1. Chapter 2
Ethical, Legal, and Economic Foundations
of the Educational Process

2. Differentiated View of Ethics, Morality
and Law
1. Natural law (basis)
2. Deontological (Golden Rule)
3. Teleological (greatest good for the
greatest number)

3. Evolution of Ethical and Legal
Principles in Health Care
• Charitable Immunity
• Cardozo Decision of 1914
A. Informed consent
B. Right to self-determination

4. Cardozo Decision
A. Informed Consent: the right to full
disclosure; the right to make one’s own
decisions
B. Right to self-determination: the right to
protect one’s own body and to
determine how it shall be treated

5. Government Regulations &
Professional Standards
1.
National Commission for the Protection of Human
Subjects of Biomedical and Behavioral Research
2.
President’s Commission for the Study of Ethical
Problems in Medicine and Biomedical and Behavioral
Research
3.
American Nurses Association’s Code of Ethics for
Nurses with Interpretative Statements
4.
American Hospital Association’s Patient’s Bill of Rights

6. Application of Ethical and Legal
Principles
1. Autonomy
2. Veracity
3. Confidentiality
4. Nonmaleficence
– Negligence
– Malpractice
– Duty
5. Beneficence
6. Justice

7. Definition of Ethical Principles
1. Autonomy: the right of a client to selfdetermination
2. Veracity: truth telling; the honesty by a
professional in providing full disclosure
to a client of the risks and benefits of any
invasive medical procedure

8. Definition of Ethical Principles (cont’d)
3. Confidentiality: a binding social contract
or covenant to protect another’s privacy;
a professional obligation to respect
privileged information between health
professional and client.

9. Definition of Ethical Principles (cont’d)
4. Nonmalfeasance: the principle of doing no
harm
A. Negligence: the doing or nondoing of an
act, pursuant to a duty, that a reasonable person
in the same circumstances would or would not
do, with these actions or nonactions leading to
injury of another person or his/her property.

10. Definition of Ethical Principles (cont’d)
B. Malpractice: refers to a limited class of
negligent activities that fall within the scope of
performance by those pursuing a particular
profession involving highly skilled and
technical services.
C. Duty: a standard of behavior; a
behavioral expectation relevant to one’s
personal or professional status in life.

11. Definition of Ethical Principles (cont’d)
5. Beneficence: The principle of doing good;
acting in the best interest of a client through
adherence to professional performance
standards and procedural protocols.
6. Justice: Equal distribution of goods, services,
benefits, and burdens regardless of client
diagnosis, culture, national origin, religious
orientation, sexual preference, and the like.

12. Legality of Patient Education and
Information
•
•
•
•
A Patients’ Bill of Rights
Joint Commission (JC)
State Regulations
Federal Regulations

13. Documentation of Patient Education...
“…probably the most undocumented skilled service….”
(Casey, 1995)
Documentation is required by:
• JC
• Third-Party Reimbursement: insurance companies,
Medicare and Medicaid programs, or “private pay”
• Respondeat Superior: The employer may be held
liable for the negligence or other unlawful acts of the
employee during the performance of his or her jobrelated responsibilities.

14. Economic Factors of Patient Education:
Justice and Duty Revisited
Challenge for healthcare providers:
• Efficient & cost-effective patient
education
• Legal responsibility of all nurses
• Little preparation on prelicensure level

15. Financial Terminology
• Direct Costs
– Fixed Costs
– Variable Costs
• Indirect Costs
• Cost Savings, Cost Benefit, and Cost
Recovery

16. Financial Terminology
Direct Costs: those that are tangible and
predictable, such as rent, food, heating, etc.
Fixed Costs: those that are stable and ongoing, such
as salaries, mortgage, utilities, durable equipment, etc.
Variable Costs: those related to fluctuation in
volume, program attendance, occupancy rates, etc.

17. Financial Terminology (cont’d)
Indirect Costs: those that may be fixed but
not necessarily directly related to a particular
activity, such as expenses of heating, lighting,
housekeeping, maintenance, etc.

18. Financial Terminology (cont’d)
Cost Savings: money realized through
decreased use of costly services,
shortened lengths of stay, or fewer
complications resulting from preventive
services or patient education.

19. Financial Terminology (cont’d)
Cost Benefit: occurs when the institution
realizes an economic gain resulting from
the educational program, such as a drop
in readmission rates.
Cost Recovery: occurs when revenues
generated are equal to or greater than
expenditures.

20. Financial Terminology (cont’d)
Revenue Generation: profit realized
when fees for an educational program
exceed the aggregate costs of program
preparation and delivery.

21. Program Planning and Implementation
Relationship of Costs and Outcomes
1. Cost-Benefit Analysis
2. Cost-Effectiveness Analysis

22. Program Planning and
Implementation (cont’d)
Cost-Benefit Analysis: the relationship
(ratio) between actual program costs and
actual program benefits, as measured in
monetary terms, to determine if revenue
generation was realized.

23. Program Planning and
Implementation (cont’d)
Cost-Effectiveness Analysis: refers to determining
the economic value of an educational offering by
making a comparison between two or more
programs, based on reliable measures of positive
changes in the behaviors of participants as well
as evidence of maintenance of these behaviors,
when a real monetary value cannot be assigned
to the achievement of program outcomes.

24. State of the Evidence
1.
2.
3.
4.
5.
Legal and ethical issues
Documentation of practice
New technologies
Health-related outcomes
Economic implications