Chapter 7 Ethical Considerations 2018 Cengage Learning All

Chapter 7 Ethical Considerations © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Ethics (Slide 1 of 2) • Defined in terms of what is considered right or wrong • Sometimes referred to as “morals” • More of a philosophy related to making judgments about right and wrong • American Medical Association (AMA) code of ethics • American Hospital Association (AHA) Patients Bill of Rights • More than 50 differing codes of ethics for professional organizations © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 2

Ethics (Slide 2 of 2) • Principle-centered leadership - Guidelines to how you might perform ethically in medical setting - Adapted from Stephen R. Covey’s The 7 Habits of Highly Effective People and Principle. Centered Leadership • Five Ps of ethical power - Purpose Pride Patience Persistence Perspective © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 3

Keys to the AAMA Code of Ethics • Render service with full respect for the dignity of humanity • Respect confidential information • Uphold honor and high principles of the profession and accept its disciplines • Seek to continually improve the knowledge and skills of medical assistants for the benefit of patients and professional colleagues • Participate in additional service activities aimed toward improving the health and well-being of the community © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 4

Confidentiality • Must not reveal information without consent unless required by law • Patients must feel comfortable revealing information • Some incidents must be reported • Patients electronic health records must be secure © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 5

Medical Records • Records property of provider and patient • Do not reveal information without patient consent • Record confidential • Transfer records to authorized provider if requested • Provider should provide copy or summary if patient requests • Cannot be withheld because of unpaid bill © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 6

Professional Fees and Charges • Illegal or excessive fees should not be charged • Based on fees customary to locale • Reflect difficulty of services and quality of performance • Fee splitting unethical • Charge only for services rendered and only what's on the patients chart © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 7

Professional Rights and Responsibilities (Slide 1 of 2) • May choose whom to serve • May not refuse patient on basis of race, color, religion, national origin, or any other illegal discrimination • Cannot deny treatment of HIV-infected patient • Cannot neglect or refuse patient treatment unless withdrawn from case • Patients have right to know their diagnoses © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 8

Professional Rights and Responsibilities (Slide 2 of 2) • Only providers should inform families of patient’s death • Should expose incompetent, corrupt, dishonest, and unethical conduct by other providers • May not treat patients if under influence of controlled substances or alcohol • Must take precautions if HIV positive • Must avoid “conflicts of interest” © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 9

Disaster Response and Emergency Preparedness • Medical professionals are essential at the time of any disaster, such as epidemic floods, fires, terrorist attacks • Care of sick and injured is primary concern • Providers should consider seeking training in emergency preparedness and disaster response © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 10

Treatment for Culturally Diverse Clientele • Same quality of care to all patients regardless of race or ethnicity • All patients have the right to participatory decision making with their providers based on a mutual trust • Eliminate biased behavior toward any individuals different from themselves • Encourage diversity when hiring © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 11

Care of the Poor • Should be regular part of every provider’s practice • Encouraged to take certain number of patients on reduced-cost basis or provide free services • Volunteer their time to lobbying and being advocates for those without medical coverage • Providers can volunteer their time to lobbying and being advocated for those without medical coverage © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 12

Abuse • Neglect, physical, emotional/psychological/mental injury, sexual • See Table 7 -1: Descriptions of Abuse • Child, elder, intimate partner violence (IPV) • All 50 states mandate reporting of child abuse • Most states have legislation regarding elder abuse • Reporting abuse of IPV varies by state - Stalking is a reportable crime in some states - Rape is a reportable criminal act © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 13

Bioethics (Slide 1 of 4) • Ethical issues dealing with all aspects of life and death • Historically, most ethical decisions were made by physicians and esteemed members of the medical or legal profession • Advancing technology allows patients to have a more active role in bioethics © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 14

Bioethics (Slide 2 of 4) • Infants - Imperiled newborns (disabled, deformed, premature/low birth weight) who survive with modern technology incur soring costs of expensive interventions, which is not always covered by insurance • Children - When not well taken care of, have a great need for preventive, curative and rehabilitation care, vaccinations and attention to eating disorders © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 15

Bioethics (Slide 3 of 4) • Adolescents - Need for independence, changing values, and desire for acceptance may lead to risky sexual behavior, drug and alcohol experimentation - Mental health issues may interfere with normal social development - Adolescents between 14 and 18 may seek treatments for substance abuse, birth control and abortion without parental consent • Adults - Adults may have a hard time balancing family and work © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 16

Bioethics (Slide 4 of 4) • Senior adults - Right to dignity and privacy - Difficult for new patients to find providers who take Medicare/Medicaid - Some may have to choose between food, health care or purchase of prescription medication - Dementia is a growing problem that is financially and emotionally exhausting - Ignored advanced directives © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 17

Allocation of Scarce or Limited Medical Resources • Medical resources are still not available to everyone, even with the Affordable Care Act (ACA) • ACA - Helps more children get health care - Young adults more access to vaccinations - Hispanic and non-Hispanic black children lack access to health care • Macroallocation • Microallocation © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 18

HIV and AIDS • CDC recommends voluntary screening and should become part of medical care in patients 13 -64 • Confidentiality must be safeguarded • It is unethical to deny treatment • Health professional must encourage an infected person to cease any activity that endangers the other person. Refusal would allow the provider to contact authorities. • Many states and cities provide partner notification programs © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19

Reproductive Issues • Female genital mutilation • Contraception • Sterilization - Tubal ligation - Vasectomy • Assisted reproduction - Artificial insemination - In vitro fertilization - Surrogacy © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 20

Abortion and Fetal Tissue Research • Constant court challenge to validity of Roe v. Wade • State restrictions vary, but abortion in first trimester is legal without interference • Health care professionals cannot be forced to perform or participate in abortions • Many unanswered ethical questions related to abortion • Raises the issue of fetal tissue research and transplantation • Use of umbilical cord blood © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 21

Genetic Engineering/Manipulation • Used in diagnosis of disease, production of medicines, forensic documentation, research • May be able to create custom-made organs to replace those that are defective or diseased • Where does cloning stop? • General Assembly of the United Nations voted to prohibit all forms of human cloning in 2005 © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22

Dying and Death • Patients making more choices • Examples seen in Karen Ann Quinlan and Terri Schiavo cases • Physician-assisted suicide legislation in Oregon • Other states considering similar action • Quality-of-life issue • Religious opposition to assisted dying • Aid in dying is not euthanasia © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 23

Hospice • Make patients comfortable and as free from pain as possible; allow them dignity in their deaths • Death treated as natural end-of-life experience • Death neither hastened nor prevented • Often covered by insurance and less expensive than inpatient hospital care © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 24