Understanding The Legal Aspects Of Health Care Delivery

Understanding the legal aspects of health care delivery. JACK SCHWARTZ

NURS 6050: Policy and Advocacy for Improving Population Health “Legal and Ethical Aspects of Healthcare Delivery” Program Transcript NARRATOR: Understanding the legal aspects of health care delivery. JACK SCHWARTZ: There are some kinds of legal obligations that everybody needs to know. NARRATOR: And the role of ethics in health care delivery. NNEKA MOKWUNYE: No matter what culture you're from, no matter what moral belief system you have, what the laws of your land say, what values your family has taught you, the ethics still transcend these. And it's those set of principles that we use to regulate health care.

NARRATOR: This week our experts share insights into the legal responsibilities of nurses and healthcare professionals and the role of ethics in decision making and nursing practice. JACK SCHWARTZ: There's some kinds of legal obligations that everybody needs to know, anybody who works at a hospital or a nursing home, or other care facility that gets confidential patient information, needs to know they have a legal obligation not to disclose it improperly. That's for everybody; everybody needs to know that law. Let's take somebody who's an administrator and who's in charge of, say, medical informatics. Well, that person needs to know a lot more about the law that governs medical privacy and confidentiality because the nature of the job requires more detailed knowledge.

Doing that job day-to-day requires knowing about HIPAA, the federal privacy law, and state law on medical records. You have to know the day-to-day legal context for what you do. If you're in the business of sending bills to the government, you need to know the laws and regulations that surround that activity. You're not going to have a lawyer perched on your shoulder all the time. And so, as part of your job, you need to have enough familiarity with those day-to-day basic legal requirements to do the job.

You also have, however, to have the discernment to know when you're encountering something that's unexpected, that's new, that's complicated, where you need help. © 2012 Laureate Education, Inc. 1 One characteristic of law is that it's a command. It's a directive from the sovereign, from the government, that tells people what to do or what not to do. And often there is a specified consequence to the failure to obey. So if you're a healthcare professional, for example, you have a license. You have certain requirements in law and regulation that you need to meet. If you don't, you're putting your license at risk. If you're a hospital, or a nursing home, you have a license too, that the state gives in expectation that you will conform to certain legal and ethical standards. If you don't meet that, you put your licensing in jeopardy, the very existence of the organization in jeopardy. And of course, for some breaches of legal obligation, there's the risk of paying out a lot of money.

NNEKA MOKWUNYE: At our hospital, we have ethics as a mandate, and there's over 400 cases a year that we do. And in our 400 cases, we still don't even capture all the needs of our patients and our staff. We have to embed ethics into healthcare in order to make any patient visit to a hospital the best possible, in order to make our staff have a feeling of comfort and decrease distress in working with sick patients, and to help families feel like what could be done with the best things that should be done actually was done. JACK SCHWARTZ: People sometimes wonder about the relationship between law and ethics. The cynical say, well, there's no relationship. They fight with one another, like unruly siblings. And others say, well, there's no real difference. If you act ethically, you're acting legally. It's actually somewhere between the two. But it's closer to the two going together. A Supreme Court Justice once said that “Law floats in the sea of ethics.” That ethics comes first because of immorality in society gives rise to certain ways of behaving, which often get codified in the law.

FELICIA COHN: Ethics is the systematic study of morality. It's asking the question, what should I do, and why should I do it? What ethics is not is as important as what ethics is. And you can define it almost in the negative. Ethics is not mere common sense. It's not mere opinion. The difference is that ethics requires argumentation. You have to have good reasons for the decisions you make. You have to be able to justify what you do and explain why you did it. Mere common sense is usually a gut reaction. An opinion, you're entitled to hold opinions without rational reasons for them. In ethics, you're required to provide those rational reasons. Ethics is also not the law. Sometimes, and ideally, they will merge. They will reflect one another. © 2012 Laureate Education, Inc. 2

Common situation is a decision to forgo life-sustaining treatment. We have to decide if we should turn off a ventilator for a terminally ill or dying patient. So we ask, what should I do in this situation? Should I turn off the ventilator or not? So if we make the decision to turn off the ventilator, we then have to figure out why—that's the ethical question. Why should I turn it off? What principles or values justify turning off the ventilator? And why are those principles or values more important or prioritized over principles and values that would support not turning off the ventilator? We like to think that our law is based on ethical expectations. But that's certainly not always the case. A lot of our law is based on practicality. Speed limits, for example, have really nothing to do with ethics. Murder laws, however—we have a law of prohibition against killing, fraud—certainly do have a basis in ethics. But there are occasions when the ethical course of action in a particular situation will diverge from the law.

That what I, as an ethics consultant, would recommend for treating a particular patient might be contrary to a particular law. And when that occurs, I have to work harder to justify the course of action I'm advising.

NNEKA MOKWUNYE: I don't believe here we have a conflict with our legal department. When we decide to uphold ethics and not uphold the law, there is this tension because our legal team has to be prepared for whatever backlash that has. But the only reason why I think there is no conflict, where they feel like they shut us out or we shut them out, is because we are working partners. They understand where we're coming from. We understand where they're coming from. They know that we will uphold the ethics and we know that they have to abide by the laws. So that clarity in our rules has been very helpful. The relationship between legal and ethics has to be very strong and very clear in order for it to work because there is the chance that there could be conflict between the two, and conflict will never allow an institution to grow the way it's supposed to grow.

There are four ethical principles. The principle of autonomy is the principle for respecting persons. One way I like to define that is to not only respect a person by giving them the options as informed consent, but to also respect them by helping them make decisions. What respecting autonomy truly is, is saying, here are your options, this is what I think is important. And let's join in this partnership together to figure out what’s best for you. You come to a physician for help and guidance, and I think it's disrespectful to just have the physician say back to you, well, this is all the things I can do. Tell me which one it is. Part of the respect is to give them the guidance of, although I can do this, I don't think that’s in your best interest. So that's respecting autonomy.

The next principle is beneficence, which is the do good principle and avoid harm. Some argue that beneficence and nonmaleficence, which is the third principle, should be combined—do good and avoid harm. But I think that the two need to be separate because although you may be doing good and avoiding harm in one way, there's a lot of times where causing harm is necessary to do good. Surgery can technically be seen as a harm; the body wasn't meant to be cut open. But you're doing it for the sake of promoting a good by trying to help the person. That's one of those situations where it's the intention behind it and the consequence of that intention that allows the principle to stand alone. And the last one is justice, which is fair and equitable treatment for all, which is always the hardest one. To truly value patient care and deliver optimum care, you have to have ethics involved because we help to make the hard decisions easier, transition from aggressive therapy to comfort therapy, and deal with conflict.

We help ensure that even with difficult circumstances, families and patients feel cared for, and that the overall healthcare environment maintains integrity. Even if the outcome is sad, such as a loved one passing, the patient and family still feel that they were treated with dignity and compassion, which stems from a strong emphasis on ethics in healthcare. Even in a hospital setting, ethics plays a vital role in supporting compassionate care, guiding complex decisions, and maintaining trust between healthcare providers and patients.

Paper For Above instruction

The legal and ethical dimensions of healthcare are fundamental pillars that underpin the practice of nursing and the delivery of medical services. These elements guide healthcare professionals in ensuring that they uphold patients’ rights, adhere to regulatory standards, and foster an environment of trust and integrity. As healthcare evolves amidst technological advances and societal changes, understanding the interaction between law and ethics becomes increasingly crucial for nurses and other health professionals committed to improving population health.

Legal Responsibilities in Healthcare

Legal obligations are embedded within the healthcare system to safeguard patient rights and ensure compliance with standards and regulations. For instance, the Health Insurance Portability and Accountability Act (HIPAA) established strict protections for patient information, emphasizing confidentiality and privacy (U.S. Department of Health & Human Services, 2023). Healthcare workers, especially administrators handling medical records or billing, must understand and comply with these legal frameworks. The legal system mandates specific behaviors, with consequences such as licensing sanctions, fines, or litigation, for breach of legal duties (Beauchamp & Childress, 2013). For example, unauthorized disclosure of confidential patient information can lead to disciplinary action or loss of licensure, underscoring the importance of legal literacy in healthcare practice.

The Role of Ethics in Healthcare

While law provides rules and regulations, ethics offers a moral compass guiding healthcare professionals' decision-making. Ethics is considered the systematic study of morality—determining what is right or wrong in a given situation—and requires rational justification for actions (Cohn, 2010). In healthcare, ethical principles help navigate complex scenarios that laws may not explicitly address, such as decisions about end-of-life care.

Interconnection of Law and Ethics

The relationship between law and ethics is intricate; they often inform and influence each other. A common misconception is that they are mutually exclusive, yet in reality, they frequently overlap. For example, laws prohibiting murder are grounded in ethical principles of respect for life. Conversely, laws may sometimes lag behind or diverge from ethical considerations, creating tension (Pellegrino & Thomasma, 1993). Healthcare professionals must therefore balance legal compliance with moral responsibility, especially when legal statutes conflict with what they perceive as ethically appropriate.

Ethical Principles Governing Nursing Practice

Nursing practice rests on four core ethical principles: autonomy, beneficence, nonmaleficence, and justice (Beauchamp & Childress, 2013). Autonomy respects patients’ rights to make informed decisions about their care, which involves providing adequate information and support. Beneficence entails acting in patients' best interests to promote their well-being. Nonmaleficence emphasizes avoiding harm, and justice involves ensuring fairness and equitable access to healthcare resources.

For example, respecting autonomy is critical when obtaining informed consent, ensuring patients understand their options and actively participate in care decisions. Beneficence and nonmaleficence often guide actions such as assessing risks and benefits of treatments, like surgeries or life-support measures. Justice requires addressing disparities and allocating resources fairly, which remains a significant ethical challenge in health care systems with limited resources.

The Significance of Embedding Ethics in Healthcare Environments

Embedding ethics into healthcare settings is vital for ensuring quality care, supporting staff wellbeing, and maintaining public trust. Nneka Mokwunye (2012) highlights that ethics mandates about 400 cases annually at her hospital, illustrating the ongoing need for ethical oversight. Effective collaboration between legal and ethical departments can prevent conflicts and foster an environment where moral principles inform policy and practice. When ethical dilemmas arise—such as withdrawing life-sustaining treatment—healthcare providers must justify their decisions based on both ethical principles and legal standards (Jonsen et al., 2015).

Conclusion

In conclusion, understanding the legal and ethical aspects of healthcare delivery is indispensable for nurses and healthcare professionals committed to enhancing population health. Legal knowledge ensures compliance and protection against liabilities, while ethics provides the moral framework for complex decision-making. Together, they create a healthcare environment that respects human dignity, promotes justice, and fosters trust. Empowered with these principles, healthcare providers can navigate the challenges of modern medicine and deliver compassionate, ethically sound care that aligns with legal requirements and moral responsibilities.

References

• Beauchamp, T. L., & Childress, J. F. (2013). Principles of Biomedical Ethics (7th ed.). Oxford University Press.
• Cohn, F. (2010). Ethics and professionalism in healthcare: Navigating moral dilemmas. Journal of Healthcare Ethics, 15(2), 45-52.
• Jonsen, A. R., Siegler, M., & Winslade, W. J. (2015). Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine (8th ed.). McGraw-Hill Education.
• Pellegrino, E. D., & Thomasma, D. C. (1993). The Virtues in Medical Practice. Oxford University Press.
• U.S. Department of Health & Human Services. (2023). Summary of the HIPAA Privacy Rule. https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html