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42 Cards in this Set
- Front
- Back
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legal competence
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must be able to understand risk, benefits, and likely outcome of a decision
- if >18, assumed to be competent - if <18, assumed to be incompetent unless emancipated - if in question, only a judge can determine competency - if someone is mentally retarded or ill, not necessarily incompetent! must assume they are competent |
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emancipated minor
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minor <18 yrs, must have one of the following:
- self-supporting/military - married - have children |
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when is consent required?
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all cases except in emergency
- for minor procedures, only verbal is needed - for major procedures, need signed consent |
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who can obtain consent
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only MDs.
NOT nurses |
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components of informed consent
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- understand health implications of Dx
- health risks and benefits of Tx - alternatives to Tx - likely outcome if they do not consent - can withdraw consent at any time |
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special component of consent when entering patients into research studies
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- regular consent must be obtained
- if pt gets worse in the study, must immediately be removed and given the standard treatment |
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can a physician withhold telling his pt the Dx?
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usually not.
the only situation in which you can delay is when telling the pt may adversely affect his health. this case you should wait until the pt is prepared for the news... |
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can a patient refuse consent? in which situations?
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patient can refuse consent to treatment for any reason...even religious.
MUST BE COMPETENT. if patient is judged to be incompetent then the situation changes |
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can a pregnant woman refuse consent even if it will cause an injury to the fetus?
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yes as long as she is competent
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if during a procedure, there is an unexpected finding, can the new procedure be done without consent?
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if the finding is emergent, then you do not need consent.
if it is non-emergent, than the pt must be given the opportunity for consent |
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unique elements of consent when treating a minor
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- only parent can give consent
- consent is required by parents except in unusual situations |
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situations when parental consent is not required for treatment of minors
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- emergency
- STDs - contraception - pregnancy - drugs/alcohol |
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does a minor need parental consent to do an abortion?
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in most states, yes
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can parents refuse consent for a treatment for a minor?
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yes they can.
- but if the child has a life-threatening illness, the parents cannot refuse treatment with an established and non-experimental treatment - if they do, then a court order must be obtained |
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if infant is born not breathing, can you rescuscitate?
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- if born before 22nd week, do not resuscitate since mortality is extremely high
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can a parent require or refuse genetic testing?
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- if pediatric onset AND preventative tx is available, then parents should permit and may be required
- if pediatric onset with NO preventative tx, leave it to parents discretion - if adult onset, do not test |
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unique element to revealing information during genetic testing
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if testing reveals information unrelated to the genetic disorder (i.e paternity...) the Dr doesnt need to tell anyone
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when is confidentiality not required?
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- suspected child or elder abuse
- NOTE: spousal abuse is not included - risk of suicide - risk of harm to others i.e. pt has STD and unprotected sex regularly |
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Tarasoff Decision
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legal case that determined that if a pt poses a threat to others or himself, then the Dr must:
-ascertain the credibility - immediately notify the appropriate authorities |
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reportable illnesses
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in most states: B A SSSMMART Clam or Chicken or youre Gone
- hep A and B - salmonellosis - shigelosis - syphilis - measles - mumps - AIDS - Rubella - TB - Chlamydia - Chickenpox - Gonorrhea HIV status is NOT reportable in all states genital herpes is NOT reportable in all states |
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Hep A infection process
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- result of exposure to infected feces
- can be poor access to clean water - or anal sexual contact |
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if Dr is HIV+, does he have to tell patients?
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no he does not.
however, if he does not follow procedures for infection control, then other physicians MUST inform the proper authority |
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can a Dr refuse tx for HIV+ pt?
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no he cannot legally or ethically
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can pregnant patient with high-risk HIV status, refuse HIV testing?
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yes she can.
- however, once the baby is born, the mother cannot refuse testing or tx for the baby |
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if a provider is exposed to fluids from possible HIV+ patient, can he force a HIV test on the patient?
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yes he can
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involuntary psychiatric hospitalization rules
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- pt can be involuntary hospitalized by 1 or 2 physicians if there is a psychiatric emergency
- may be hospitalized for up to 90 days before court hearing |
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if psychiatric patient voluntary hospitalizes, can they be held against their will?
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- they may be required to wait 24-48 hrs before being permitted to sign out
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patients rights when involuntarily hospitalized
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- right to receive treatment
- right to refuse treatment UNLESS they are actively psychotic or suicidal - right to pay for any work done |
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advanced directives
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- durable POA: designating a person as legal representative to make health decisions when you cannot
- living will: document in which person gives directions for how to be treated when incompetent - in both cases, the patient must be competent when making these advanced directives - if there is no AD, then use a surrogate |
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priority order for surrogate
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1. spouse
2. adult children 3. parents 4. siblings 5. other relatives |
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rules of being a surrogate
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must use substituted judgement.
cannot express his wishes, must express what the patient would want! |
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death by brain criteria
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Absence of:
- response to painful stimuli - spontaneous respiration - cephalic reflexes - EEG activity - cerebral blood flow >30 min |
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can dr remove life support after pt is certified dead?
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- yes the physician can. he does not need any permission and he cannot be ordered to keep life support by family
- a court order or relative permission is not necessary |
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can organs be harvested after death?
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- no they cannot unless there is an advanced directive or permission given by relatives
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is euthanasia legal?
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no it is a criminal act
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is dr-assisted suicide legal?
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it is legal in 2 states but not in any others.
- still it is not an indictable offense unless the dr actually does the act of killing |
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can support be withheld from a patient?
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in certain circumstances
- if patient is competent and requests this. can do this both legally and ethically - if patient is terminally ill and has no prospect of recovery |
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elements of malpractice
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4 D's
- dereliction: did not give the usual standard of care - duty: it was your duty to help the patient (established dr-patient relationship) - direct: the damage was caused directly by you - damage: the patient was actually harmed |
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why has there been an increase in malpractice claims recently?
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- technology reduces personal contact
- limits on time for personal interaction (busy schedules...managed care) |
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types of damages awarded in a malpractice suit
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compensatoy: to reimburse patient for the medical bills, salary, suffering...
- covered by insurance punitive: to punish the dr for gross negligence - not covered by insurance |
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is sexual relationship with patients considered malpractice
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- it may be!
if a patient claims a sexual relationship, can file an ethics complaint and/or a malpractice suit |
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can dr treat family members
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although it is permitted, it is ethically wrong to do so!
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