Chapter 12: Ethics, Law, and Physician Behavior

Question 1

What are the 5 components of informed consent?

Answer 1

1. Nature of procedure
2. Purpose of rationale
3. Risks of the treatment regimen
4. Benefits of the treatment regimen
5. Alternatives to the recommended treatment regimen

Question 2

4 situations in which a physician does not need to obtain consent?

Answer 2

1. emergency situations
2. waiver is provided by patient
3. patient is incompetent
4. therapeutic privilege

Question 3

What are the 4 major rights of a committed patient?

Answer 3

• must have treatment available (patient should be informed on a regular basis what treatment options are available
• can refuse treatment
• can request a legal hearing to determine sanity
• loses only the civil liberty to “ come and go”

Question 4

Capacity

Answer 4

an assessment of your decision making ability

Question 5

Who can make a determination of capacity to make informed decisions?

Answer 5

physician

Question 6

Competence

Answer 6

a legal assessment of your ability to make medical decisions for yourself

Question 7

Who can make a judgement on competence?

Answer 7

judge

Question 8

Sanity

Answer 8

a verdict on your ability to make decisions and be held accountable for the consequence of those decisions

Question 9

Who can make a determination on sanity?

Answer 9

jury

Question 10

How long is a physician permitted to “detain” a patient?

Answer 10

up to 48 hours

Question 11

What are the 3 requirements for a surrogate to make decisions?

Answer 11

• patient must be incapacitated
• patient must not have made an advance directive
• surrogate must know what the patient would truly want if he was competent

Question 12

What is the order for decision making a surrogate must use?

Answer 12

1. subjective standard
2. substituted judgement
3. best interests standard

Question 13

What is the order of people who can make decisions about a patient after a surrogate?

Answer 13

1. spouse
2. adult children
3. parents
4. adult siblings
5. other relatives

Question 14

What is the appropriate response of a physician who needs to answer questions from an insurance company?

Answer 14

obtain a release from patient

Question 15

What is the appropriate response for a physician who needs to answer questions from patient’s family?

Answer 15

requires explicit permission from patient

Question 16

What is the appropriate response as a physician when someone has asked to withhold information from patient?

Answer 16

never i.e under no circumstance (if concerned about negative reaction by patient, figure out a way to explain and mitigate negative outcome)

also 1st try to figure out why they may want you to withold

Question 17

What are examples of emancipated minors?

Answer 17

• if child is age > 13 and taking care of self (i.e living alone, responsible for all aspects of own life) he is essentially treated as an adult
• person age < 18 who is married
• pregnancy or birth does not always emancipate; difference from state to state
• person < 18 serving in the military

Question 18

Partial emancipation conditions.

Answer 18

• substance and drug-abuse treatment
• prenatal care
• sexually transmitted disease
• birth control

Question 19

What are the good samaritan laws that are important to remember?

Answer 19

• actions are within the physician’s competence
• only accepted procedures are performed
• the physician remains at the scene after starting therapy, until relieved by competent personnel
• no compensation changes hands

Question 20

What types of abuse are mandatory to report? Which is not?

Answer 20

child abuse and elder abuse

domestic abuse; no mandatory reportable offense

Question 21

What is transference?

Answer 21

pateint may unconsciously transfer thought onto physician

Question 22

What is countertransference?

Answer 22

physician may unconsciously transfer throught onto patient