__________________________________________________________________ Medical Ethics for Physicians
JOINT COMMISSION PATIENT RIGHTS STANDARDS ON ETHICAL ISSUES a. The patient’s right to care that is considerate and respectful of his or her personal values and beliefs; b. The patient’s right to be informed about and participate in decisions regarding his or her care;
c. The patient’s right to participate in ethical questions that arise in the course of his or her care, including issues of conflict resolution, withholding resuscitative services, forgoing or withdrawal of life-sustaining treatment, and participation in investigational studies or clinical trials; Although there are many standards to the Joint Commission Accreditation of Healthcare Organization’s Chapter on Patient Rights, the following standards address what the JCAHO requires specifically regarding ethical issues: Standard: RI.1 requires that the hospital address ethical issues in providing patient care. The intent of this standard includes: d. The patient’s right to reasonable access to care; e. The patient’s right to security and personal privacy and confidentiality of information; f. The issue of designating a decision maker in case the patient is incapable of understanding a proposed treatment or procedure or is unable to communicate his or her wishes regarding care; g. The hospital’s method of informing the patient of these issues identified in the intent; h. The hospital’s method of educating staff about patient rights and their role in supporting those rights; and i. The patient’s right to access protective services. RI.1.2.3 Patients are involved in resolving dilemmas about care decision. Examples of Implementation: 1. The hospital has a multidisciplinary committee or designated individual who reviews and assesses reports of dilemmas in patient care (for example, between family members) and applies hospital policies and procedures to help in conflict resolution. 2. Hospital policy directs clinicians to refer family members to appropriate clergy or other organization spiritual advisor for consultation when the issue of withholding resuscitative services arises. RI.1.2.4 The hospital addresses advance directives. Example of Implementation: The hospital’s policies and procedures require that a patient be told his or her right to make advance directives. The discussion is facilitated by authorized staff members who have specific training in this area or by the attending physician. The course of discussion, including any educational materials used, and its outcome is documented in the medical record. Only the patient may review and
modify the advance directives any time throughout the episode of care. RI.1.2.5 The hospital addresses withholding resuscitative services. RI.1.2.6 The hospital addresses forgoing or withdrawing life-sustaining treatment. RI.1.2.7 The hospital addresses care at the end-of-life. Intent and Example:
No single process can anticipate all of the situations in which such decisions must be made. This is all the more reason why it is important for the hospital to develop a collaborative framework for making these difficult decisions. The framework established by the hospital: • Offers guidance to health professionals on the ethical and legal issues involved in these decisions and decreases their uncertainty about the practices permitted by the hospital; • Sensitively addresses issues such as autopsy and organ donation; • Respects the patient’s values, religion, and philosophy; • Involves the patient and, where appropriate, the family in every aspect of care; • Responds to the psychologic, social emotional, spiritual and cultural concerns of the patient and family; And in end-of-life situations, the framework guides staff to: • Provide appropriate treatment for any primary and secondary symptoms, according to the wishes of the patient or the surrogate decision maker: • Manage pain aggressively and effectively; • Sensitively address issues such as autopsy and organ donation; • Respect the patient’s values, religion, and philosophy; • Involve the patient and, where appropriate, the family in every aspect of care; and • Respond to the psychologic, social, emotional, spiritual, and cultural concerns of the patient and the family.
Source: [9]
Figure 1
29
MDTX1625
Powered by FlippingBook