Each year, US hospitals receive 18.6 million emergency visits resulting in hospital admission, with 3.1 million of these admissions belonging to the critical care unit. With an aging population, physicians and registered nurses increasingly face complex medical situations that expose them to ethical dilemmas when it comes to crucial decisions. During such scenarios, existing legal and ethical frameworks can help healthcare providers arrive at the most satisfactory decision for all parties involved based on the need to provide quality care.
Let’s explore all the legal and ethical that go into decision-making in hospitals.
What are the legal and ethical frameworks in the decision-making process?
Legal and ethical frameworks are analytical tools designed to help doctors and other involved healthcare workers in complex moral decision-making situations. Most frameworks offer step-by-step plans that may be followed chronologically during moral case deliberations and reviews. The plans provide specific guidance regarding acceptable conclusions when a specific decision is taken concerning medical intervention.
The legal frameworks in medical decision-making processes
The legal frameworks that govern decision-making in hospitals are essential for ensuring the provision of high-quality healthcare while protecting the rights and well-being of patients, healthcare providers, and other stakeholders. Here are some of the essential legal requirements that guide everyday decision-making in healthcare facilities:
Informed consent
Informed consent is a crucial provision that mandates healthcare providers to obtain the voluntary and informed agreement of a patient or a loved one before performing medical interventions such as surgeries, treatments, and research participation.
Patients have a right to be adequately informed regarding the proposed medical interventions’ risks, benefits, alternatives, and potential consequences. The consent codes seek to protect both the caregivers and care receivers while fostering mutual trust between the parties to prevent possible misunderstandings and lapses in communication.
Capacity and competence
Laws often define the criteria for determining a patient’s capacity or competence to make medical decisions. Decision-making capacity and legal competence describe a patient’s ability to make consequential decisions regarding themselves as a manifestation of their autonomy. Capacity focuses on a patient’s ability to make autonomous decisions regarding their care as guided by a physician.
Competence is also a legal term describing a patient’s ability to participate in legal processes focused on enabling medical intervention. If a patient lacks the capacity to make decisions, healthcare providers may need to involve a legally authorized surrogate decision-maker, such as a guardian or family member.
Best interest standard
Best interest is a standard in healthcare decision-making used when a patient’s wishes are unknown or have never been expressed. In cases where patients cannot make decisions and have not provided advance directives, healthcare providers may make decisions based on the patient’s best interest, considering their values, beliefs, and medical conditions. In cases where parents are assigned surrogate decision-making roles, healthcare providers must consider several factors following the child’s best interest and not their own preferences.
Some of the factors that determine a child’s best interest include their medical condition and overall well-being, questions regarding quality of life, their prognosis, and the future impact of the current decisions.
Privacy and confidentiality
In the US, any medical decision-making process has to comply with specific laws and regulations that protect patient privacy and confidentiality. Laws such as the Health Insurance Portability and Accountability Act (HIPAA) prohibit healthcare providers from disclosing patients’ medical information without their consent or a legal justification.
Specifically, HIPAA protects patient privacy and governs the use and disclosure of health information. The primary goal of the rule is to ensure an individual’s health information is adequately protected and that there is the necessary flow of information to make informed decisions regarding their healthcare. It permits crucial uses of information while protecting the privacy of the patients seeking care.
Individuals and organizations subject to the Privacy Rule include:
- Healthcare providers: All healthcare providers, regardless of the size of practice, must consider HIPAA rules when deciding to electronically transmit health information in connection with specific transactions such as claims, referral authorization requests, benefit eligibility requests, and any other transaction guided by the HIPAA Transactions Rule.
- Health plans: Health plans such as the health, dental, vision, and prescription drug insurers; the health maintenance organizations (HMOs); the Medicare, Medicaid, Medicare+Choice, and Medicare supplement insurers; and long-term care insurance, are all subject to the Privacy Rule. However, a group health plan with less than 50 participants administered solely by the employer is not a covered entity.
- Healthcare clearinghouses: Companies that process nonstandard information obtained from another entity may also be subject to the Privacy Rule. Clearinghouses help standardize healthcare data by translating information from one format or standard to another, ensuring that all parties involved can understand and use the data effectively. They serve as intermediaries that help ensure healthcare data’s secure and efficient transmission.
The ethical principles in medical decision-making processes
The modern ethical principles in healthcare have undergone several revisions to address developments in medical research, laws, technology, and emerging trends in medical care. Ethical principles ensure patients receive the best possible care while respecting their autonomy, dignity, and well-being. The primary ethical principles in hospitals include:
Autonomy
Autonomy is the principle that individuals have the right to make decisions about their own medical care. Healthcare professionals should respect patients’ right to make informed choices about their treatment options, including the right to refuse treatment, as long as they have the capacity to make such decisions. In essence, healthcare providers should provide the patients with all the information they need to make decisions. Doctors and nurses should also obtain informed consent before performing medical procedures.
Respect
This principle considers the demands made by a patient during the decision-making process. A nurse should always honor or obey the patient’s decisions regarding their medical care. Provided they are well-informed, patients have a right to accept or decline a medical procedure. This framework also requires physicians to always give patients time to consider their options. In this regard, patients should be treated with respect and dignity, recognizing their intrinsic worth as human beings. This includes respecting cultural, religious, and personal values and ensuring that patients are not subjected to unnecessary humiliation or degrading treatment.
Beneficence
Beneficence is the ethical obligation to act in the patient’s best interests and promote their well-being. Healthcare providers should strive to maximize benefits and minimize harm when making medical decisions. This principle emphasizes the importance of providing effective and appropriate care. In essence, a physician should always act to benefit everyone, including patients, the community, and wider society. They should always strive to show love and kindness through their actions. A good example of beneficence is a nurse who interacts with a patient in a friendly manner while willing to honor their wishes.
Non-maleficence
This principle emphasizes the ethical duty of healthcare providers to avoid causing harm to patients. Medical decisions should prioritize minimizing risks and potential harm to patients, and any potential risks should be weighed against the potential benefits of a particular intervention. In cases where patients are incapacitated or not knowledgeable enough regarding a specific medical procedure, the physicians or nurses should always promote actions that will not hurt the patient.
Justice
Justice in healthcare refers to the fair and equitable distribution of healthcare resources and access to care. It emphasizes the need to treat patients fairly and without discrimination, and to allocate resources in a just and equitable way. This principle can be particularly challenging in situations where resources are limited. Medical professionals should ensure that medical burdens and benefits are distributed fairly across all patients when presented with such situations. If there is a patient triage, healthcare providers must evaluate all the patients and determine the areas where attention is required the most.
Veracity
Healthcare professionals have an ethical obligation to be honest and truthful with patients. This includes providing accurate information about the patient’s condition, treatment options, risks, and potential outcomes. Patients need to make informed decisions, and trust is built on honest communication.
Fidelity
Fidelity refers to the duty of healthcare professionals to be loyal and faithful to their patients. This involves acting in the best interests of the patient and maintaining trust and confidentiality. Healthcare providers should avoid conflicts of interest that could compromise their fidelity to the patient.
Common ethical issues in the nursing profession
Ethical issues in nursing refer to a situation where healthcare professionals are tasked with making decisions, but the options available don’t offer a straightforward answer. Generally, the options on the table would usually present a dilemma while complicating clinical relationships and undermining the quality of patient care. Such options may also present moral distress to the decision-maker.
Below are some of the common areas in which ethical issues arise.
Health disparities
It is not uncommon for nurse practitioners to encounter disparities in health and healthcare per a given population. These variations can be attributed to differences in income levels, racial minorities, and immigrants. Generally, the marginalized group tends to have different medical predispositions from the majority population. During crucial decision-making, nurses are obligated to identify such variations to equate healthcare provisions.
Confidentiality issues
As mentioned earlier, nurses are required to protect the confidential health information of a patient. However, there are times when nurses find themselves breaching their confidentiality unintentionally or intentionally. This issue can be challenging when nurses deal with patients’ family members, coworkers, and law enforcement officials. Nurses have to avoid oversharing confidential health information when presented with such scenarios.
Patients’ beliefs
These issues comprise a patient’s cultural and religious perspectives regarding a medical procedure. Nurses are expected to consider possible cultural implications when dealing with a patient. If a nurse is uninformed about a patient’s beliefs, they may breach the patient’s trust when enforcing specific medical procedures. Before deciding on a medical procedure, healthcare professionals should fully inform the patient of the medical procedure’s benefits and relevance regarding their overall well-being. Clear communication with the patient helps establish trust while fostering grounds for modifying procedures to ensure the patient’s beliefs are not violated.
Laws and regulations that impact decision-making in healthcare facilities
Hospitals are subject to a wide range of laws and regulations at the federal, state, and local levels. These laws cover licensing, accreditation, patient rights, and healthcare reimbursement. For example, Healthcare privacy laws such as the Health Insurance Portability and Accountability Act (HIPAA) in the United States protect patient privacy and govern the use and disclosure of health information. Other laws include Medical Malpractice Laws that establish the legal standards for medical negligence and liability, which can impact how healthcare decisions are made to avoid potential legal consequences, and the Emergency Medical Treatment and Labor Act (EMTALA), that requires hospitals to provide emergency medical care regardless of a patient’s ability to pay and ensures ethical treatment in emergencies.
Examples of ethical decision-making in healthcare
An excellent example of ethical decision-making in healthcare is when a physician or a nurse has to choose between patient autonomy and beneficence. Another example is choosing between withholding information that a patient’s close relatives might have requested and being honest with the patient.
Importance of being updated on modern legal and ethical frameworks
Staying informed about legal and ethical issues in healthcare is crucial for providing high-quality patient care. This is why nurses should enroll in online nurse practitioner programs that are
focused on legal and ethical issues in healthcare. The University of Indianapolis’ online MSN-FNP program offers a flexible part-time format for working nurses, in which students have access to personalized support and hands-on clinical training to empower them as future primary care providers. An exemplary education such as this gives students all they need to help shape a brighter future in healthcare.
Final thoughts
Legal and ethical frameworks are designed to help healthcare professionals faced with morally complex decisions regarding patients. These frameworks benefit physicians and nurses by ensuring the decisions they make are in the patient’s interest while ensuring the most satisfaction to all the involved parties.