Ethical, Legal, and Economic Foundations of the Educational Process.pptx

After completing this chapter, the reader will be
able to:
1. Identify major ethical principles as they apply to
education in health care.
2. Distinguish between ethical and legal dimensions of
the healthcare delivery system with respect to patient,
staff, and student education.
3. Describe the importance of nurse practice acts and
the code of ethics for the nursing profession.
4. Recognize the potential ethical consequences of
power imbalances between the teacher and the
student, or between the nurse and the patient, in
educational and practice settings

5. Describe the legal and financial implications of
documentation.
6. Delineate the ethical, legal, and economic
importance of federal, state, and accrediting body
regulations and standards in the delivery of healthcare
services.
7. Differentiate among financial terms associated with
the development, implementation, and evaluation of
patient and staff education programs.

Ethico-moral and legal foundation of client education
It refers to the ideals that guide one's behaviour. Refers to the behavioural norms or
standards accepted by the society to which a person belongs.
The goal of this discussion is to give the ethical, legal, and economic grounds that support
the patient education initiative on one side, and the provider's rights and obligations on the
other.
Approximately 40 years ago, the field of modern western bioethics arose in response to the
increasing complexity of medical care and decision making.
Ex: when a patient denies a life-saving blood transfusion Should he/she be permitted to
decline or should a health professional persuade him/her otherwise?
This type of scenario described both a medical and a moral concern.Thus, MORAL refers to
the principles of right and wrong action, as well as the goodness and badness of human
character.

Ethics
It refers to the guiding
principles of behavior, and
ethical refers to norms
and standard of behavior.
Moral
Morals refers to an internal value
system ( the moral fabric of one's
being) and this value system,
defined as morality, is expressed
externally through ethical
behavior.
Legal
Legal rights and obligations, on the
other hand, are laws that control
behavior or conduct and are
enforced through the fear of
punishment or consequence, such
as a fine, imprisonment, or both..

Morals and ethics are related concepts, but they have distinct meanings and contexts:
Morals refer to the individual's internal beliefs
and values that guide their behaviour and
judgments of right and wrong. Morals are often
shaped by personal beliefs, cultural upbringing,
religious teachings and individual experiences.
They provide a framework for making decisions
and determining what actions are considered
morally acceptable or unacceptable. Morals
are deeply ingrained and can vary from person
to person.
To summarise, morals are more subjective and individual-oriented whereas ethics are more
objective and are meant to ensure consistent and responsible behaviour within a group.
Ethics, on the other hand, are broader and more
systematic set of guidelines that govern the
conduct and interactions of individuals within a
specific group, profession or society. Ethics
provide a structured framework for evaluating
behavior and making ethical decisions that align
with shared values and norms. Ethical
principles often transcend personal beliefs and
focus on universal concepts of fairness, justice,
honesty and respect.

EVOLUTION OF ETHICAL AND
LEGAL PRINCIPLES
Ethical Codes
Systematic guides for developing
ethical behavior. This represents an
articulation of nine provisions for
professional values and moral
obligations with respect to nurse
patient relationship

1. Service to others
2. Integrity and Objectivity
3. Professional Competence
4. Solidarity and Teamwork
5. Social and Civic Responsibility
6. Global Competitiveness
7. Equality of all professions

As early as 1950, the American Nurses Association
(ANA) developed and adopted an ethical code for
professional practice, titled the Code of Ethics for
Nurses with Interpretative Statements, that has
since been revised and updated several times
(ANA, 1976, 1985, 2001, 2015). This code of ethics
represents an articulation of nine provisions for
professional values and moral obligations with
respect to the nurse–patient relationship and with
respect of the profession and its mission. Lachman
(2009a, 2009b) outlines these provisions and
further clarifies the nursing role in each provision:

• Honor the human dignity of all patients and coworkers.
2. Establish appropriate nurse–patient boundaries, and focus on
interdisciplinary collaboration.
3. The nurse–patient relationship is grounded in privacy and
confidentiality.
4. The nurse is accountable for the personal actions and the behaviors
of those persons to whom the nurse has delegated responsibilities.
5. The nurse is responsible for maintaining competence, preserving
integrity and safety, and continuing personal growth.
6. The nurse has a responsibility to deliver high-quality care to patients.
7. The nurse contributes to the advancement of the profession.
8. The nurse participates in global efforts for both health promotion and
disease prevention.
9. Involvement in professional nursing organizations supports the
development of social policy.

A statement of the rights to which
patients are entitled as recipients of
medical care were created and has
been framed and posted in every
health care facility

1. Right to Appropriate Medical Care and Humane Treatment.
- Every person has a right to health and medical care
corresponding to his state of health, without any discrimination
and within the limits of the resources, manpowerand competence
available for health and medical care at the relevant time. The
patient has the right to appropriate health and medical care of
good quality. In the course of such, his human dignity, convictions,
integrity, individual needs and culture shall be respected. If any
person cannot immediately be given treatment that is medically
necessary he shall, depending on his state of health, either be
directed to wait for care, or be reffered or sent for treatment
elsewhere, where the appropriate care can be provided. If the
patient has to wait for care, he shall be informed of the reason for
the delay. Patients in emergency shall be extended immediate
medical care and treatment without any deposit, pledge,
mortgage or any form of advance paymentfor treatment.

2. Right to Informed Consent. - The patient has a
right to a clear, truthful and substantial explanation,
in a manner and language understandable to the
patient, of all proposed procedures, whether
diagnostic, preventive, curative, rehabilitative or
therapeutic, wherein the person who will perform the
said procedure shall provide his name and
credentials to the patient, possibilities of any risk of
mortality or serious side effects, problems related to
recuperation, and probability of success and
reasonable risks involved: Provided, That the patient
will not be subjected to any procedure without his
written informed consent, except in the following
cases:

a) in emergency cases, when the patient is at imminent risk of physical injury, decline Of death if treatment is withheld
or postponed. In such cases, the physician can perform any diagnostic or treatment procedure as good practice of
medicine dictates without such consent;
b) when the health of the population is dependent on the adoption of a mass health program to control epidemic;
c) when the law makes it compulsory for everyone to submit a procedure;
d) When the patient is either a minor, or legally incompetent, in which case. a third party consent Is required;
e) when disclosure of material information to patient will jeopardize the success of treatment, in which case, third
party disclosure and consent shall be in order;
f) When the patient waives his right in writing.
Informed consent shall be obtained from a patient concerned if he is of legal age and of sound mind. In case the patient is
incapable of giving consent and a third party consent is required. the following persons, in the order of priority
stated hereunder, may give consent:
i. spouse;
ii. son or daughter of legal age;
iii. either parent;
iv. brother or sister of legal age, or
v. guardian
If a patient is a minor, consent shall be obtained from his parents or legal guardian. If next of kin, parents or legal
guardians refuse to give consent to a medical or surgical procedure necessary to save the life or limb of a minor or a
patient incapable of giving consent, courts, upon the petition of the physician or any person interested in the welfare of
the patient, in a summary proceeding, may issue an order giving consent.

3. Right to Privacy and Confidentiality. - The
privacy of the patients must be assured at all
stages of his treatment. The patient has the right
to be free from unwarranted public exposure,
except in the foHowing cases: a) when his mental
or physical condition is in controversy and the
appropriate court, in its discretion, order him to
submit to a physical or mental examination by a
physician; b) when the public health and safety
so demand; and c) when the patient waives this
right in writing.

3. Right to Privacy and Confidentiality(con’t).
The patient has the right to demand that all information, communication and
records pertaining to his care be treated as confidential. Any health care provider or
practitioner involved in the treatment of a patient and all those who have legitimate
access to the patient's record is not authorized to divulge any information to a third
party who has no concern with the care and welfare of the patient without his
consent, except: a) when such disclosure will benefit public health and safety; b)
when it is in the interest of justice and upon the order of a competent court; and c)
when the patients waives in writing the confidential nature of such information; d)
when it is needed for continued medical treatment or advancement of medical
science subject to de-identification of patient and shared medical confidentiality for
those who have access to the information.
Informing the spouse or the family to the first degree of the patient's medical
condition may be allowed; Provided That the patient of legal age shall have the right
to choose on whom to inform. In case the patient is not of legal age or is mentally
incapacitated, such information shall be given to the parents, legal guardian or his
next of kin.

4. Right to Information. - In the course of his/her treatment
and hospital care, the patient or his/her legal guardian has a
right to be informed of the result of the evaluation of the
nature and extent of his/her disease, any other additional or
further contemplated medical treatment on surgical
procedure or procedures, including any other additional
medicines to be administered and their generic counterpart
including the possible complications and other pertinent
facts, statistics or studies, regarding his/her illness, any
change in the plan of care before the change is made, the
person's participation in the plan of care and necessary
changes before its implementation, the extent to which
payment maybe expected from Philhealth or any payor and
any charges for which the patient maybe liable, the disciplines
of health care practitioners who will fumish the care and the
frequency of services that are proposed to be furnished.

4. Right to Information (con’t)- The patient or his
legal guardian has the right to examine and be given
an itemized bill of the hospital and medical services
rendered in the facility or by his/her physician and
other health care providers, regardless of the manner
and source of payment.He is entitled to a thorough
explanation of such bill.
The patient or hislher legal guardian has the right to be
informed by the physician or his/her delegate of
hisJher continuing health care requirements following
discharge, including instructions about home
medications, diet, physical activity and all other
pertinent information to promote health and well-
being.

4. Right to Information (con’t)- At the end of his/her confinement,
the patient is entitled to a brief, written summary of the course of
his/her illness which shall include at least the history, physical
examination, diagnosis, medications, surgical procedure, ancillary
and laboratory procedures, and the plan of further treatment, and
which shall be provided by the attending physician. He/she is
likewise entitled to the explanation of, and to view, the contents of
medical record of his/her confinement but with the presence of
his/her attending physician or in the absence of the attending
physician, the hospital's representative. Notwithstanding that he/she
may not be able to settle his accounts by reason of financial
incapacity, he/she is entitled to reproduction, at his/her expense,
the pertinent part or parts of the medical record the purpose or
purposes of which he shall indicate in his/her written request for
reproduction. The patient shall likewise be entitled to medical
certificate, free of charge, with respect to his/her previous
confinement.

5. The Right to Choose Health Care Provider
and Facility.
- The patient is free to choose the health care
provider to serve him as well as the facility except
when he is under the care of a service facility or
when public health and safety so demands or
when the patient expressly waives this right in
writing.
The patient has the right to discuss his condition
with a consultant specialist, at the patient's
request and expense. He also has the right to
seek for a second opinion and subsequent
opinions, if appropriate, from another health care
provider/practitioner.

6. Right to Self-Determination.
- The patient has the right to avail himself/herself
of any recommended diagnostic and treatment
procedures.Any person of legal age and of sound
mind may make an advance written directive for
physicians to administer terminal care when
he/she suffers from the terminal phase of a
terminal illness: Provided That a) he is informed of
the medical consequences of his choice; b) he
releases those involved in his care from any
obligation relative to the consequences of his
decision; c) his decision will not prejudice public
health and safety.

7. Right to Religious Belief.
- The patient has the right to refuse medical
treatment or procedures which may be
contrary to his religious beliefs, subject to
the limitations described in the preceding
subsection: Provided, That such a right shall
not be imposed by parents upon their
children who have not reached the legal
age in a life threatening situation as
determined by the attending physician or
the medical director of the facility.

8. Right to Medical Records. - The patient is entitled to a
summary of his medical history and condition.He has the right to
view the contents of his medical records, except psychiatric notes
and other incriminatory information obtained about third parties,
with the attending physician explaining contents thereof. At his
expense and upon discharge of the patient, he may obtain from the
health care institution a reproduction of the same record whether
or not he has fully settled his financial obligation with the physician
or institution concerned.
The health care institution shall safeguard the confidentiality of the
medical records and to likewise ensure the integrity and
authenticity of the medical records and shall keep the same within
a reasonable time as may be determined by the Department of
Health.
The health care institution shall issue a medical certificate to the
patient upon request.Any other document that the patient may
require for insurance claims shall also be made available to him
within forty-fIVe (45) days from request.

9. Right to Leave.
- The patient has the right to leave hospital or any other health
care institution regardless of his physical condition: Provided.
That a) he/she is informed of the medical consequences of
his/her decisionl b) helshe releases those involved in his/her
care from any obligation relative to the consequences of his
decision; c) hislher decision will not prejudice public health and
safety.
No patient shaD be detained against hi$/her will in any health
care institution on the sole basis of his failure to fully settle his
financial obligations. However, he/she shall only be allowed to
leave the hospital provided appropriate arrangements have
been made to settle the unpaid bills: Provided. further, That
unpaid bills of patients shall be considered as loss income by the
hospital and health care provider/practitioner and shall be
deducted from gross income as income loss only on that
particular year.

10. Right to Refuse Participation In Medical Research.
- The patient has the right to be advised if the health care
provider plans to involve him in medical research, including but
not limited to human experimentation which may be performed
only with the written informed consent of the patient: Provided,
That, an institutional review board or ethical review board in
accordance with the guidelines set in the Declaration of
Helsinki be established for research involving human
experimentation: Provided, further, That the Department of
Health shall safeguard the continuing training and education of
fUture health care provider/practitioner to ensure the
development of the health care delivery in the country:
Provided, fUfthermore, That the patient involved in the human
experimentation shall be made aware of the provisions of the
Declaration of Helsinki and its respective guidelines.

11. Right to Correspondence and to
Receive Visitors.
- The patient has the right to communicate
with relatives and other persons and to
receive visitors subject to reasonable limits
prescribed by the rules and regulations of
the health care institution.

12. Right to Express Grievances.
- The patient has the right to express
complaints and grievances about the care
and services received without fear of
discrimination or reprisal and to know
about the disposition of such
complaints.Such a system shall afford all
parties concerned with the opportunity to
settle amicably all grievances.

13. Right to be Informed of His Rights and Obligations as a
Patient.
- Every person has the right to be informed of his rights and
obligations as a patient. The Department of Health, in
coordination with heath care providers, professional and civic
groups, the media, health insurance corporations, people's
organizations, local government organizations, shall launch and
sustain a nationwide information and education campaign to
make known to people their rights as patients, as declared in
this Act Such rights and obligations of patients shall be posted
in a bulletin board conspicuously placed in a health care
institution.
It shall be the duty of health care institutions to inform of their
rights as well as of the institution's rules and regulations that
apply to the conduct of the patient while in the care of such
institution.

The first of these principles, autonomy, is derived
from the Greek words auto (self) and nomos (law)
and refers to the right to self-determination (Tong,
2007). Are upheld when the nurse accepts the client
as a unique person who has the innate right to have
their own opinions, perspectives, values and beliefs.
Nurses encourage patients to make their own
decision without any judgments or coercion from
the nurse. The patient has the right to reject or
accept all treatments.
is being completely truthful with patients;
nurses must not withhold the whole truth
from clients even when it may lead to
patient distress.
Vital aspects of patient education:
-COMPETENCE
-DISCLOSURE OF INFORMATION
-COMPREHENSION
-VOLUNTARINESS

Confidentiality refers to personal information
that is entrusted and protected as privileged
information via a social contract, healthcare
standard or code, or legal covenant. Such
information may not be disclosed by healthcare
providers when acquired in a professional capacity
from a patient without the consent of that patient. If
sensitive information were not to be protected,
patients would lose trust in their providers and
would be reluctant to openly share problems with
them
Nonmaleficence means “do no harm” and
constitutes the ethical fabric of legal
determinations encompassing
negligence and/or malpractice.
According to Brent (2001), negligence is
defined as “conduct which falls below the
standard established by law for the
protection of others against
unreasonable risk of harm”

Beneficence is defined as “doing
good” for the benefit of others. It is a
concept that is legalized through
adherence to critical tasks and duties
contained in job descriptions; in
policies, procedures, and protocols
set forth by the healthcare facility;
and in standards and codes of ethical
behaviors established by professional
nursing organizations.
The sixth and final ethical principle, justice, speaks to the
fairness and equal distribution of goods and services. The
law is the justice system. The focus of the law is the
protection of society; the focus of health law is the
protection of the consumer.
Decision making for the fair distribution of resources
includes the following criteria as defined by Tong (2007):
1. To each, an equal share
2. To each, according to need
3. To each, according to effort
4. To each, according to contribution
5. To each, according to merit
6. To each, according to the ability to pay

-The patient’s right to adequate information
regarding his or her physical condition,
medications, risks, and access to information
regarding alternative treatments is specifically
spelled out in various renditions of the Patient’s
Bill of Rights.

Customers deserve outstanding treatment
whatever income, race, etc. Do this. Providers
may request payment. Employer rules must be
followed. Inpatient, outpatient, and community
education. Justice should be taught. Modern
healthcare is driven by economics. Humanism is
disputed. Institutions must maximize resources.

are tangible, predictable
expenditures, a substantial
portion of which include
personnel salaries,
employment benefits, and
equipment.
are those costs not directly
related to the actual delivery
of an educational program.

When patient lengths of stay are
shortened or fall within the allotted
diagnostic-related group (DRG) time
frames. Patients who have fewer
complications and use less expensive
services will yield a cost savings for the
institution.

Occurs when there is increased patient
satisfaction with an institution as a result of
the services it renders, including educational
programs it provides such as childbirth
classes, weight and stress reduction sessions,
and cardiac fitness and rehabilitation
programs. This is an opportunity for an
institution to capture a patient population for
lifetime coverage.

Results when either the patient or
insurer pays a fee for educational
services that are provided. Cost
recovery is realized through the
marketing of health education
programs offered for a fee.

Ethical, Legal, and Economic Foundations of the Educational Process.pptx

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