Medical Ethics and Public Health Quiz

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