Physical Therapy

Incorrectly Interpreting Physician’s Orders

Resident Neglect

Physician Assistant Psychology

Failure to Minimize Harm: Unethical Conduct

Sexual Harassment

Reporting Child Abuse

Radiology

Failure to Restrain Causes Patient Fall

Respiratory Care

Social Work

Certification of Healthcare Professionals

Licensing of Healthcare Professionals

Suspension and Revocation of License

Helpful Advice for Caregivers

Chapter 10 Physicians’Ethical andLegalIssues

Learning Objectives

Introduction

The Hippocratic Oath

Code of Medical Ethics

Law and Ethics Intertwine

Morally Wrong, Legally Actionable

Hippocratic Oath and AMACode of Ethics Violated

Principles of Medical Ethics

Compassionate Care

Responsibility to the Patient Is Paramount Trust

Failure to Refer for Consultation

Falsification of Records

Justice

Respect for Privacy

Negligence

Patient Assessments and Diagnosis

Patient Diagnosis

Patient Treatment

Discharge and Follow-Up Care

Untimely Discharge

Failure to Provide Follow-Up Care

Failure to Follow-Up on Test Results

Physician–Patient Relationship

Personalized Treatment Versus Assembly-Line Medicine

Treat Caregivers with Respect

Chapter 11 Employee Rights andResponsibilities

Learning Objectives

Introduction

Employee Rights

Fair Treatment and Employment at Will

Refuse to Participate in Patient Care

Question Patient Care

Suggest Changing Physician

FreedomfromDisruptive Behavior

Sexual Harassment

Treatment with Dignity and Respect

FreedomfromIntimidation

Privacy and Confidentiality

Family Medical Leave

Whistleblowing

Safe Environment

Unemployment Compensation

Employee Responsibilities

Know Your Patient

Educate and Encourage Patients to Ask Questions

Be Compassionate

Comply with State and Federal Regulations

Comply with Hospital Policy

Comply with Assigned Duties

Honor and Respect Patient Rights

Maintain Confidentiality

Adhere to Safe Practices

Admit to Mistakes

Adhere to Professional Standards

Maintain Professional Relationships

Sexual Harassment

Report Unethical Behavior

Protect Patients fromHarm

Report Patient Abuse

Stand as a Patient Advocate

Maintain Professional Competence

Encourage Teamwork

Helpful Advice

The Caregiver’s Pledge

Chapter 12 Patient Consent

Learning Objectives

Introduction

Informed Consent

Codes of Ethics

Proof of Consent

Statutory Consent

Capacity to Consent

Adequacy of Consent

Competent Patient

Spouse

Parental Consent

Consent by Minors

Incompetent Patients

Guardian

Right to Refuse Treatment

Refusal of Care Based on Religious Beliefs

Chapter 13 Patient Abuse

Learning Objectives

Introduction

Child Abuse

Reporting Abuse

Detecting Abuse

Good-Faith Reporting

Immunity and Good-Faith Reporting

Senior Abuse

Reporting Senior Abuse

Signs of Abuse

Intimidation of Abusive

Resident/Disciplinary Overkill

Abusers Abused

Prevention of Senior Abuse

Look Closer, See Me

Chapter 14 Patient Rights and Responsibilities

Learning Objectives

Introduction

Patient Rights

Right to Know One’s Rights

Right to Explanation of One’s Rights

Right to Exercise Rights

Right to Ask Questions

Right to Complain

Right to Emergency Care

Right to Admission

Right to Examination and Treatment

Right to Know Caregivers

Right to Informed Consent

Right to Refuse Treatment

Right to Execute Advance Directives

Right to Have Special Needs Addressed

Right to Choose Physician(s)

Right to Trust Caregivers

Right to Patient Advocacy Services

Right to Have Spiritual Needs Assessed and Addressed

Right to Ethics Consultation

Right to Choose Treatment

Right to Try Experimental Drugs

Right to Timely Response to Care Needs

Right to Receive Quality Care

Right to Compassionate Care

Right to Respect

Right to Pain Management

Privacy and Confidentiality

Right to FreedomfromAbuse and Harassment

Right to Know Hospital’s Adverse Events

Right to Discharge

Right to Transfer

Right to Access Medical Records

Right to Access Lab Reports

Right to Know Third-Party Care Relationships

Right to Know Hospital Charges

Right to Know Medical Errors

Right to a Safe Healing Environment

Right to be Free fromRestraints and Seclusion

Which Right is the Greater Good?

Patient Responsibilities

Maintain a Healthy Lifestyle

Keep Appointments

Maintain Current Medication Records

Accurately Describe Symptoms

Provide Full and Honest Disclosure of Medical History

Report Sudden Changes in Health Status

Adhere to the Treatment Plan

When in Doubt, Seek a Second Opinion

Stay Informed

Ask Questions

Follow Discharge Instructions

Treat Caregivers with Respect

Respect the Rights of Other Patients

Show Compassion for Caregivers

Advisory Commission Describes Patient Responsibilities

Teamwork and Professional Relationships

Chapter 15 SummaryCase: Searchfor Truth

Learning Objectives

Introduction

Case:Code of Silence

Characters

Settings

Background

Events of Sunday, October 2

Events of Thursday Morning, October 6

Events of Thursday Luncheon, October 6

Events of Thursday Late Afternoon, October 6

Events of Thursday Evening, October 6

Events of December 27–29 Educational Conference

Glossary

Index

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