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Legal, professional and ethical issues relating to patients

| February 8, 2017

Abstract

The role of professionalism, ethics and the law has a direct impact on the experience of a patient in the modern world. This essay examines several facets that impact the patient and play a factor in the level of care provided. The data provided illustrates the integrated nature of the three aspects as well as demonstrating the benefit of ethical action. This essay will be of use to any researcher identifying patient rights.

1 Introduction

The legal, professional and ethical issues surrounding patients have long been a matter of debate (Baylis, 2010). This essay assesses the state of expectations that surrounds each of these areas in an effort to identify specific elements that provide clarity. Beginning with a base background this evaluation will define each element in order to create a foundation for continued study. Next will be a critical appraisal of the ethical, legal and professional issues that have an impact on a patient seeking assistance. A combination of the elements of this essay will create the capacity to illustrate the strengths and detriments commonly associated with being a patient in the modern system.

In the end, this essay examines past policy, modern practice and future potential in an effort to establish a better understanding of the professional, legal and ethical issues that influence and impact patients.

2 Patient Issues

2.1 Background

The moment that a consensual relationship has been established between doctor and patient there are critical legal, ethical and professional duties that are required on the part of the professional and expected on the part of the patient (Purtilo, Haddad and Doherty, 2014). A working relationship is enacted when a patient knowingly seeks out a health provider in order to address issues, and is cemented when the provider accepts the patient. After this point the physician and patient role becomes increasingly complex as issues must be continually assessed (Baylis, 2010). The role of patient rights and a physician or administrator duties are subject to change depending on the culture, region or nation that the person resides in (Baylis, 2010). With a distinct view to societal influence the legal and cultural definition of rights and responsibilities will vary. Others contend that a patient’s rights should be universal regardless of the place of residence or status (Corey, Corey and Callahan, 2014). A standardization of policy would reduce many issues that often plaque both patients and management (Corey et al, 2014). A demonstration of the effort to amend the build progress rests in the Declaration of Helsinki that served to lay out a set of ethical guidelines that have come to be highly regarded as a form of basic infrastructure (Purtilo et al, 2014).

In an effort to address many of the legal, professional and ethical issues that surround the care of patients nations such as the United States have enacted a patient’s bill of rights with the express purpose of protecting and clarifying the role and duties of the health care system (Purtilo et al , 2014). These protections and guarantees create a form of reassurance that many find necessary in order to depend on the modern medical system. Hafferty and Franks (1994) conversely argue that a standardization of legal and professional behaviours will limit the capacity of the staff to respond to the patient’s needs. This argument further illustrates with the increase attention to teaching and adherence to an ethical standard much ability to move forward and progress in the practical world is lost (Hafferty et al 1994). However, the increase in ethical teaching over the course of the past decade has illustrated a benefit to making ethically and morally based business patient decisions (Kraus, Stricker and Speyer, 2011). With sensitive issues commonly addressed in a as regards the patients, an understanding and compassionate assessment and care pattern enhances the entire experience.

Common elements of a patient’s rights platform will include a right to make independent medical decisions fully informed by responsible authority (Kraus et al, 2011). A patient form consent is a highly sought after protection this area (Kraus et al, 2011). With a clear need to provide a balanced opportunity for treatment, yet allow the provider latitude to accomplish what is necessary there is a delicate adjustment that must be maintained. There is a clear and abiding need to include patient autonomy in any form of care (Kraus et al, 2011). Many in the health care industry have opposed a formalized standard for patient care as an unnecessary burden that would only increase the paperwork and fundamental cost (Stirrat, Johnston, Gillon and Boyd, 2009). In the industry itself, the providers often cite the element of private competition as adequate to continually spur on high standards of patient care. The opposite argument states that patient care has been seen to be lax in environments that do not have adequate oversight to ensure compliance (Ellershaw and Wilkinson, 2003). Occasionally a patient’s care has been diminished by the lax form of care instituted by the institution (Ellershaw et al, 2003). Others point to the continued high standards that are a model of the high end private market as an example of what a positive free market patient care policy should embody (Stirrat et al, 2009). However most utilize the deontological tool to assess and evaluate the benefits of any one care process (Stirrat et al, 2009). Much like the

Morally, the ethical position of a professional caregiver dictates a well-rounded and considered implementation of care that provides a solution to the patient’s on-going issues (Nettina, 2013). The position of non-maleficence, or, ‘first do no harm’, illustrates the proper role of the provider (Nettina, 2013). Further, this form of care creates a perception of beneficence that provides much of the moral standing for care providers (Nettina, 2013). A legal obligation may prevent the caregiver from doing what may be an ethically right act (Ellershaw et al, 2003). This combination of considerations comprises the full range of professional liability that patients are linked to.
2.2 Ethical Issues
An ethical issue that ranks high at every level of care is the capacity for the patient to remain safe while receiving care (Leape, 2005). There is an ethical necessity for the caregiver to do all that is necessary to prevent injury to their patients (Leape, 2005). This broad umbrella of safety expectations has led to an over expectation of comfort and quality of care, which in turn diminishes the perception of care (Hafferty et al, 1994). If in the process of ensuring patients safety something goes wrong, it becomes the ethical responsibility of care giver to identify new method to respond to similar cases (Leape, 2005). Others illustrate the high cost that can quickly be generated from investing resources haphazardly in an attempt to anticipate each and ethical issue (Ellershaw et al, 2003).

All care providers have an ethical responsibility to take responsibility for mistakes made that impact their patients in any manner (Leape, 2005). The all too common effort to avoid or shift blame away, in order to preserve other clients must not be a consideration during the implementation of ethical patient’s considerations. The full scope of an issue may not be apparent immediately, dictating a delay in admitting fault (Stirrat et al, 2013). This argument is clearly illustrated in the complex issues surrounding ethical considerations in the field of mental health care for patients (Kraus et al, 2011).

Ethically, mentally ill patients should be given the exact same rights and comforts that any other patient would receive (Kraus et al, 2011). Influences that include safety and behavior often have impact on the manner in which care is given (Stirrat et al, 2013). In some situations the question of care comes down to the decision of the provider and their unique approach to the illness. A common ethical dilemma that can lead to other professional and legal issues rests in the question of when to medicate and when to refrain from medication (Nettina, 2013). With a patient’s rights indicating that the best possible method be utilized, is this to be found in the reduction of pain or the allowance of pain in order to treat the larger issue? The ethical and moral questions must be continually addressed by both the patient and the provider in order to arrive at the best fundamental answer (Corey et al, 2014). The converse argument states that the professional knows best and should the person making the crucial decisions (Hafferty et al, 1994).

2.3 Legal Issues

There are a wide range of legal issues that make providing care for a patient a complex experience (Nettina, 2013). A patient must consider each element of their care in order to ensure that the appropriate services have been rendered. Nettina (2013) identifies the primary sources of legal risk in the nurse’s profession as patient care, procedures performed and the associated quality of documentation. This implies that at any one point a mistake in care may be interpreted as a legal lapse making the provider liable (Nettina, 2013). In order to minimize the exposure to legal and financial process, instruments including risk management systems and the implementation of devices designed to anticipate and reduce the risk of injury for patients (Nettina, 2013). The converse position argue that the financial expense of keeping up with the latest developments in science has a direct adverse impact on the manner in which a small provider can find it difficult to sustain operations (Corey, 2014).

In many nations including the United States and the United Kingdom, the fact that it is illegal to discriminate against a patient based on gender, nationality, religion or any reason allows for every person to find adequate care (Richardson and Storr, 2010). Others advocate for the application of health care after an assessment of insurance and payment abilities (Ellerwshaw et al, 2010). Potentially, those lacking an adequate source of funding for health care have received only marginal consideration, which in turn can quickly become not only an ethical and professional detriment but a legal issue that can diminish overall operations (Richardson et al, 2010). Yet, the provider can cite the case as bringing beyond their capacity and turn a patient away, thereby citing a legal reason to turn away patients (White and O’sullivan, 2012).

Once treatment has commenced it is legally required to obtain consent of the patient prior to the performance of any treatment that may substantially impact the patient (Bayliss, 2012). This legal right ensures that a patient is informed before possible life altering decisions are made. In some cases a layman patient will not adequately understand the full issue at hand, and therefore the professional associated with the concern should make the call (Kraus et al, 2013). This position of decision making capacity again touches on the elements that are directly related to the ethical and professional policies and positions of the institution that is providing the patient with care. Further, once care has begun, the patient is assured of continuity of care as well as confidentially (Bayliss, 2012). This legal underpinning ensures that an incapacitated patient will not have to make critical decisions immediately or during the procedure.

A primary method of protection for patients and overall control for care providers rests in the legal institution of mal practice (Jonsen, Siegler and Winslade, 2006). Others argue that the institution of mal practice ties the hands of care providers by putting too many hurdles in way of effective care (Hafferty et al, 1994). Still others advocate for a mitigated form of malpractice that addresses the needs of the patient without threatening the entire structure of the provider’s livelihood (Corey et al, 2014). In cases that a providers services can be proven to be less than what was expected by the patient or the institution, there is the opportunity for financial redress. In order to mal practice to be claimed, there must be an existing patient and provider relationship acknowledged on all sides (Jonsen et al, 2006).

A patient is legally entitled to a referral to a better provider if the first practitioner is unable to meet their needs (Bayliss, 2013). This area touches on the ethical responsibly of the provider to assist the patient in any reasonable manner (Corey, 2014). Others cite the potential for litigation if the referral goes wrong and there are problems for the patient (Hafferty et al, 1994). A continued source of worry for the medical profession is the looming threat of court action over a mistake or oversight on their part (Bayliss, 2013).

2.4 Professional Issues

The entirety of the expected behaviour of any patient related institution is required to exhibit professional and exemplary behaviour (Corey et al, 2014). This expectation is tempered by region, financial issues and the available of competent staff (Urden, Lough, Stacy and Thelan, 2006). Many contend that care for the patient should come before financial or regulatory concerns (Bayliss, 2012). Regional and national political regulations play a large part in the establishment of professional standards as regards the treatment of patients in several areas around the world (Corey et al, 2014). A Professional perception is made up of the ethical and legal considerations that are relevant to the position, again providing a firm indication of the integrated nature of the legal, ethical and professional aspect of patient care (Bayliss, 2012).

The professional will not neglect the rights of the patient in the pursuit of their goals (Corey et al, 2014). This facet reflects the need for the professional to terminate the relationship at the correct time, for the proper reason. In many cases, some professionals will make a billing cycle longer for the simple reason of increased revenue with little effort (Corey et al, 2014). Others describe this approach as overly cautious and cite the need to be certain of the outcome for the patient before any change of status should be implemented (Bayliss, 2012). This same sense of professionalism is extended to the form of treatment that a patient has the right to expect, with the best choice, not the latest trend being the choice (Stirrat et al, 2013). The patient must be given every component of information in order to provide an informed consent. Anything less than full transparency on the part of the provider is an ethical, legal and professional blunder (Corey et al, 2014).

3 Conclusion

This essay examines the role of the legal, ethical and professional actions as regards the expectations of the patient. With the evidence presented in this review, there is argument for many issues that touch on all three aspects. Lacking a universal patient’s bill of rights, the issues experienced by patients seeking assistance can vary widely according to region and financial ability. The data presented in the this essay indicates that while the ideal system advocates for a fair and equal patient experience, it is often those that have the financial support that have the best care.

The evidence presented here provided support for the contention that ethical decisions will benefit the professional and legal standing of the patient provider. By ensuring a high standard of care, the provider is doing everything possible ethically and morally to address the concern. This effort diminishes the potential legal ramifications that centre on the mal practice and court process. The areas of ethics, professionalism and legality correspond to create a complex environment for a patient to navigate. This makes it necessary to ensure a high standard of professionalism within the ranks of the patient provider network. There must be a balance as there cannot be an effort to placate the patient that becomes adverse to the overall treatment. Much like any other industry there is a balance that must be maintained in the relationship between provider and patient in order for the best results to be experienced.

The modern world has provided patients with new and diverse opportunities for care in nearly every nation around the world. With the areas of professionalism, legality and ethics playing a building role in the way services are provided, there must be a continual and considered approach to each policy in order to ensure the rights of everypatient. In the end it will be the combination of all three aspects that create the opportunity for progress.

References

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