medical law and ethics 1

Ethics must be grounded in ________.

emotion OR reason and fact?

Which of the following is NOT commonly considered to be unprofessional conduct by the medical practice acts?

practicing medicine while on medication

Cases that have been decided and NOT overturned are considered to have established ________.

precedent

Some doctors order unnecessary tests and procedures ________.

to protect themselves from lawsuits

Criminal law

Laws designed to protect people from harm caused by other people by prohibiting conduct that threatens or harms public safety and welfare

Constitutional law

Laws stemming from the Constitution and the state constitutions (related only to individuals and the government)

Discovery

Discovery is when the attorneys present evidence that supports their side of the case --standard of care=proof of licensed physician, prudent person rule=physicians in the same specialty and type of practice would be called as expert witnesses and scope of practice

Statutory law

Laws created by the legislature

Morals

Morals are standards that people choose to make and involve personal decisions that may or may not include a system of reason or logic.

Three-Step Model

One model comes from Kenneth Blanchard and Norman Vincent Peale. They suggest a three-step question-based model: Is it legal? Is it balanced? How does it make me feel?

Constitutional law

The interpretation and implementation of the U.S. Constitution or state constitutions

law

The law is a set of rules prescribed by a governing body that are enforced through a binding legal force and are thus enforceable.

4 types of public law

criminal, constitutional, adminstrative, and international

Medical Laws

major one is malpractice, When comparing malpractice law to medical ethics, the litigious society (potentially taking advantage of a situation to get money from a provider) creates a situation for health care professionals to practice "defensive medicine." Defensive medicine includes ordering tests and procedures that may not be necessary to avoid malpractice suits. Other physicians may see this practice as unethical because it causes more cost to patients and eventually leads to insurance rate hikes to cover these procedures.

Differentiating between ethics and morals

To differentiate ethics from moral judgments, look at the history of the process in developing a code of ethics. The first medical ethics document was published in 1847 by the American Medical Association (AMA). This document served to set uniform standards for training, education, and conduct of physicians. Similar to development of new laws, the AMA updates the code of ethics as new technology and inevitable ethical issues arise.The most current change in the Code of Medical Ethics by the AMA was in 2001. The first new article, Principle VIII, states that physicians will consider their responsibility to patients of paramount importance while they are in charge of the patients. The second new article, Principle IX, states that physicians will support access to health care for all people.

private law

Tort law- Laws involving a wrongful act against another person that causes that person harm; can either be intentional or unintentional; intentional torts occur when one person intentionally injures another Contract law- Laws governing agreements or promises between people Property law- Laws related to property Inheritance law- Laws governing inheritances Family law- Laws related to marriage, family, and children Corporate law- Laws involving corporations and their action

Knowing Your Limits

alertness, physical well being, phycological well being and stress management

physician rights

-get to choose patients (other than emergency) -get to choose treatment=Given options, physicians still have the right to refuse to perform certain treatments if they believe the treatment is not ethical (such as an elective mastectomy to avoid getting breast cancer) or is not within the physicians' skill level (such as a complicated fracture). Physicians can also withdraw their agreement to treat patients if the patients refuse to meet their financial agreement for services or if the patients are non-cooperative with the prescribed treatment. -treat patients within specialty

Physician Duties (ethical side)

-medial emergency's -treatment of indigent patients=Physicians agree not to turn away accepted patients (patients with whom they have entered into a physician/patient relationship) because they are unable to pay. -notice of withdrawal=If physicians can no longer care for patients because the patients are uncooperative or refuse to pay, they agree to give formal notice of withdrawal from the patients' cases. -honesty about diagnosis etc.

Regulatory law

Laws created by an agency appointed by the legislature to make such laws (also called regulations)

Common law

Laws created by decisions made by judges, who apply precedent from previous cases to a current case (also called case law)

International law

Laws designed to govern international relationships

Overall Treatment from the Provider

Also related to treatment is the right to privacy, confidentiality, continuity, and reasonable response to a request for care and services.

AMA Preamble of Conduct Standards

1 Human dignity (providing competent service with compassion and respect) 2 Honesty (practicing honesty with patients and exposing those physicians who are unethical or fraudulent) 3 Responsibility to society (respect the law and work to change requirements that are contrary to the patients' best interests) 4 Confidentiality (keep protected health information confidential and private) 5 Continued study (continue education regarding medical field, obtain consultation when necessary) 6 Freedom of choice (choose who they will treat and where they will treat them) 7 Responsibility to improve community (participate in public health improvement activities) 8 Responsibility to patient is paramount 9 Patient access to medical care (support access to medical care for all people)

An advance directive gives health care workers and people close to patients their decision regarding life-saving and life-sustaining treatments when patients cannot make the decisions for themselves. Sometimes these decisions are personal preference, but they can also be based on religion.

CPR does the patient want to be brought back -living will=If two physicians certify that a patient has little chance of recovering from a state of unconsciousness (usually because the brain stops functioning), does the patient want the following life-sustaining measures: Artificial nutrition (a tube feeding) and artificial respiration/ventilation Dialysis (process of cleaning kidneys in failure) Medications, such as antibiotics to treat disease and/or infection CPR (to restart the heart if it stops) Hospitalization in cases of emergency or injury -medical durable power of attorney=MDPOA assigns someone to make decisions on a patient's behalf if the patient is incapacitated. -uniform anatomical gift act=gives permission for the patient's viable organs to be donated to those needing a transplant or for scientific study. This decision needs to be made in advance, and most states offer this decision to be indicated on driver's licenses.

Which of the following is part of the "gather information" step in Dr. Bernard Lo's clinical model used to examine an ethical dilemma?

Asking what the views of the health care team are.

Bioethics

Autonomy- The principle is further defined as requiring a patient to be informed about the consequences of a medical treatment or procedure and the consequences of not participating in the recommended medical treatment or procedure. Beneficence- The principle of beneficence means that, as practitioners treat patients, they must not harm the patients. "Harm" does not include pain that would normally occur during an exam, treatment, or procedure. Often beneficence is tied to autonomy in that the patient is required to give informed consent to any consequences that may occur. Non-Malfeasance-The principle of non-malfeasance means first do no harm. Closely related to beneficence, malfeasance asks the medical profession to always consider the risks of harm compared to the benefits when treating a patient. Justice- The principle of justice encompasses all areas of nondiscrimination. In other words, a patient who is poor will get the same treatment as someone who is rich, someone who is disabled will get the same treatment as someone who isn't disabled, and so on

What is the problem with measuring our actions using only the law and not considering the ethical aspects of an issue?

The law allows many actions that are morally offensive.

Which of the following is an example of the difference between law and ethics?

The law is official and enforced by the government, while ethics are unofficial but still generally accepted by society.

Unintentional Torts

Unintentional torts are when a patient is harmed but the practitioner had no intention of causing such harm. Depending on the situation involved, the health care professional can be considered negligent or may have committed malpractice. Negligence is usually an unintentional act or lack of action that causes a patient harm. A physician can be charged with malpractice as a result of professional misconduct, improper handling of duties, or failure to meet standards of care that result in patient harm

types of torts

assault- the type of tort in which a patient feels threatened by the health care provider. battery- involves actual touching, such as when a doctor performs a procedure without the patient's permission. false imprisonment- a health care professional refuses to allow a patient to leave the office or facility when the patient wants to leave and is competent to make such a decision defamanation of character- can be charged when a health care professional makes negative statements about another health care professional. fraud- making false claims, such as promising a cure invasion of privacy- can be charged against a health care professional who gives personal information about a patient to others without that patient's permission.

Administrative law

aws that govern the creation and operation of administrative agencies

patients responsibilities

full disclosure= telling doctor the truth and correct info, following instructions, honoring payment plans and not sharing meds with other people

forms of consent

informed consent= a doctor tells patient stuff about diagnosis/ surgery Implied consent comes into play when patients take unplanned actions, such as going to the emergency room. When immediate treatment is required to save a patient's life or to prevent serious harm, and the patient cannot give informed consent, the caregiver does not have time to get consent from the patient's legal guardian or next of kin. In such life-threatening emergencies, consent is implied. minors= parents, in some states mature minors can get std treatment, drug/alcohol help, prescription without parents consent

Patient complaints relating to confidentiality would likely be reviewed by ________.

a quality assurance committee

Centers for Medicare and Medicaid

exemplifies how the federal and state regulations intertwine. Medicare is a federally funded health insurance program, and Medicaid is a state and federally funded health insurance program. States don't have to participate in Medicaid; it's voluntary, although all states do participate. Medicare is administered through the federal government and not through the states. For health care providers to receive funding from either program, they must follow the regulations set forth by CMS. Each state designs and administers its own version of the program under broad federal guidelines. One of these federal laws is the Omnibus Budget Reconciliation Act (OBRA) of 1987. This law is a simple list of standards that health care providers must meet to get funding from the Medicare and Medicaid programs. Each state has its own set of regulations created to ensure that it is adhering to the federal laws. The states also created agencies to govern health care practice. Therefore, a health care practice is likely to be inspected by a state agency frequently enough to ensure that the practice is complying with the states' versions of OBRA. CMS is then responsible for inspecting the state agencies' findings to ensure that the state is compliant with the federal laws.

Legal Issues in the Medical Field

violations of confidentiality medication errors practicing outside one's licensure/certification and negligence causing harm

decision making

1 Make decisions about the plan of care before and during the course of treatment 2 Refuse a recommended treatment or plan of care to the extent permitted by law and hospital policy 3 Have an advance directive (a written declaration of their wishes regarding life-saving or life-sustaining measures) 4 Appoint someone to make decisions if they are incapable of doing so 5 Consent or decline to participate in proposed research studies or human experimentation 6 Be informed of the risks and benefits of receiving or not receiving medical treatment and to consent to the treatment

Obtaining Information

1 Obtain relevant information from the physicians and other direct caregivers 2 Review the records pertaining to their medical care and to have the information explained or interpreted as necessary 3 Ask and be informed of the existence of business relationships among the hospital 4 Be informed of hospital policies and practices that relate to patient care

Seven-Step Model

1. Determine the facts by asking the following questions. What do we need to know? Who is involved? Where does the ethical situation take place? When does it occur? 2. Define the precise ethical issue (such as fairness, morality, rights). 3. Identify the major principles, rules, and values (such as integrity, quality, respect, profit). 4. Specify the alternative courses of action. 5. Compare the values and the alternatives. 6. Assess the consequences of each action. 7. Make a decision

Clinical Model

1. Gather information (very similar to the seven-step model). 2. Clarify the ethical issues (similar to the second step of the seven-step model, except you are also asked to determine the ethical guidelines that people involved in the dilemma are using and what the reasons are for and against alternative plans). 3. Resolve the dilemma.

1. Which of the following is NOT a requirement of the Doctrine of Informed Consent? 2. Which of the following is NOT an advance directive? 3. According to the Patient's Bill of Rights, the patient has the right to be informed of hospital policies and practices that relate to ________. 4. According to the Patient's Bill of Rights, the patient has the right to every consideration of ________. 5. Which of the following is NOT an example of implied consent? 6. The Patient's Bill of Rights must be followed ________. 7. Which of the following is NOT in the Patient's Bill of Rights? 8. An informed consent form does NOT need to be signed for ________. 9. According to the Patient's Bill of Rights, the patient has the right to ________ care. 10. Copies of advance directives should be given to ________.

1. The physician must explain any alternative treatments that the patient can afford. 2. parens patriae authority 3. patient care, treatment, and responsibilities 4. privacy 5. A patient implies consent to the removal of an organ by consenting to the removal of a different organ. 6. by all health care professionals 7. The patient has the right to ask and be informed of the existence of personal relationships among the hospital staff that do not necessarily have any influence over the patient's treatment or care. 8. emergency surgery 9. considerate and respectful 10. the personal physician, close relatives, and a close friend

1. In order to hospitalize a noncompliant and incompetent patient, a physician must ________. 2. Over the past several decades, physicians' policies concerning telling dying patients the truth about their prognosis have ________. 3. Which of the following is an example of a situation where the policy of truth-telling might be at variance with the medical profession's obligation of confidentiality? 4. The best method physicians can use to protect themselves from a charge of abandonment when they have to sever a relationship with a patient is ________. 5. Which of the following is NOT a valid argument against requiring mandatory testing and restricting the activities of HIV-positive healthcare workers? 6. Healthcare workers who have received needlestick injuries wish to know if the patient's blood contained the HIV or AIDS virus. HIV testing without the patient's consent is illegal. However, some states have allowed HIV testing without the patient's consent when a serious situation warrants the testing. From an ethical standpoint, HIV testing in spite of the patient's objection ________. 7. Which of the following is NOT one of the American Medical Association's Principles of Medical Ethics? 8. if a patient enters a medical office with an emergency situation, the physician ________ 9. From an ethical standpoint, MOST physicians treat patients who need their skills. Legally, physicians ________. 10. Legally, a hospital must stabilize a patient during an emergency situation even if that patient cannot pay. Ethically, according to the American Medical Association, physicians ________.

1. submit an emergency application to a judge 2. shifted from the majority hiding the truth to the majority telling the truth 3. A psychiatrist warns a third party of a patient's threats. 4. sending a letter by certified mail 5. Healthcare workers do not take part in any procedures in which HIV could be transmitted. 6. violates the patient's autonomy and privacy 7. A physician shall provide appropriate health care, even in non-emergencies, to whoever asks for such care, in whatever environment requested. 8. cannot ethically or legally turn the patient away 9. have the right to refuse service to new patients when their condition is not an emergency 10. may select which patients to treat, but may not dismiss patients they have agreed to treat even if they cannot pay

1. The discovery rule establishes ________. 2. Good Samaritan laws do not protect physicians when they ________. 3. Case law is based on ________. 4. A preponderance of evidence establishes that ________. 5. Unintentional torts occur when ________. 6. Intentional torts occur when ________. 7. Healthcare professionals are more involved in ________ than in any other source of law. 8. Attempts to deceive a patient would fall under ________. 9. The intentional tort of battery requires ________. 10. Which of the following is an example of an unintentional tort?

1. when the statute of limitations begins 2. are in there work environment 3. judicial interpretation of previous law 4. that more than likely than not the incident did occur 5. a medical practitioner injures a patient by failing to exercise the ordinary standard of care 6. a person has been deliberately injured 7. administrative law 8. the unintentional tort of fraud 9. bodily harm or unlawful touching 10. A medical practitioner mistakenly alters a patient's medical record

Overlap of Medical Ethics and Laws

Being aware of the ladder of responsibility Differentiating between ethics and morals Knowing the basic principles of medical ethics

ethics

Ethics are related to morals and moral judgments; however, ethics force people to use reason and logic to make a decision.

ethics

Ethics have a moral component and, unless linked to a law, are not necessarily punishable. When it comes to the health care field, ethics have an impact on actions that affect life, quality of life, and death. Illegal action is most likely unethical, but unethical actions are not always illegal.

patients complaints-what happens when people complain

First is a legal complaint. This is when a lawsuit is filed on behalf of the patient. Another is writing to the practitioner's licensing or authorizing agency (such as contacting the state licensing board for information). Next is the option of contacting the respective ombudsman (patients can find the phone number on their admission paperwork). An ombudsman is a confidential person assigned to listen to complaints and investigate to ensure patients' rights. The ombudsman usually works to mediate a solution between the patient and practitioner. The ombudsman will report to the appropriate state agency for additional investigation or action if there is evidence of mistreatment or unethical behavior by the practitioner. Finally, a patient can contact the licensing agency for the institution (hospital, nursing home, clinic) and file a complaint. Usually, this agency is connected to the state's health department. Patients will sometimes use the media to get attention to their complaint. Contacting the local news may get attention but may not bring a resolution to the matter.

The Court Process

First, Mr. Jones hires an attorney who will file a claim with the civil courts. The court issues a subpoena to Dr. Murphy, which instructs him to appear in court and to provide documentation of his treatment of Ms. Jones for the assumed flu-like virus. Mr. Jones is considered the plaintiff (the one doing the suing). Once Dr. Murphy is served the subpoena, he becomes the defendant (the one being sued). Dr. Murphy's first option is to have his attorney discuss a settlement with Mr. Jones with or without admitting that his actions contributed to Ms. Jones's death. The second option is to ask the court for a summary judgment. In this case, the attorneys each provide pleadings, or written arguments, to the judge, who uses these documents alone to render a decision. Otherwise, Dr. Murphy will have to go to court and have a trial whereby a jury would decide the fate of the case. If Dr. Murphy disagrees with the decision that is made by the judge or the jury, he can appeal the decision to potentially have it changed. Dr. Murphy would need to show the appellate court that the trial court erred and that his attorney made timely objections to these errors. Otherwise, the appellate court will not review the trial court's decision.

Health Insurance and Portability and Accountability Act 1996 (HIPAA)

HIPAA required practitioners to add the disclaimer at the bottom of faxes and emails reminding people that the information received is confidential and to destroy the information if they are not the intended recipient. HIPAA is responsible for the special codes given to patients at the hospital so that only those with the code can obtain information about the patients' condition. ==Dr. Jacobs could likely answer the questions being asked between the nurse and physician at the nursing home, but is it ethical to discuss what he knows about a patient with other health care providers without the patient's permission? There is a portion of HIPAA that allows communication among providers for continuity of care, but most providers still require the patients to sign a release of information to ensure they are following HIPAA rules and, more importantly, honoring the patients' right to privacy and confidentiality of their health care information.

Principles of Medical Ethics

I-A physician shall, while caring for a patient, regard responsibility to the patient as paramount. II-A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities. III-A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient. IV-A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law. V-A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated. VI-A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care. VII-A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health. VIIII-A physician shall, while caring for a patient, regard responsibility to the patient as paramount. IX-A physician shall support access to medical care for all people.

Adherence to Ethical Standards of Honesty

If, for example, a nurse forgets to provide an ordered treatment to a patient's wound, the nurse is ethically responsible to notify both the physician and patient and to ensure that any new instructions from the physician are carried out. Not only is it illegal for a professional to knowingly indicate that a treatment was provided when it was not, but the patient's wound may not heal as quickly and/or a change in the wound may not be quickly observed.

Balancing Laws and Ethics

Major organizations, such as the American Medical Association and the American Psychological Association, have studied the impact of medical actions, the laws, and employment in the medical industry. These studies have born codes or standards of practice, and these codes are often used to justify decisions made and actions taken by medical personnel. To balance medical laws and ethical dilemmas, health care practitioners must take these codes and standards into consideration as they care for and treat people. The standards that apply to most practitioners are patient rights, patient choice, confidentiality, and physician responsibilities.

morality

Personal values and beliefs obtained from family, religion, culture, and education

Theory of Ethics

Principles or values that drive ethical behavior

Code of Ethics

Principles used for decision making

more legal concepts

Respondeat superior= In another scenario, if the nurse was told this information about the trip to Missouri and did not write it down, Dr. Murphy could be held liable for misdiagnosis through respondeat superior, in which case the actions of the nurse (and everyone else working under the physician) can be attributed to the physician because he is the head of the practice. Similarly, if this misdiagnosis happened at a hospital, the hospital as an organization could be held liable. Statutes of limitations= If Mr. Jones waited a certain length of time before filing a claim, Dr. Murphy may not be held liable because of the "statute of limitations." This means that there is a time frame in which a practitioner can be held accountable for certain injuries or negligence. After that time period, the injured can no longer sue the practitioner. These statutes of limitation vary for different practitioners and circumstances and by state. Good Samaritan laws= If Dr. Murphy had treated Ms. Jones under less formal circumstances (for example, at an accident scene that he drove by), he may have been protected by a type of "Good Samaritan" law. These laws also differ by profession, circumstances, and location. Simply put, Good Samaritan laws imply consent for treatment by someone who is trained to deal with whatever circumstance has arisen but without the standard written, formal consent of all parties involved.

Federal Legislative Oversight

The legistrative branch makes the laws and consists of the Senate and the House of Representatives, The executive branch is charged with enforcing the law and is composed of the President and various agencies. The judicial branch interprets and applies the law and consists of the Supreme Court, down to the local courts. the executive branch is charged with enforcing the laws and is composed of the president and various agencies

Adhering to Legal and Ethical Standards

The many standards, ethical codes, and institution-specific policies related to patient treatment are designed to assist health care workers in making decisions and acting within their realm of practice. There are even mandated trainings within health care laws that require health care institutions to provide regular training for their workers. This training can include safety, patients' rights, and competency of skills specific to their licensure/certification. =OSHA

Burden of Proof

a checks-and-balances portion of the law process that ensures a defendant is guilty according to the letter of the law. "Preponderance of the evidence" is a phrase used to describe the function of the decision maker in a case. This concept gives the burden to the prosecution. Because the prosecution is bringing the law suit, the legal system has deemed them responsible to prove that the accusations are valid.