Which principle of ethics requires caregivers to involve the patient in medical decision making?

There are four commonly accepted principles of health care ethics that providers follow to ensure optimal patient safety: autonomy, beneficence, non-maleficence, and justice. Let’s take a closer look at the definition of each of these principles and how they are put into practice in the home health care environment.

Autonomy

In the medical field, autonomy refers to the right of the patient to retain control over his or her body. In the home health care environment, it begins with the patient’s decision to receive care at home in lieu of a nursing home or assisted living facility. He or she made this decision because of the desire to age in place in the comfort of home. As a home health care provider, this decision must be respected. It’s also important that while assisting a patient with daily activities, including skilled nursing, personal care, physical therapy, dietary and nutritional services, speech therapy, medical management and other related services, that the patient continues to “have a say” in his or her own decisions. Professionals (RNs) and para-professionals (personal care aides, home health aides, nursing aides) can suggest or advise a course action based on the physician’s assessment and directives, but the ultimate decision lies with the patient. If there is any conflict of interest based on the patient’s beliefs or values, the staff should immediately notify their home health care agency/employer to determine next steps.

Patient autonomy is also critical when it comes to how home health care agencies handle incapacitated patient and life-sustaining treatment decisions and the procedures providers have in place. Consistent written policies and training are both needed for nurses, aides and other staff to handle such difficult ethical dilemmas.

Beneficence

Health care providers are charged with doing all they can to benefit a patient, with all recommended procedures and treatments intended to do the most good for the patient. In order to do this, a high level of skill and knowledge, including ongoing training is needed. In the home health care field, benefiting each client is best accomplished in part by providing continuing education.  Not only does this ensure regulatory compliance but it also helps improve patient outcomes and mitigates injuries and accidents by staying up to date on the latest in patient care, technology and techniques.

As we previously discussed, continuing education requirements in home care differs from state to state, with home health aides working for providers that receive federal funding from Medicare or Medicaid required to finish at least a 75-hour training program along with 16 hours of supervised training. Certified aides who work in Medicare or Medicaid-reimbursed facilities must also accumulate 12 hours of continuing education per 12-month period.

Non-Maleficence

This principle is about “doing no harm”, intended for providers to consider if any decision made may harm another individual or society – even it is made to benefit an individual patient. This is why it’s so important for home health care agencies to implement strong risk management strategies, safety procedures and protocols and best practices for staff to follow. When staff members are well versed in – and understand – a provider’s protocols, there is less room for deviation or exceptions that, while perhaps performed with good intentions, can cause overall harm and liability issues for the provider.

Justice

The principle of justice states that there should be an element of fairness in all medical decisions. This means fairness in decisions that burden and benefit, as well as equal allocation of health care dollars and resources, and for medical practitioners to uphold applicable laws and legislation when making choices. For home health providers, it means having a policy in place to provide care, treatment and services to patients without regard to age, race, religion, sex, national origin or disability. It also requires providers to ensure they are in compliance with both federal and state regulations that govern them.

About Manchester Specialty

Manchester Specialty Programs provides the home health care industry with a wide range of insurance and risk management solutions. We can help home care providers and their insurance brokers navigate the coverage needs of a home health care business and find the best fit for insurance coverage. For more information about our programs and coverages, you or your local insurance agent can contact us today at 802.472.1500.