UNIT 4

LEGAL AND ETHICAL FRAMEWORK

By: [email protected]
May 2023
 Learning Objectives
upon completion of this unit you will be able to :
 Understand legislation and common laws relevant to work role
 Ensure confidentiality of individual’s record.
 Prevent disclosure of patient’s information to another person
without patient’s consent.
 Recognize ethical issues and ethical dilemma in the workplace
 Released patient-specific data to only authorize users in
accordance with organizational policy.
 Publicize ethical standards related to patient privacy rights
according to organizational policy.
 Legislation and Common Laws
 Legislation:- is law made by parliaments.
 Legislation is also known as statute law, statutes, or Acts of
Parliament.
 If there is a conflict between legislation and the common law,
legislation will over-ride the common law. However, that
conflict must be clear.
 There is a presumption that rights under common law continue
unless the legislation clearly does away with them.
 Legislation is written on the common law.
 Ethics and law as enablers of CRC
 Ethics as discussed in the previous sessions, is considered as a
standard of behavior and a concept of right and wrong beyond
what the legal consideration is in any given situation.
 Law is defined as a rule of conduct or action prescribed or
formally recognized as binding or enforced by a controlling
authority.
 Law is composed of a system of rules that govern a society
with the intention of maintaining social order, upholding
justice and preventing harm to individuals and property.
 Law systems are often based on ethical principles and are
enforced by the police and criminal justice systems, such as
the court system.
 Confidentiality of Individual’s Record

Concept of Confidentiality
• Confidentiality in healthcare ethics underlines the
importance of respecting the privacy of
information revealed by a patient to his or her
health care provider, as well the limitation of
healthcare providers to disclose information to a
third party.
• The healthcare provider must obtain permission
from the patient to make such a disclosure.
 Concept of Confidentiality
The information given confidentially, if
disclosed to the third party without the consent
of the patient, may harm the patient, violating
the principle of non-malfeasance. Keeping
confidentiality promotes autonomy and benefit
of the patient.
The high value that is placed on confidentiality has
three sources:

 Autonomy: personal information should be

confidential, and be revealed after getting a
consent from the person
Respect for others: human beings deserve
respect; one important way of showing respect
is by preserving their privacy.
Trust: confidentiality promotes trust between
patients and health workers
 The right of patient to confidentiality:

All identifiable information about a patient’s

health status, medical condition, diagnosis,
prognosis and treatment and all other
information of a personal kind must be kept
confidential (secretly), even after death.
Exceptionally, family may have a right of access
to information that would inform them of their
health risks.
 The right of patient to confidentiality:
 Confidential information can only be disclosed if the
patient gives explicit consent or if expressly provided
for in the law. Information can be disclosed to other
healthcare providers only on a strictly "need to know"
basis unless the patient has given explicit consent.
All identifiable patient data must be protected. The
protection of the data must be appropriate to the
manner of its storage. Human substances from which
identifiable data can be derived must also be
protected
 The right of patient to confidentiality …
 Disclosure of patient information occurs frequently in many
healthcare institutions. Many individuals (physicians, health
officers, nurses, laboratory technicians, students, etc) require
access to a patient’s health records in order to provide adequate
care to that person and, for students, to learn how to practice care
provision.
 Care providers routinely inform the family members of a deceased
person about the cause of death. These breaches of confidentiality
are usually justified, but they should be kept to a minimum and
those who gain access to confidential information should be made
aware of the need not to spread it any further than is necessary for
descendants benefit. Where possible, patients should be informed
ahead that such a breach might occur.
 The right of patient to confidentiality ….
 Many countries have laws for the mandatory reporting
of patients who suffer from designated diseases, those
deemed not fit to drive
 Care providers should be aware of the legal
requirements to be able to disclose patient information.
However, legal requirements can conflict with the
respect for human rights that underlies healthcare
ethics. Therefore, care providers should look carefully at
the legal requirement to allow such an infringement on
a patient’s confidentiality and assure that it is
justified.and those suspected of child abuse.
 Ethiopia Council of Ministers Regulation299/2013,
Article77

 A health professional may not disclose, verbally or in

writing, information regarding a patient unless the
appropriate organ believed that there is a prominent
health risk to the public demanding to do so, it is ordered
by a court, he gets written consent from the patient or
the patient's guardian or it is permitted bylaw
 A health professional may release or transfer
information regarding patients for the purpose of
conducting scientific research or studies where the
information released is in such a manner that it does not
identify directly or indirectly any individual patient.
 Ethiopia Council of Ministers Regulation299/2013,
Article77

 A health professional shall encourage a

patient with communicable diseases to
disclose his status to individuals with potential
exposure to the infection.
 Ethical liabilities listed on proclamation661/2009

 Duty to fully record personal health information generated during each

encounter (Art.37)
 Duty to report the existence of professional mal-practice to the appropriate
regulatory organ (36).
 Duty to practice in accordance with the standards of healthcare (Art.34)
 Duty to practice with the scope of professional practice (Art.34).
 Duty to render emergency medical treatment within the scope of his
professional practice (Art.38).
 If a health professional is not capable of providing the necessary emergency
medical treatment, he or she shall immediately refer the patient
 Duty to perform in accordance with the relevant Code of Ethics (Art.35).
 No person shall practice as a health professional without having obtained a
professional practice license (Art.33).
 Informed consent
 Informed consent is legal document whereby a patient signs written
information with complete information about the purpose, benefits, risks and
other alternatives before he/she receives the care intended. It is a body of
shared decision making process, not just an agreement
 Concepts of Ethical issues and ethical
dilemma
A dilemma is a situation in which two or more
choices are available; it is difficult to determine
which choice is best and the needs of all these
involved cannot be solved by the available
alternatives.
Ethical dilemmas arise when a difficult problem is
seemingly incapable of a solution that will satisfy
everyone who is involved. The same dilemma might
occur when a situation arises that involves a choice
between equally unsatisfactory alternatives.
 Concepts of Ethical issues and ethical
dilemma…
In ethical conflicts, the decision maker is confronted with
more than one course of action that respects personal,
professional and societal morality, but by deciding on
one course of action the other course is harmed in some
way. For example, as a Health Extension worker you may
face confidentiality conflicts. You are morally and legally
obliged to keep patient information confidential. At the
same time, you may be required to disclose sensitive
information because breaking the rules of confidentiality
would benefit the family or the wider community.
 The following are among common ethical
dilemmas encountered in the healthcare:

Resource scarcity related dilemmas: Health care is

resource intensive and there is always gap
between demand and supply. This dilemma is a
universal phenomenon though particularly severe
in low-income countries where there is a large
population and high burden of disease. Handling
such dilemmas fairly in a companionate, respectful
and caring manner should be satisfying to all
parties. A type of dilemmas may appear could be:
Refusal of Treatment dilemma: This can happen
in many ways including withdrawal from
treatment against medical advice for different
reasons, because of cultural and/or religious
beliefs or personal reason
Disclosure and truth telling Dilemma: Healthcare
providers have the responsibility to tell the truth
about the diagnosis, treatment, prognosis and
related issues to the patient, parent or legitimate
care taker. However, it is quite a common dilemma
that relatives of patient come and ask health workers
not to tell the truth to the patient with an excuse of
protecting the patient from stress. The patient should
be allowed to plan his/her life based on firsthand
information on his/her health status.
End of Life dilemma: Futility is when it is known
that all possible efforts would not reverse the
patient’s condition or patient is brain dead. In
such situations, the dilemma of withholding or
withdrawal of treatment arises.
Health care providers and families get conflicted
whether continuing the treatment is actually
helping or hurting the patient, prolonging
suffering
 Common ethical issues
Practitioner-client relationship
 Privacy and confidentiality
 Shared decision making
 Allocation of scarce resources
Stigma and illness
Reproductive health care
 Disclosure of Information
• Disclosure of information is not necessarily an
actionable breach of confidence. Disclosure may
be allowed, under certain circumstances, when
it is requested by: the patient, and where it
applies, freedom of information can be used by
patients to obtain health care information:
 Other health practitioners (with the patient’s consent, and
where the information is relevant to the patient’scare);
 Relatives in limited circumstances (e.g., parents when it is
in the interests of the child);
 Researchers with ethics committee approval (and where
the approved process is followed);
 The court
 The media, if the patient has consented;and
 The police, when the health profession has a duty to
provide the information.
 The responsibility of health workers
 Obtain informed consent from a patient, in accordance with the
relevant law, before rendering a service.
 Respect patient confidentiality, privacy, choices and dignity
 Maintain highest standards of personal conduct and integrity
 Provide appropriate counseling service to the client
 Maintain proper and effective communication with his patient and
other health professionals
 Register and keep accurate client records
 Provide professional service in the working place during assigned duty
hours
 Ensure public participation and acceptance in designing and
implementing public health programme
 Comply with any lawful instructions and procedures of the appropriate
 Benefits of ethical practice
A professional code of ethics sets a standard for
which each member of the profession can be
expected to meet. It is a promise to act in a manner
that protects the public’s well-being. A professional
code of ethics informs the public what to expect of
one’s doctor, lawyer, accountant, health extension
worker or property manager. As long as professionals
adhere to these standards, the public is willing to
have their professional associations create and
enforce their ethical codes.
 Conduct training for health care providers

1. Overcoming compassion fatigue:

Compassion focused exercises and imagery is
designed to try and create feelings to stimulate a
particular kind of imagery. We can try to stimulate
more compassionate responses in a number of ways.
For example:
2. Developing an inner compassionate self:
Focusing on creating a sense of a compassionate self,
just like actors do if they are trying to carry out a
specific role.
3. Compassion to yourself: This is linked to developing
feelings, thoughts and experiences focusing on self-
compassion. Life is often very difficult and learning how to
generate self- compassion can be helpful during these
times, particularly to help understand emotions.
4. Teaching/training compassion to professionals
through, training and education
Healthcare professional’s role is to increase compassion in
healthcare. Training of health professionals should focus
on aspects of care that are important in establishing a
good relationship with patients.
5.Dealing with staff stress and burnout: Ways
to address staff stress may include providing
preventive strategies, including creating regular
support groups or stress management
workshops for health professionals or suggesting
taking time outs. These preventive interventions
can run parallel to secondary strategies
including counseling and occupational health
services.
Dealing with wider health facility context: As
health facility scope with increasing patient
demand and higher levels of patient need, it
becomes even more important to address issues
of humanity within the process, dealing
compassionately with staff so that health facility
staff can do the same for patients.
 Concepts of patient privacy
Health privacy is the practice of maintaining the security
and confidentiality of patient records.
It involves both the conversational discretion of health
care providers and the security of medical records.
Patient privacy refers to the right of patients to determine
when, how and to what extent their health information is
shared with others.
It involves maintaining confidentiality and sharing
identifying data, known as protected health information
(PHI), only with healthcare providers and related
professionals who need it in order to care for the patient.
Patients also have a right to decide and control how their
health information is used and shared. In particular, patients
have the right to decide whether their information can be
shared, such as with employers or with other entities that are
not otherwise involved in their care. Patients also have a right
to say how they want to be contacted. For example, they can
tell a provider that they want to be contacted at a particular
phone number or to tell them where a covered entity can or
cannot leave a message. Patients may also request that their
health information, such as bills or lab reports, be received at
a location other than their home address.
Patients should also be given an option to take a copy
home of the notice of privacy practices. This is
another area where we sometimes do get complaints
from patients. One, we get complaints that providers
do not provide the notice, or we have had complaints
that patients who are asked to sign a form stating that
they received the form, but in fact, according to the
patient, they never did get it. This is a relatively simple
area with which to comply, so we really encourage
providers to really be careful with theseissues.
 Ways to protect patient privacy
• Think about people before thinking about data(rule one:
a profiled person means a protected patient.)
• Encourage a security mindset across the organization
(rule two: more ease-of- use means more security of PHI.)
• Give the patient easy access to their own records (rule
three: a single version of the data means multiple
protections for the patient.)
• Turn remote access into a competitive advantage (rule
four: never forget who the customer is. the patient
receiving care.)