Liability And Ethics Unit

A contract is a voluntary agreement between two or more people.

Liability refers to being legally responsible for causing harm. Health care workers are liable if they commit a criminal offense. They are liable if they do not meet the established standards of care. And they are liable if they breach a contract. If health care workers cause harm, liability may extend beyond them. The following are three levels of liability that may occur in a health care setting: Personal liability refers to health care workers being responsible for causing harm. Supervisory liability refers to supervisors of health care workers being responsible for workers causing harm. Supervisors are liable because subordinates are expected to work according to the supervisor's management, and the supervisor is responsible for providing adequate supervision. Employer liability refers to employers of health care workers being responsible for workers causing harm. Employers are liable because employees are expected to follow the employer's policies and practices. And the employer is responsible for hiring qualified personnel, providing an appropriate environment, and providing adequate supervision.

Liability, liable

If they breach a contract If they commit a criminal offense If they do not meet the established standards of care

Liability refers to being legally responsible for causing harm.

There are several ways liability can be reduced in health care settings. These include following policies and procedures, keeping proper documentation, filing event reports and keeping anecdotal records, using problem solving, and applying risk management.

Pathogens are microorganisms that are harmful to the body. Pathogens cause infection and disease.

The Environmental Protection Agency (EPA) is a government agency that creates and enforces regulations to protect human health and the environment.

To reduce liability, health care workers should follow their facility's policies and procedures. Policies are the principles that direct the facility's activities. Policies state what the facility does. Procedures are the methods the facility uses to carry out its policies. Procedures explain how the facility operates. For example, in order to prevent exposure to environmental pathogens, a hospital has the policy "Cleaners and disinfectants will be used appropriately." The procedures used to carry out this policy are then described. For example, in order to clean and disinfect environmental surfaces in patient-care areas, health care workers should do the following procedures: Use EPA-registered, hospital detergents and disinfectants, and use them in accordance with the manufacturer's instructions Keep floors and tabletops visibly clean by cleaning them on a regular basis and clean up spills promptly Clean high-touch surfaces such as doorknobs, light switches, bed rails, faucets, and toilets more frequently than minimal-touch surfaces such as walls, blinds, and curtains Clean mops and cloths after use and allow them to dry before reuse, or use single-use, disposable mop heads and cloths Avoid dusting methods that disperse dust Keep vacuums in good repair and equip vacuums with HEPA filters

Policies

Gastrointestinal (GI) has to do with the principal tube structure of the digestive system that runs from the mouth to the anus.

A stomach ulcer is an inflamed area of the stomach lining.

To reduce liability, health care workers should keep proper documentation. In other words, they should properly record all aspects of patient care, including maintaining patients' medical records. In addition, if health care providers warn patients of a potential danger and patients ignore the warning, the patients, not the health care providers, are responsible for any injury. Health care workers should be sure to document if patients disregard such warnings. For example, a man has been taking aspirin daily to reduce the risk of heart disease. Recently, he has been experiencing heartburn and stomach upset. The man's physician recommends that the man stop taking aspirin because it increases the risk of gastrointestinal problems. The man disregards the physician's warning and continues to take aspirin. If the man's stomach upset develops into greater gastrointestinal problems, such as ulcers, bleeding, and perforations, the physician is not responsible. To reduce possible future liability, the physician documents his warning and the patient's decision.

To reduce liability if accidents or violations occur in health care facilities, health care workers must file event reports. Event reports include the following information: Who was involved in the event What occurred When it occurred Where it occurred What actions were taken Statements by any people who were harmed as a result of the event Statements by any health care workers who were involved in the event Statements by any witnesses Health care workers must comply with federal laws and the laws in their state regarding event reporting. In addition to filing event reports, if accidents or violations as well as unusual or noteworthy incidents occur in health care facilities, health care workers should keep anecdotal records. Anecdotal records are personal accounts of events. Health care workers hold anecdotal records in their own possession.

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To reduce liability when faced with a health care issue to which there is no clear resolution, health care workers should use problem solving. The problem solving method is made of the following six steps: Identify the problem: What is the basis of the problem? What is causing the problem? Identify the objective that must be achieved: What is the goal? What must be accomplished? What is the big picture? Identify the circumstances that affect the problem: What are the facts? What is preventing the goal or task from being accomplished? Name all possible solutions: How might the problem be eliminated? How might the goal be adapted? Make and implement a plan: Which solution will be the most effective? Is the solution reasonable? Evaluate the results: Did the solution solve the problem? Would another plan have worked better? Should the solution be repeated or changed? Repeat the problem-solving method until the objective is achieved.

The following is an example of problem solving in a health care scenario: 1) Identify the problem: An elderly patient with severe dementia in a long-term care facility is not eating enough. 2) Identify the objective that must be achieved: The patient's care should promote her health and well-being. 3) Identify the circumstances that affect the problem: Because of her dementia, the patient is unable to make decisions, and she has no advance directives. She also has no family. Therefore, the facility must decide whether or not to implement artificial nutrition. 4) Name all possible solutions: The facility can choose to insert a feeding tube in the attempt to provide adequate nutrition and prolong the patient's life. Or the facility can choose not to insert a feeding tube in order to preserve the patient's pleasure of eating as well as being hand fed by a person as opposed to a machine. 5) Make and implement a plan: The facility chooses to insert a feeding tube. 6) Evaluate the results: The feeding tube agitates the patient so she pulls it out. As a result, the facility restrains the patient and reinserts the feeding tube. The restraints upset the patient so the facility sedates her. The facility reconsiders the patient's well-being. It then decides to remove the patient's feeding tube and return to hand feeding.

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To reduce liability, health care facilities should apply risk management. Risk management is a process of identification, evaluation, and prevention. In other words, risk management first identifies harm to patients, staff, and visitors. Then it evaluates this information. Following this, it uses the results to prevent predicted harm. As a result of preventing harm, risk management reduces liability and loss to health care facilities. For example, a hospital identifies that a number of patients are infected with a disease during surgery. Then the hospital evaluates this information to discover that patients are infected with the disease through contaminated surgical instruments. To prevent future harm, the hospital institutes a new, more effective instrument sterilization process. Because patients are no longer infected with the disease, the hospital is no longer subject to liability and loss. Most health care facilities employ professional risk managers.

Applying risk management

Filing event reports

Personal liability refers to health care workers being responsible for causing harm.

Supervisory liability refers to supervisors of health care workers being responsible for workers causing harm.

Employer liability refers to employers of health care workers being responsible for workers causing harm.

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Laws are rules of conduct enacted and enforced by governments. Ethics are rules of proper conduct among a group of people, such as a religion or profession. Morals, also known as personal ethics, are an individual's personal values. Morals are reflected in people's personal beliefs about what is right and wrong conduct. Ethics and morals may conflict, especially in health care settings. For example, pharmacists are to respect patients' rights to make decisions concerning their health care. A patient gives a pharmacist a prescription for birth control. The pharmacist, though, objects to dispensing birth control on the ground that birth control goes against his moral beliefs.

Ethics

A code of ethics is a list of written statements describing proper conduct for a group of people. The code directs the behavior of the people belonging to the group. And, it directs the people's decisions when faced with ethical problems. A code of ethics for health care workers includes the following behaviors: Autonomy - Health care workers respect patients' dignity and rights, including their right to make decisions regarding their health care. Fidelity - Health care workers care for patients according to their profession's scope of practice. Beneficence - Health care workers promote patients' health and well being. Nonmaleficence - Health care workers refrain from harming patients. Veracity - Health care workers communicate with patients truthfully. Confidentiality - Health care workers maintain confidentiality of patients' health information. Justice - Health care workers treat patients equally and without discrimination.

Direct the behavior of the people belonging to the group Directs the decisions of the people belonging to the group when faced with ethical problems

Respect patients' right to make decisions regarding their health care Care for patients according to their profession's scope of practice Maintain confidentiality of patients' health information Treat patients equally and without discrimination

Associations for many health care professions have established specific codes of ethics. Examples include the Code of Ethics of the American Association of Medical Assistants, the American Nurses Association, the American Medical Association, the American Dental Hygienists Association, the American Dental Association, and the American Pharmacists Association. Health care workers should become aware of their profession's code of ethics.

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Ethical dilemmas occur when moral beliefs conflict. Bioethical dilemmas are dilemmas that involve health care and biological sciences. For example, euthanasia is a bioethical dilemma. Euthanasia is the act of painlessly ending the life of a terminally ill patient at the patient's request due to intense suffering. The moral beliefs in conflict are that ending people's lives is wrong but that diminishing people's suffering and people's right to make decisions regarding their health are right. The following are other bioethical dilemmas: Genetic testing, gene therapy, somatic (adult) stem cell research, embryonic stem cell research, fetal tissue research, and cloning Organ donation and selection of transplant patients Xenotransplantation Withholding or withdrawing of life support Marijuana for pain relief Experimental treatments Human research subjects Animal testing Birth control, emergency contraception, and abortion Artificial insemination, in vitro fertilization, frozen embryos, and surrogate mothers Managed health care and access to health care Even if health care workers feel strongly about bioethical dilemmas, they must respect patients' right to their own opinions.

Morals are reflected in people's personal beliefs about what is right and wrong conduct.

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