Healthcare -- Legal Issues Religion

Healthcare -- Legal Issues

RELIGION and NURSING

Describe how the issues that Florence Nightingale encountered in the 1800s were a major source and/or vehicle for the spread of infection and how her contributions continue to be important today.

The hospitals and medical procedures that Florence Nightingale encountered in the 19th century may have done more to spread bacterial infection than to contain it. The physical condition of the facilities was filthy, even by ordinary non-medical standards and everyday hygienic concerns. Before the introduction of antibiotics, relatively superficial battlefield wounds became matters of life or death, very often requiring limb amputation by battle surgeons, without anesthetic.

Joseph Lister's discovery of the crucial importance of aseptic principles coincided with the American Civil War, but surgeons still routinely treated multiple patients, one after the other, with the same unwashed instruments for years (Starr, 1984). By fortuitous coincidence rather than specific concern with bacterial infection, Florence

Nightingale emphasized cleanliness as a matter of her patients' dignity, ultimately lowering infection and mortality rates of thousands of soldiers injured toward the end of the Civil War (Caplan, Engelhardt & McCartney 1981).

Today, antisepsis is a universal fundamental element of modern medicine.

Ironically, several recent studies indicate that major metropolitan hospitals still sometimes have unnecessarily high bacterial infection transmission rates because even a century and a half since the publication of Lister's germ theory of infection, non- compliance with the most basic antiseptic protocol continues to be an issue even today.

2. Describe the duties and responsibilities of the Department of Health and Human Services.

The United States Department of Health and Human Services (USDHHS) is one of the largest non-military government agencies, staffed by more federal employees than any other agency and accounting for one-quarter of the entire national budget for federal agencies. Headquartered in Washington D.C., it is the primary entity responsible for ensuring the safety, health, and welfare of Americans by administrating all medical licensing and practice standards, food and drugs through the Food and Drug

Administration (FDA) and funding medical research through the National Institutes of Health (NIH).

The USDHHS administrates all federal funding for medical assistance programs through the Centers for Medicare and Medicaid Services (CMS), and monitors myriad elements of issues affecting health and welfare through dozens of agency components and regional and field offices throughout the United States and Puerto Rico (USDHHS

2007).

3. Explain why physicians have been so reluctant to remove a patient's life support systems.

The complexity of modern medicine introduces philosophical ambiguity to the distinction between the precise definition of life and death. Hospitals and medical centers either employ or consult with medical ethicists and must take into account legal considerations, family relationships, as well as different religious and cultural traditions with different beliefs and attitudes about life, death, and the process of dying. In addition to the need to respect the varied beliefs of their patients, doctors may have their own personal beliefs that militate against removing life support from a living patient.

As with other aspects of medical care, mistakes and wrong decisions implemented during end-of-life care may support lawsuits and professional career consequences;

unlike most other honest mistakes in providing medical care, end-of-life mistakes and misjudgments are, by definition, irreversible after the fact (Abrams & Buckner 1989).

Medical anomalies that contradict the relative certainty of prognoses based on past experience and objective criteria (such as defining "irreversible" coma and persistent vegetative state") only complicate end-of-life decisions even further, because instances of recovery of consciousness after comas lasting a decade or more add a level of uncertainty in predicting medical outcomes and in recognizing lesser degrees of conscious awareness in comatose patients.

4. Many patients are reluctant to complain about their health care. Recommend means to alleviate this issue. Support your rationale.

Many patients regard medical professionals, especially physicians, as authority figures whose high level of education and occupational status makes the prospect of complaining about or questioning their care too intimidating. Some patients may even harbor the fear that, human nature being what it often is, their physicians may be angered by any complaints and even retaliate in their subsequent treatment.

As with other issues of educating the lay public to understand medical concepts, the reluctance to complain about aspects of their health care is addressable through patient-oriented literature, such as that commonly used to increase specific symptom recognition and to raise awareness of environmental medical risks and inspire healthful life changes. In terms of encouraging the reporting of complaints against particular medical practitioners, publication of the available channels for submitting complaints either anonymously or with sufficient guarantees of confidentiality is a proven method of increasing rates of reports and professional compliance.

5. Employment handbooks have become the basis for many recent lawsuits based on the premise of implied contracts. Take a position either in favor of or against the use of employment handbooks. Recommend alternative solutions to your course of action.

Employment handbooks are much less susceptible to becoming the basis of lawsuits when they include specific provisions explicitly outlining the criteria distinguishing at-will employment from contract employment in connection with explicit designation of the employee-employer relationship that is, bilaterally, an at-will situation.

Principles of implied contract are imposed mainly in the absence of sufficient detail in the employee handbook rather than as a matter of law, but contractual ambiguities are, as a general matter of contract law, construed against the party responsible for drafting the printed material giving rise to the inference of contractual obligation. By the same token, the party drafting the employee handbook may include sufficient detail and specificity to define the employee-employer relationship as at-will according to the commonly used criteria used to determine that issue.

One alternative solution would be do avoid distributing any type of employee handbook altogether, possibly in conjunction with the use of disclosure forms signed by the employees acknowledging the application of each element of every possible criteria defining the employee-employer relationship as bilaterally at-will with equal right to termination without notice or cause on the part of both employee and employer.

6. Many health insurance plans now restrict coverage for pre-existing conditions.

Examine the issues surrounding this lack of coverage and recommend an alternative solution.

Possible alternative solutions in lieu of restricting coverage for pre-existing conditions include imposing higher deductibles as well as higher premiums for conditions otherwise excluded by virtue of predating the health insurance policy. A more radical alternative solution would be to allow coverage for pre-existing conditions and exclude, instead, preventable conditions caused by patient behavior, particularly after documented medical advice against such behaviors. Cigarette smoking and sun worshipping are two of the best examples, and persisting in those behaviors could justify prior notice from insurers that conditions such as some types of lung cancer and skin cancers (respectively) would be excluded from coverage.

7. Compare and contrast the two legal concepts of a burden of proof and the preponderance of the credible evidence. Should the same level of proof be used in all cases?

In civil cases, such as lawsuits over damages, the standard of proof to establish liability is preponderance of credible evidence, meaning simply, that proving one's case requires establishing only that, according to the relevant evidence, it is more likely than not that the facts and circumstances are responsible for the damages suffered by the plaintiff.

In criminal cases, such as government prosecution of defendants charged with violations of penal law, the standard of proof to establish guilt is beyond a reasonable doubt. For one of the best known examples of this distinction, O.J. Simpson was acquitted of the criminal charges associated with murdering his ex-wife and another person but was determined to have been responsible for the same killings under the less stringent civil burden of proof after a civil trial.

The rationale for this higher standard of proof is justified by the consequences of unjustly punishing the innocent, which the Founding Fathers specifically suggested is a worse travesty of justice than the necessity of suspending punishment of the guilty on occasion. The alternative would ensure that fewer individuals guilty of criminal conduct would escape punishment, but at the expense of those wrongfully accused and prosecuted.

8. Compare and contrast the differences between nominal, compensatory, hedonic, in punitive damages.

Nominal damages are those awarded more to acknowledge the principle of rightness than for the value of the award itself. Compensatory damages are those intended to compensate for measurable costs incurred by the plaintiff by virtue of the defendant's conduct. Hedonic damages are those intended as compensation for intangible pleasures of life lost by the plaintiff by virtue of the defendant's conduct where those pleasures are difficult to value monetarily. Punitive damages are those specifically intended more as punishment for improper conduct rather than as compensation for harm; their other purpose is to deter future improper conduct.

9. Explain the concept of a respondent superior. In today's society, is it just to hold an organizational liable for the negligent acts of its employees, even though there was no wrongful conduct on the part of the organization?

In principle, respondent superior is a concept of vicarious liability for the conduct of another where (most often) the employer is held responsible for the damages caused by the employee in the course of conducting the business of the employer. While it may not be just to hold an organization liable, absolutely, for every instance of employee negligence, there is a rationale for imposing such liability in many cases. For example, many types of industries entail potential danger to others that are inherent to the industry.

Individual workers are not likely to be capable of compensating victims of their negligence, but the employer benefits and profits financially by engaging in the particular industry. Therefore, the employer should not necessarily escape liability for compensating all harm caused by their activities, regardless of fault in particular instances.

10.A nurse is responsible for making an inquiry if there is uncertainty about the accuracy of a physician's medication order in a patient's record. Explain the process a nurse should use to evaluate whether or not to make an inquiry into the accuracy of the physician's medication order.