Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_2939_Библиотеки_им_академика_М_И_Перельмана

Justice is the ethical principle espousing the responsibility of medical profes­sionals to treat patients equitably (fairly) and to consider not only one’s patient, but also the good of society. An example of this principle is when a physician assists with terminating the driving privileges of an unsafe driver. This principle also entails the equitable allocation of society’s limited healthcare dollars and resources (dis- tributive justice).

Finally, delity, a corollary to the principle of justice, involves the medical prac- titioner’s responsibility to keep the terms of the “doctor/patient contract.” Truthfulness and substantial compliance with informed consent are components of delity as is non-abandonment. Practitioners should not summarily cease to act for the benet of one’s patient even when that patient has not lived up to their side of the doctor/patient contract (e.g., noncompliance) or exerted their autonomy and chosen a course of medical action with which the physician disagrees. In such cir­cumstances the physician should attempt to provide the best possible outcome in the context of the patient’s treatment choices. Alternatively, practitioners may exit the doctor/patient contract by providing emergency care as needed, while affording the patient sufcient time to become established with another health care professional.

Historically, physicians often made decisions for patients based on the prin­ciple of benecence without an appreciation of patient autonomy, a practice known as paternalism. Society’s response was a consumer movement, which included the Patient’s Bill of Rights. While needed, it may have inadvertently resulted in patient autonomy to supersede other ethical principles. We must rec­ognize that the principles of autonomy, benecence, non-malecence and justice all be considered to guide ethical decision-making. For example, autonomy and the right to privacy could be subordinate to the principles of benecence and justice in the case of an individual with a contagious illness posing a public health threat who refuses to follow guidelines to prevent the transmission of the disease to others. Conversely, benecence and justice (the State’s interest in pro­tecting life) would be subordinate to autonomy when a capacitated adult Jehovah’s Witness declines a lifesaving blood transfusion. However, if a patient were a child below the age of consent, the State’s interest in protecting life would prevail.

When an individual enters any facility or program within the long-term care con­tinuum they do not lose their fundamental constitutional rights. Providers have an obligation to inform residents of their rights and to encourage and assist them in exercising these rights. It is illegal for a facility, program, or any employee to infringe upon a person’s human rights by threatening, coercing, intimidating, or retaliating against a resident who is exercising their rights. A facility or program should educate residents on how to use the complaint process if they feel their human rights are being violated. Specic responsibilities of PALTC institutions are further described in the Abuse, Neglect, and Exploitation section of this chapter. A synopsis of Resident rights are listed in state and federal regulations, which are summarized in Table1. For full text see [1].

A resident’s rights may only be restricted when it is necessary to protect the resi­dent or another individual (resident, staff or family) from potential harm, or to pro­tect the rights of another resident, e.g., infringement on another’s privacy. Facility rules must be fully disclosed before admission, such as scheduled smoking breaks or a nonsmoking policy. These can only be enforced if the resident or their surrogate have agreed to these rules as a condition of admission. Furthermore, problem behav­iors may be addressed by practitioners through behavior modication program­ming, behavioral contracting with the resident, or as a condition of continued residence in the facility if done as part of a therapeutic plan of care and in keeping with nursing facility regulations. A resident with mental incapacity still retains all of the rights outlined in Table1. However, if a resident lacks capacity, their rights would be advocated by their legally designated surrogate decision-maker. For instance, a mentally incapacitated resident with diabetes mellitus who wants to spend their money on candy and soda may be care planned to receive budgeted amounts of spending money from their facility account and to be encouraged to choose more healthy snacks, given that the resident’s surrogate decision-maker is in agreement. Facilities and practitioners should be aware that litigation alleging