Podcast
Questions and Answers
Which of the following situations does not require parental consent for minors aged 14-17 years?
Which of the following situations does not require parental consent for minors aged 14-17 years?
Which of the following genetic disorders should be tested for in a minor if there are no preventive therapies or treatments?
Which of the following genetic disorders should be tested for in a minor if there are no preventive therapies or treatments?
In which situation can a physician breach patient confidentiality?
In which situation can a physician breach patient confidentiality?
Which of the following diseases is not typically subject to quarantine?
Which of the following diseases is not typically subject to quarantine?
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What is the primary reason for the low incidence of hepatitis A in the United States, Canada, Western Europe, Australia, and Japan?
What is the primary reason for the low incidence of hepatitis A in the United States, Canada, Western Europe, Australia, and Japan?
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Which of the following individuals is assumed to be legally competent to make health care decisions for themselves?
Which of the following individuals is assumed to be legally competent to make health care decisions for themselves?
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What is a key consideration when evaluating a patient's competence to accept or refuse medical management?
What is a key consideration when evaluating a patient's competence to accept or refuse medical management?
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What is the primary responsibility of a legal guardian appointed by the court?
What is the primary responsibility of a legal guardian appointed by the court?
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Who is typically responsible for obtaining informed consent from a patient?
Who is typically responsible for obtaining informed consent from a patient?
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Under what circumstances can a physician delay telling a patient their diagnosis?
Under what circumstances can a physician delay telling a patient their diagnosis?
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Which principle of medical ethics requires a physician to act for the benefit of a patient?
Which principle of medical ethics requires a physician to act for the benefit of a patient?
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What is the primary criterion for a minor to be considered an emancipated minor?
What is the primary criterion for a minor to be considered an emancipated minor?
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What happens if an unexpected finding during surgery necessitates a nonemergency procedure for which the patient has not given consent?
What happens if an unexpected finding during surgery necessitates a nonemergency procedure for which the patient has not given consent?
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Who can legally determine a person's incompetence for future health care decisions?
Who can legally determine a person's incompetence for future health care decisions?
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Who can give consent for surgical or medical treatment of a minor?
Who can give consent for surgical or medical treatment of a minor?
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What is the order of priority in which family members make decisions for an incompetent patient?
What is the order of priority in which family members make decisions for an incompetent patient?
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What is the main difference between euthanasia and physician-assisted suicide?
What is the main difference between euthanasia and physician-assisted suicide?
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What is the legal standard of death in the United States?
What is the legal standard of death in the United States?
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When can a minor be compelled to donate tissue to a close relative?
When can a minor be compelled to donate tissue to a close relative?
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What is the ethical distinction between withholding and withdrawing life-sustaining treatment?
What is the ethical distinction between withholding and withdrawing life-sustaining treatment?
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What is the primary risk factor for hepatitis A in men?
What is the primary risk factor for hepatitis A in men?
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Under what circumstances can a physician refuse to treat an HIV-positive patient?
Under what circumstances can a physician refuse to treat an HIV-positive patient?
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In what situation can a patient be hospitalized without their consent?
In what situation can a patient be hospitalized without their consent?
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What is the primary purpose of advance directives?
What is the primary purpose of advance directives?
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What is the primary consideration in determining whether to maintain a patient in a persistent vegetative state (PVS) on life support?
What is the primary consideration in determining whether to maintain a patient in a persistent vegetative state (PVS) on life support?
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What is the primary reason why physicians should avoid treating family members or close friends?
What is the primary reason why physicians should avoid treating family members or close friends?
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A patient claims that they had a sexual relationship with their physician. What can the patient do?
A patient claims that they had a sexual relationship with their physician. What can the patient do?
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What should a physician do if they receive a valuable gift from a patient?
What should a physician do if they receive a valuable gift from a patient?
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Who should an impaired medical student be reported to?
Who should an impaired medical student be reported to?
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What is the primary reason for removing an impaired colleague from contact with patients?
What is the primary reason for removing an impaired colleague from contact with patients?
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Who should an impaired resident or attending physician be reported to?
Who should an impaired resident or attending physician be reported to?
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What is the main reason for the increase in malpractice claims over the years?
What is the main reason for the increase in malpractice claims over the years?
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What is the legal requirement for reporting impaired colleagues?
What is the legal requirement for reporting impaired colleagues?
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What is the purpose of punitive damages in a malpractice case?
What is the purpose of punitive damages in a malpractice case?
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Who should an impaired physician in private practice be reported to?
Who should an impaired physician in private practice be reported to?
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What is the primary reason why sexual relationships with current or former patients are prohibited?
What is the primary reason why sexual relationships with current or former patients are prohibited?
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What is a common cause of impairment in physicians?
What is a common cause of impairment in physicians?
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Why is it important to report an impaired colleague?
Why is it important to report an impaired colleague?
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Why should physicians avoid treating family members or close friends?
Why should physicians avoid treating family members or close friends?
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What is the main difference between compensatory and punitive damages in a malpractice case?
What is the main difference between compensatory and punitive damages in a malpractice case?
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Study Notes
Principles of Medical Ethics
- A patient is legally competent to make healthcare decisions if they understand the risks, benefits, and likely outcome of those decisions.
- All adults (18 years and older) are assumed to be legally competent to make healthcare decisions for themselves.
- The four principles of medical ethics are:
- Autonomy: A patient has the right to make medical decisions concerning themselves free of coercion.
- Beneficence: A physician is obligated to act for the benefit of the patient.
- Non-maleficence: A physician is obligated not to harm the patient.
- Justice: A physician is obligated to allocate healthcare fairly to all patients.
Minors
- Minors (under 18 years old) are not considered legally competent, but emancipated minors (14-17 years old) can be considered legally competent adults.
- Emancipated minors must meet certain criteria, such as being self-supporting, in the military, married, or having a child.
Decision-Making Capacity
- A patient's competence can be questioned if they have an intellectual disability or neurocognitive disorder.
- Physicians can evaluate and testify to a patient's capacity to make healthcare decisions, but only a judge can determine legal incompetence.
- A patient may be competent to make decisions even if they are mentally ill, have an intellectual disability, or are incompetent in other areas of life.
Informed Consent
- A physician must inform and obtain consent from a competent adult patient before proceeding with any medical or surgical test or treatment.
- Components of informed consent include:
- Understanding of diagnosis and treatment options
- Knowledge of risks, benefits, and alternatives
- Understanding of likely outcome if treatment is not given
- Right to withdraw consent at any time
- Special situations may arise, such as:
- Refusal of treatment for religious or personal reasons
- Pregnant women's right to refuse medical intervention
- Delaying disclosure of diagnosis to protect the patient's health
Confidentiality
- Physicians are expected to maintain patient confidentiality, but may not do so in certain situations, such as:
- Child or elder abuse
- Risk of suicide
- Threat to another person
- Risk to public safety
- If a patient poses a threat to another person, the physician must:
- Ascertain the credibility of the threat
- Notify authorities and warn the intended victim (Tarasoff decision)
Reportable Illnesses
- Physicians are required to report certain infectious illnesses to state health departments, which then report to the CDC.
- Examples of reportable illnesses include hepatitis, tuberculosis, and AIDS.
- Quarantine may be used for certain illnesses, such as cholera and plague.
Ethical Issues Involving HIV Infection
- HIV-positive physicians are not required to disclose their status to patients or colleagues.
- HIV-positive patients cannot be refused treatment by a physician, even if they pose a risk to others.
- Pregnant women cannot be forced to be tested or treated for HIV against their will.
- Physicians are not required to maintain confidentiality if an HIV-positive patient puts others at risk.
Involuntary and Voluntary Psychiatric Hospitalization
- Patients in psychiatric emergency situations may be hospitalized against their will or without consent.
- Patients who are confined to mental health facilities have the right to:
- Receive treatment
- Refuse treatment
- Have a surrogate make decisions for them
Advance Directives
- Advance directives are instructions given by patients in anticipation of the need for a medical decision.
- Examples of advance directives include:
- Durable power of attorney
- Living will
- Patients who are incompetent may have their advance directives followed by a surrogate or healthcare proxy.
Death and Euthanasia
- The legal standard of death is irreversible cessation of all brain function.
- Physicians certify the cause of death and sign the death certificate.
- Organ donation requires patient consent or consent from a surrogate.
- Euthanasia is a criminal act and is never appropriate.
- Physician-assisted suicide is legal in some states, but is not generally an indictable offense.
Medical Malpractice
- Medical malpractice occurs when harm comes to a patient as a result of a physician's action or inaction.
- Elements of malpractice include:
- Dereliction of duty
- Breach of standard of care
- Causation of injury
- Damages
- Malpractice is a tort, or civil wrong, and may result in financial damages.
Relationships with Patients
- Sexual relationships with patients are inappropriate and are prohibited by ethical standards.
- Physicians should avoid treating family members, close friends, or employees.
- Physicians should avoid accepting valuable gifts from patients.
Impaired Physicians
- Causes of impairment in physicians include:
- Drug or alcohol use
- Physical or mental illness
- Age-related impairment
- Impaired physicians may be reported to the medical board or a professional organization.### Malpractice
- A malpractice claim requires four elements: duty, breach, damages, and direct causation
- Duty refers to an established physician-patient relationship
- Breach refers to a failure to meet the standard of care
- Damages refer to the injury or harm caused to the patient
- Direct causation means that the damages were caused directly by the negligence, not by another factor
Likelihood of Being Sued
- Surgeons (including obstetricians) and anesthesiologists are the most likely to be sued for malpractice
- Psychiatrists and family practitioners are the least likely to be sued
Malpractice as a Tort
- Malpractice is a civil wrong, not a crime
- A finding for the plaintiff results in a financial award, not a jail term or loss of license
Increase in Malpractice Claims
- The number of malpractice claims has increased over the years
- This increase is mainly due to a breakdown of the traditional physician-patient relationship
- Breakdown of relationship caused by:
- Technological advances in medicine, reducing personal contact with the physician
- Limits on time for personal interaction and physician autonomy, partly due to managed care
Damages
- Compensatory damages reimburse the patient for medical bills, lost salary, and pain and suffering
- Punitive damages punish the physician and set an example for the medical community
- Punitive damages are rare and awarded only in cases of wanton carelessness or gross negligence
Relationships with Patients
- Sexual relationships with current or former patients are inappropriate and prohibited by ethical standards
- Physicians should avoid treating family members, close friends, or employees due to potential interference with professional objectivity
- Physicians should avoid accepting valuable gifts from patients
- Removing an impaired colleague from contact with patients is an ethical requirement to protect patients and help the impaired colleague
Reporting Impaired Colleagues
- Impaired medical students should be reported to the dean of the medical school or dean of students
- Impaired residents or attending physicians should be reported to the person directly in charge of them
- Impaired physicians in private practice should be reported to the state licensing board or impaired physician program
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Description
Test your knowledge of medical ethics and public health principles, including patient confidentiality, quarantine, and genetic disorders.
