Chapter Summaries Flashcards
Ethics
- definition
- main purpose
- penalties
- standards/guide to conduct
- elevate standard of conduct
- penalty determined by peers as part of the ethics committee
Moral Values
- definition
- main purpose
- penalties
- personal beliefs created from family, culture, society
- serves as a guide for ethical conduct
- not a penalty, but as a consequence. If you do not have moral values you will have difficulty getting along with others
Bioethics
- definition
- main purpose
- penalties
-medical discipline relating to the ethics concerning biological research
Law
- definition
- main purpose
- penalties
- set of governing rules
- to protect consumers (public)
- upon conviction: fine/imprisonment/license revocation/other penalty determined by court
Explain why knowledge of law & ethics is important to heal care practitioners
To perform at the highest level of your profession and to avoid litigation
Distinguish among law, ethics, bioethics, etiquette, protocol
Law-rules for conduct (protects consumers)
Ethics-rules for governing behavior
Bioethics-study of ethical implications in biomedical research
Etiquette-good manners
Protocol-Expectations of behavior set forth by employer
Define moral values and explain how they relate to law, ethics, and etiquette
Moral values are the ideas and beliefs a person accrues over time from influences of family, religion, environment, etc. Without good moral values you will not have a good base of moral ethics or etiquette. Without those, you will be left vulnerable to legal entanglements.
Discuss the characteristics & skills most likely to lead to a successful career in one of the health care professions
Courtesy, Common Sense, Compassion, People Skills, Technical Skills, Critical Thinking Skills
Describe and compare need and value development theories
Maslow’s Hierarchy of Needs stands on the idea that human behavior is based on specific human needs that must often be med in a specific order
Piaget believed in 4 stages of development (Sensorimotor, Preoperational, Concrete Operational, Formal Operational)
Kohlberg expanded upon Piaget’s model. It may take longer for stages to fulfill. 6 levels in 3 stages (Preconventional, Conventional, Postconventional)
Identify the major principles of contemporary consequence-oriented, duty-oriented, and virtue ethics
Consequence-Oriented (Teleological) says that it is the outcome of the act that determine its moral rightness or wrongness. Utilitarianism is a form of consequence-oriented ethics in which the outcome of the decision made must benefit the majority of people
Duty-Oriented (Deontelogical) says that it is the intent of the action that determine its moral rightness or wrongness. The outcome of the action/decision is irrelevant
Virtue Ethics says that whatever decision the person chooses is the morally right decision because the person is virtuous. The outcome will be virtuous because the person making the decision makes moral choices since he/she is virtuous.
Define the basic principles of health care ethics
Veracity (truth telling)
Justice (give patient what he/she is due)
Role Fidelity (stay within limitations of your capabilities)
Autonomy (patient can decide for themselves)
Beneficence (promote well-being)
Nonmaleficence (do no harm)
Confidentiality (do not misuse or divulge private information)
How do licensure, certification, registration, accreditation differ?
Licensure is a mandatory credentialing process
Certification is a voluntary credentialing process
Registration means you are registered in an official record
Accreditation is the process in which schools, facilities,
health care plans are officially authorized
How are physicians licensed and regulated?
Medical Board enacted by the state Medical Practice Acts
What is the health care team?
Physicians and allied health workers who generally have completed a course of study leading to licensure, certification, or registration in one of the health care professions
What are the different types of medical practice management systems?
Sole Proprietorship- One doctor working as private practice
Associate Practice- Two or more doctors sharing staff and facilities but operating separately
Partnership- Two or more doctors who share all costs of business under contract)
Corporation- Multiple operation under single entity
Group Practice- Three or more doctors functioning together. Can be Partnership or Corporation. Can be same profession or a collective of specialites
What is the basis of law in the United States?
Federal Statutes
Stat Statutes
Municipal Ordinances
Constitutional Law (law derived from federal/state constitutions)
Case Law (established through common law and legal precedent)
Common Law (body of unwritten law developed in England; primarily from judicial decisions based on custom and tradition)
How are laws classified?
Substantive- Statutory (legislative) or written law that defines and regulates legal rights and regulations
-Criminal law involves crimes against the state
(misdemeanor/felony)
-Civil law involves wrongful act against persons
Procedural- law that defines the rules used to enforce substantive law
What are the torts and how do they affect health care practitioners?
A tort is a civil wrong committed against a person or property (excluding breach of contract)
Intentional tort involves intentional misconduct
Unintentional torts are not meant to cause harm but are committed unreasonably or with a disregard for the consequences. In legal terms, this constitutes negligence.
What is a contract, and what are its essential elements?
A contract is a voluntary agreement between two parties in which specific promises are made for a consideration.
The agreement- one party makes an offer, and another party accepts it
The consideration- something of value is bargained for as part of the agreement
Legal subject matter- contracts are not valid and enforceable in court if terms if the services or purposes of the contract are legal.
How do expressed contracts differ from implied contracts?
Expressed contracts are spoke/written in precise terms
Implied contracts aren’t spoken/written in precise terms, but are understood
What are the contractual rights and responsibilities of physicans?
Physician has the right to:
- setup practice w/in the boundaries of his/her license to practice medicine
- setup an office wherever he/she chooses and establish -office hours
- specialize
- decide which services he/she will provide and how those services will be provided
Physician has the obligation to:
- use due care, skill, judgment, and diligence in treating patients
- Stay informed about the best methods of diagnosis/treatment
- exercise his/her best judgment
- consider the established, customary treatment in similar cases
- no experimenting on patient w/o prior approval and consent
- provide proper instructions for post-care
- provide complete information about diagnosis, options, methods of treatment, and fees for services
- take every precaution to prevent the spread of contagious disease
- advise patients against needles or unwise operations
What are the contractual rights and responsibilities of patients?
Patients have the right to:
- receive considerate and respectful care
- receive complete information concerning his/her diagnoses, treatment, and prognosis
- receive information necessary to give informed consent prior to the star of any procedure and/or treatment
- refuse treatment to the extent permitted by law
- receive every consideration of his/her privacy
- be assured of confidentiality
- obtain information about his/her health care
- know whether treatment is experimental and be free to refuse to participate
- expect reasonable continuity of care
- examine his/her bill and have it explained
- know which hospital rules and regulations apply to patient conduct
- terminate the physician-patient contract
Patients are obligated to:
- follow instructions given and cooperate as much as possible
- give all relevant info to physician (if not, physician can’t be held liable)
- follow treatment orders (if not, patient does not have legal recourse)
- pay fees for services rendered
What is the law of agency and how does respondeat superior apply to health care contracts?
Law of agency: employee=agent employer=principal
(governs the relationship between agent and principal)
Respondeat superior: employer is liable for employee acts, if the acts are within the scope of the employee’s duties
What are the three areas of general liability for which physician/employer is responsible?
Employee safety
Grounds of facility
Automobiles used for job fulfillment
Differences between reasonable person standard, standard of care, and duty of care.
Reasonable person standard: individual can be charged with negligence if they acted in a manner that a reasonable person would not have acted or failed to act in a way which a reasonable person would have acted in a similar situation
Standard of care- level of performance expected of a health care practitioner in carrying out his/her professional duties
Duty of care- legal obligation of health care workers to patients and nonpatients
What are the responsibilities of health care practitioners concerning privacy, confidentiality, and privileged communication?
Health care practitioners have a legal and ethical obligation to safeguard a patient’s privacy and maintain confidentiality.
Patients may sue for breach of confidence if protected information is released and results in damage to the patient.
What are the four D’s of negligence?
Duty (responsibility to patient care)
Dereliction (breach of duty of care)
Direct Cause (breach of duty of care was the direct cause to injury)
Damages (legally recognizable injury)
What are the phases of a lawsuit?
Pleading Phase
Interrogatory/Pretrial Discovery Phase
Trial Phase
Appeal Phase
Difference between testimony by deposition and interrogatory testimony.
Testimony by deposition- recorded outside courtroom during pretrial phase
Interrogatory testimony- written set of questions requiring written set of answers under oath
What is alternative dispute resolution?
Settlement of civil disputes between parties using neutral mediators or arbitrators without going to court
What are the four Cs of medical malpractice prevention?
Caring
Communication
Competence
Charting
Why do patients sue?
- unrealistic expectations
- poor rapport and poor communication
- greed
- lawyers and our litigious society
- poor quality of care (either in fact or perception)
- poor outcome
- failure to understand patients’/families’ perspectives and devaluing their point of view
What general categories of information should be documented for legal purposes?
- what treatment was performed and when
- referrals
- missed appointments
- dismissals
- treatment refusals
- all other patient contact
What types of defense may be used in medical malpractice lawsuit?
Denial
Affirmative (contributory negligence, comparative negligence, assumption of risk, emergency)
Technical (release of tortfeasor/person responsible for original wrong, res judicata/double jeopardy, statute of limitations)
What are the common risk management methods?
Quality Assurance/Quality Improvement
Credentialing
What types of professional liability insurance are available to medical providers?
Claims made (only valid for claims made while policy is in force)
Tail coverage (with canceled policies, coverage provided for malpractice claims that occurred during time when policy was in effect)
Prior acts coverage (can only be purchased as new subscriber to insurance policy. Coverage granted for malpractice claims that have not yet occurred/been filed)
Occurence (coverage is granted for any malpractice claims that occur while the policy is in force, regardless of when the claim is made)
Self-Coverage (subscriber pays in to trust fund to pay for potential damage awards)
What purposes do medical records serve?
- they are required by licensing authorities and provide a format for tracking, documenting, and maintaining a patient’s communication data, both inside and outside a health care facility
- they provide documentation of a patient’s continuing health care, from birth to death
- they provide a foundation for managing a patient’s health care
- they serve as legal documents in lawsuits
- they provide clinical data for education, research, statistical tracking, and assessing the quality of health care
What information is entered into a patient’s medical record?
- contact and identifying information/drivers license/emergency contact
- insurance information
- person responsible for payment and billing
- patient’s health history
- dates and times of appointments
- description of patient’s symptoms and reasons for appointments
- examinations performed
- physician’s assessment, diagnosis, recommendations, treatment, progress notes, prescriptions, and instructions to patient
- all test results
- notations of telephone calls
- notations of copies made
- documentation of informed consent
- names of guardians/legal representatives if patient is unable to give informed consent
- all other documentation
- condition of patient at time of termination of treatment
What are the five Cs of entries in medical records?
Concise Complete Clear Correct Chronologically Ordered
What is the accepted manner for correcting errors in a medical record?
- Draw a line through the error
- Write correct information above or below original line
- Note why correction was made
- Enter the date, time, and initial the correction
- Ask a coworker to witness and initial the correction when it is made
Who owns a person’s medical record?
How long should medical records be kept?
The owners of the facility where the records were created
Until the applicable statute of limitations period has elapsed
For what purposes is medical information routinely released?
- insurance claims
- transfer of the patient to another physician
- use in a court of law
What information does the patient need in order to give informed consent?
- proposed methods of treatment
- why the treatment is necessary
- risks involved
- available alternatives
- risks of alternatives
- risks involved if treatment is refused
Who cannot give informed consent?
- minors
- persons who are mentally incompetent
- persons who speak limited or no English
When do Good Samaritan laws protect health care practitioners who stop to help in emergencies?
- when care is given in good faith
- when caregivers act within the scope of their training and knowledge
- when caregivers use due care and under the circumstances
- when caregivers do not bill for their services
What benefits does the federal government ascribe to the adoption of health information technology, including the conversion to electronic health records?
- improving health care quality
- preventing medical errors
- reducing health care costs
- increasing administrative efficiency
- decreasing paperwork
- expanding access to affordable care
What machines require special care in preventing technological threats to confidentiality?
- photocopiers
- fax machines
- computers
- printers
What considerations do federal and state privacy laws share?
- information collected and stored about individuals, and the access of that information, should be limited to what is necessary to carry out the functions of the business, including employees, or government agency collecting the information
- personal information cannot be released outside the organization collecting it unless authorization is obtained from the subject
- when information is collected about a person, that person should know that the information is being collected and should have the opportunity to check the information for accuracy
Which federal laws most extensively regulate health care, including privacy?
- Health Insurance Portability and Accountability Act (HIPAA) of 1996
- American Recovery and Reinvestment Act (ARRA) of 2009
- Patient Protection and Affordable Care Act (PPACA) of 2010
- Health Care and Education Reconciliation Act (HCERA) of 2010
Which HIPAA terms are health care practitioners most likely to routinely use?
- business associate
- covered entity
- covered transaction
- de-identify
- designated record set
- electronic data interchange (EDI)
- electronic transmission
- encryption
- limited data set
- minimum necessary
- Notice of Privacy Practices (NPP)
- patient identifiers
- permission
- protected health information (PHI)
What are the four HIPAA standards and rules?
- Transactions and Code Sets: A transaction refers to the transmission of information between two parties to carry out financial or administrative activities. A code set is any set of codes used to encode data elements, such as tables of terms, medical concepts, medical diagnostic codes, or medical procedure codes
- Privacy Rule: Policies and procedures health care providers and their business associates put in place to ensure confidentiality of electronic, written, and oral protected health information
- Security Rule: Security refers to those policies and procedures health care providers and their business associates use to protect electronically transmitted and stored PHI from unauthorized access
- National Identifier Standards: Provide unique identifiers (addresses) for electronic transmissions
What rules does HIPAA have for disclosing PHI?
- permission from patients required for releasing PHI
- special requirements for disclosing PHI
- civil/criminal penalties for unauthorized disclosure of PHI
- patient’s rights under HIPAA: (1) right to obtain personal medical records (with some exceptions), (2) right to request a change to one’s own medical records, (3) right to request a list of disclosure over the past 3 years, (4) right to request notifications at alternative locations, (5) right to restrict access, (6) right to file a complaint
What recent legislation significantly changed HIPAA privacy, security, and enforcement rules?
-American Recovery and Reinvestment Act (ARRA) of 2009
(Title XIII, called the Health Information Technology for Economic and Clinical Health (HITECH) Act)
What patient rights does HIPAA define?
- access to medical records and the right to copy them
- request for amendment to designated record set
- request for an accounting of disclosures of PHI
- request to be contacted at an alternate location
- requests for further restrictions on who has access to PHI
- right to file a complaint
How can you protect the privacy of your own medical records?
- read notices of privacy practices carefully
- tell your health care provider your confidentiality concerns
- ask how large health care organizations share your information
- read authorized forms carefully before you sign
- register your objection of disclosures you consider inappropriate
- request a copy of your medical record, and review it carefully to be sure the information is correct
- be cautious when visiting Web sites
- request a copy of your file from the Medical Information Bureau (MIB)
- educate yourself about medical privacy issues
What is the truth about some common HIPAA myths?
- physicians may exchange information about a patient without written authorization
- doctor-patient emails are permitted, as long as proper security is in place
- employers may not access employees’ PHI without patients’ written authorization, even if the employer is the health care payer
- failure to pay medical bills can affect one’s credit rating
- patients must give consent before being listed in a hospital directory
- hospital directories may be available to the public, with patients’ consent
- clergy members can learn of congregation members’ hospitalization, but only with patients’ authorization
- hospitals can share patient information with patients’ authorization
- hospitals can share patient information with designated family members
- family members can pick up prescriptions, X-rays, and other similar forms of PHI for patients
What are the vital events for which government collects statistics?
- live births
- deaths
- fetal deaths
- marriages
- divorces
- induced terminations of pregnancy
- any change in an individual’s civil status
What is the correct procedure for completing a birth certificate?
- type or legibly print all entries
- leave no entries blank
- avoid corrections and erasures
- where requested, provide signatures. do not sure use rubber stamps or initials in place of signatures
- file only originals with state registrars
- verify the spelling of names
- avoid abbreviations when possible
- refer any problems to the appropriate state officials
What information does a death certificate generally include?
- disease, injury and/or complication that caused the death and time treated before death
- date and time of death
- place of death
- if decedent was female, presence or absence of pregnancy
- whether or not an autopsy was performed
When are autopsies performed?
- when a death is suspicious
- to determine cause of death, if cause is uknown
When is a physician not allowed to sign a death certificate?
- when death is possible due to criminal causes
- when person is not attended by a physician within a specified length of time before death
- when death is due to causes undetermined by the physician
- in cases of violent or otherwise suspicious deaths
What provisions do all public health statuses have in common?
- guard against unsanitary conditions in public facilities
- inspect establishments where food and drink are processed and sold
- exterminate pests and vermin that can spread disease
- check water quality
- set up measures of control for certain diseases
- require physicians, school nurses, and other health care workers to file certain reports for the protection of citizens
What are some examples of authority states have to enforce public health laws?
- require investigations be conducted in infectious disease outbreaks
- make childhood vaccinations a condition for school entry
- ban the distribution of free cigarette samples around schools or in areas where children congregate
- institute smoking bans or restrictions
- involuntarily detain (quarantine) individuals who have certain infectious diseases
- seize and/or destroy property to contain the threat of toxic substances
Under public health law, what diseases and conditions are generally reported to public health departments?
- diseases that, if left unchecked, could threaten the health and well-being of the population
- infectious diseases
- sexually transmitted diseases or infections
- other diseases that may have mandated reporting if a higher than normal incidence occurs
Which no-fault federal laws compensate for vaccine injury?
- National Childhood Vaccine Injury Act of 1986
- Established National Vaccine Injury Compensation Program (VICP)
- Smallpox Emergency Personnel Protection Act of 2003
What information must vaccine administrators document in a patient’s medical record?
- The date the vaccine was administered.
- The vaccine manufacturer.
- The vaccine lot number.
- The name, address, and title of the health care provider who administered the vaccine.
- Any adverse event listed in the Vaccine Injury Table.
- Any contraindicating event as listed in the manufacturer’s package insert.
What injuries are reportable to the authorities under the auspices of public health?
- Spousal abuse
- Child abuse
- Elder abuse
What two federal agencies oversee drugs in the US?
- Food and Drug Administration (FDA).
- Oversees drug quality and standardization and must approve drugs before they are released for public use.
- Drug Enforcement Administration (DEA).
- Branch of the U.S. Department of Justice that regulates the sale and use of drugs.
What are the requirements for physicians who prescribe, dispense, and administer controlled substances?
- Register with the Drug Enforcement Administration through a division office.
- Keep records concerning the administering or dispensing of a controlled drug on file for two years.
- Note on a patient’s chart when controlled substances are administered or dispensed.
- Make a written inventory of drug supplies every two years, and keep such records an additional two years.
- Keep drugs in a locked cabinet or safe, and report any thefts immediately to the nearest DEA office and the local police.
What are schedules under which controlled substances are listed?
- Schedule I—No proven medical use; usually used only for research.
- Schedule II—Potential for abuse high, but accepted medical uses.
- chedule III—Less potential for abuse; have accepted medical uses.
- Schedule IV—Low potential for abuse compared to other schedules, but may lead to dependency.
- Schedule V—Low potential for abuse, but may lead to dependency.
What is the role of the medical assistant regarding controlled substances in the medical facility?
- Checking to be sure that all controlled substances are kept in a locked cabinet or safe.
- Reminding the physician to keep his or her “black bag” in a safe place.
- Keeping all prescription blanks, especially those used for narcotics, under lock and key.
- Ordering prescription blanks that are serially numbered or otherwise printed to help detect alterations and theft.
- Reporting to the physician any behavior by patients that would suggest an attempt to secure addictive drugs.
- Checking patients’ records to verify all prescriptions that may be questioned by a pharmacist.
What issues affected by federal law have traditionally affected employees in the workplace?
- Employment-at-will.
- Wrongful discharge.
- Just cause.
- Public policy.
What categories do federal and state laws generally address, regarding employees in the workplace?
- Discrimination.
- Sexual harassment.
- Physical disability.
- Pregnancy.
- Age.
- Genetic discrimination.
- Wages and work hours.
- Equal pay.
- Retirement income security.
- Safety and welfare.
What is the role of the health care practitioner following OSHA standards for work done in the clinical setting and for infection control in the medical office?
- Right-to-know.
- Hazard Communication Standard.
- Chemical Hygiene Plan.
- Occupational Exposure to Bloodborne Pathogen Standard.
- Medical Waste Tracking Act.
What is the purpose of worker’s compensation and unemployment insurance.
- five types of benefits
- claimant requirements
What should health care practitioners know about hiring and paperwork for new employees?
- Prohibited questions to ask job applicants.
- Guidelines for conducting interviews.
- Required paperwork.
- Surety bond.
How does the term genetics differ from the term heredity?
- Genetics is the science that accounts for natural differences and resemblances among organisms related by descent.
- Heredity is the process by which organisms pass on genetic traits to their offspring.
What is the Human Genome Project?
A scientific project funded by the U.S. government, begun in 1990 and successfully completed in 2000, for the purpose of mapping all of a human’s genes.
What is genetic testing?
Testing one’s DNA to discover one’s genetic makeup
What are the different types of genetic testing?
- Predictive
- Carrier
- Prenatal
- Amniocentesis—testing a sample of amniotic fluid for genetic or other conditions in a developing fetus—is a common prenatal test.
- Preimplantation
- Forensic
- Tracing linage
- Newborn screening
- Diagnostic
What is a mutation?
A permanent change in DNA
What does a genetic counselor do?
Genetic counselors are qualified to counsel individuals before and after genetic testing
What is genetic discrimination?
Genetic discrimination is different treatment of individuals based on actual or presumed genetic differences
What federal laws are in place to protect Americans against genetic discrimination in health insurance and employment?
- Genetic Information Nondiscrimination Act (GINA) of 2008.
- Health Insurance Portability and Accountability Act (HIPAA).
- Americans with Disabilities Act (ADA).
What is genetic engineering?
Genetic engineering is the manipulation of DNA within an organism’s cells through synthesis, alteration, or repair to ensure that certain harmful traits will be eliminated in offspring and that desirable traits will appear and be passed on.
What is a clone?
An organism produced asexually, usually from a single cell of the parent.
What is xenotransplantation?
Transplantation of animal tissues and organs into humans
What are stem cells?
- Cells that can become another type of body cell.
- Multipotent: Adult cells that can become a limited number of types of tissues and cells.
- Pluripotent: Embryonic cells that can become almost all types of tissues and cells.
What is gene therapy?
Treatment of harmful genetic diseases or traits by eliminating or modifying the harmful gene.
What is infertility?
The failure to conceive for a period of 12 months or longer due to a deviation from or interruption of the normal structure or function of any reproductive part, organ, or system.
What alternatives are available for infertile couples who want to become parents?
- In vitro fertilization (IVF).
- Artificial insemination.
- Homologous: husband’s sperm/wife’s eggs.
- Heterologous: donor sperm/wife’s eggs.
- Surrogacy.
- Adoption.
Under what doctrine may the state act as a child’s parental authority?
- parents patraie
- best interest of the child concept
When may physicians, with the parents’ consent, legally withhold treatment and nourishment from a newborn who is severely disabled?
- If the child is chronically and irreversibly comatose.
- If the child will most certainly die, and treatment is considered futile.
- If the child would suffer inhumanely if treatment were provided.
What are safe haven laws?
Laws that allow mothers to abandon newborns to designated safe facilities without penalty
How do mature minors differ from emancipated minors?
Mature minors: Individuals in mid- to late teens who legally live outside parental or guardian control.
Emancipated minors: Individuals in mid- to late teens who legally live outside parental or guardian control, usually through judicial decree, as long as minor
(a) Is self-supporting.
(b) Is legally married.
(c) Is serving in the armed forces.
How does the term genetics differ from the term heredity?
Genetics is the science that accounts for natural differences and resemblances among organisms related by descent.
Heredity is the process by which organisms pass on genetic traits to their offspring.
What terms, integral to the study of genetics, are defined in this chapter?
DNA—deoxyribonucleic acid: The combination of proteins, called nucleotides, that is arranged to make up an organism’s chromosomes.
Chromosome: A microscopic structure found within the nucleus of all living cells that carries genes responsible for the organism’s characteristics.
Gene: A tiny segment of DNA that holds the formula for making a specific enzyme or protein.
Genome: All the DNA in an organism, including its genes.
What is the Human Genome Project?
A scientific project funded by the U.S. government, begun in 1990 and successfully completed in 2000, for the purpose of mapping all of a human’s genes.
What is genetic testing?
Testing one’s DNA to discover one’s genetic makeup
What are the different types of genetic testing explained in this chapter?
- Predictive
- Carrier
- Prenatal
- Amniocentesis—testing a sample of amniotic fluid for genetic or other conditions in a developing fetus—is a common prenatal test.
- Preimplantation
- Forensic
- Tracing linage
- Newborn screening
- Diagnostic
What is a mutation?
A permanent change in DNA
What does a genetic counselor do?
Genetic counselors are qualified to counsel individuals before and after genetic testing.
What is genetic discrimination?
Genetic discrimination is different treatment of individuals based on actual or presumed genetic differences.
What federal laws are in place to protect Americans against genetic discrimination in health insurance and employment?
Genetic Information Nondiscrimination Act (GINA) of 2008.
Health Insurance Portability and Accountability Act (HIPAA).
Americans with Disabilities Act (ADA).
What is genetic engineering?
Genetic engineering is the manipulation of DNA within an organism’s cells through synthesis, alteration, or repair to ensure that certain harmful traits will be eliminated in offspring and that desirable traits will appear and be passed on.
What is a clone?
An organism produced asexually, usually from a single cell of the parent.
What is xenotransplantation?
Transplantation of animal tissues and organs into humans?
What are stem cells?
Cells that can become another type of body cell.
Multipotent: Adult cells that can become a limited number of types of tissues and cells
Pluripotent: Embryonic cells that can become almost all types of tissues and cells.
What is gene therapy?
Treatment of harmful genetic diseases or traits by eliminating or modifying the harmful gene.
What is infertility?
The failure to conceive for a period of 12 months or longer due to a deviation from or interruption of the normal structure or function of any reproductive part, organ, or system.
What alternatives are available for infertile couples who want to become parents?
In vitro fertilization (IVF).
Artificial insemination.
Homologous: husband’s sperm/wife’s eggs.
Heterologous: donor sperm/wife’s eggs.
Surrogacy.
Adoption.
Under what doctrine may the state act as a child’s paternal authority?
Parens patriae.
Best Interest of the child concept.
When may physicians, with the parents’ consent, legally withhold treatment and nourishment from a newborn who is severely disabled?
If the child is chronically and irreversibly comatose.
If the child will most certainly die, and treatment is considered futile.
If the child would suffer inhumanely if treatment were provided.
What are safe haven laws?
Laws that allow mothers to abandon newborns to designated safe facilities without penalty.
How do mature minors differ from emancipated minors?
Mature minors: Individuals in mid- to late teens who legally live outside parental or guardian control.
Emancipated minors: Individuals in mid- to late teens who legally live outside parental or guardian control, usually through judicial decree, as long as minor
• Is self-supporting.
• Is legally married.
• Is serving in the armed forces.
Which rituals surrounding death have survived to the present?
Mourners wearing black.
Halting traffic for a funeral procession.
Wakes.
Firing a rifle volley over the deceased.
Funeral wreaths.
What is the Uniform Determination of Death Act?
A federal proposal that defines brain death as a means of determining when death actually occurs:
- Circulation and respiration have irreversibly ceased.
- The entire brain, including the brain stem, has irreversibly ceased to function.
What is the difference between a coma and a persistent vegetative state?
Coma: A condition of deep stupor from which the patient cannot be roused by external stimuli.
Persistent vegetative state (PVS): Severe mental impairment characterized by irreversible cessation of the higher functions of the brain, most often caused by damage to the cerebral cortex.
What tests may be performed to determine if death has occurred?
Cannot breathe without assistance.
No coughing or gagging reflex.
No pupil response to light.
No blinking reflex when cornea is touched.
No grimace reflex when head is rotated or ears are flushed with ice water.
No response to pain.
What is the difference between palliative care and curative care?
Palliative care: Treatment of a terminally ill patient’s symptoms to make dying more comfortable—also called comfort care.
Curative care: Treatment directed toward curing a patient’s disease.
What is a hospice?
A facility or program in which health care practitioners and volunteers provide a continuous environment that focuses on the physical, emotional, and psychological needs of the dying patient.
What is meant by the phrase terminally ill?
A patient has six months or less to live.
What is the Uniform Rights of the Terminally Ill Act?
A 1989 federal proposal to guide state legislatures in constructing laws concerned with advance directives.
What is euthanasia?
Mercy killing of the hopelessly ill.
Active euthanasia: A conscious medical act that results in the death of a dying person.
Passive euthanasia: Allowing a dying patient to die without medical interference.
Voluntary euthanasia: Requires the patient’s consent or the consent of the patient’s legal representative to implement.
Involuntary euthanasia: The use of medical means to end a dying patient’s life without his or her consent.
Physician-assisted suicide: Any of the previously listed methods in which a physician takes part in the patient’s suicide.
What is the Patient Self-Determination Act?
A federal act that requires hospitals and other health care providers to give written information to patients regarding their rights under state law to make medical decisions and to execute advance directives.
Living will: An advance directive that specifies a patient’s end-of-life wishes.
Durable power of attorney: An advance directive that gives a designee authority to make a variety of legal decisions for a patient, including health care decisions.
Health care proxy: A durable power of attorney for health care decisions only.
Do-not-resuscitate order (DNR): The patient specifies in writing that he or she does not wish to be resuscitated if his or her heart stops.
What is the National Organ Transplant Act?
A 1984 federal law that provides grants to qualified organ procurement organizations and that established an Organ Procurement and Transplantation Network (OPTN).
Established the United Network of Organ Sharing (UNOS) to administer the OPTN. The UNOS
Increases the effectiveness and efficiency of organ sharing and equity in the national system of organ allocation.
Increases the supply of donated organs available for transplant.
What is the Uniform Anatomical Gift Act?
A federal proposal that states enact laws allowing anyone 18 or older, of sound mind, may make a gift of his or her body or certain organs to be used in medical research, transplantation, or storage in a tissue bank. The act recommends that
Donations made through a legal will are not to be held up by probate.
Except in autopsies, the donor’s rights override those of others.
Survivors may speak for the deceased if no arrangements for donation were made prior to death, provided the deceased did not express an objection to donation before death.
Physicians who rely on donation documents for the acceptance of bodies or organs are immune from civil or criminal prosecution.
Hospitals, surgeons, physicians, accredited medical or dental schools, colleges and universities, and tissue banks or storage facilities may accept anatomical gifts for research, advancement of medical or dental science, therapy, or transplantation.
Time of death of the donor must be established by a physician who is not involved in transplanting the donor’s designated organs, and the donor’s attending physician cannot be a member of the transplant team.
Donors may revoke the gift, and gifts may be rejected.
What is grief?
The human reaction to loss.
What are Elizabeth Kubler-Ross’ stages of grief?
Denial
Anger
Bargaining
Depression
Acceptance
What are Roberta Temes’s stages of grief?
Numbness
Disorganization
Reorganization
Who are health care stakeholders?
Anyone with a vested interest in the health care industry.
Who are the major stakeholders in the US health care industry?
The public.
Employers.
Health care facilities and practitioners.
Federal, state, and local governments.
Managed care organizations.
Private insurers.
Volunteer facilities and agencies.
Health care practitioner training institutions.
Professional associations and other health care industry organizations.
Medical and pharmaceutical research groups.
What are the key issues of concern to health care industry stakeholders?
COST: The amount individuals, employers, state and federal governments, HMOs, and insurers spend on health care in the United States.
Health care costs as a percentage of gross national product (GDP) rise yearly.
GDP: Total value of all goods produced and services provided in American for one year.
Factors adding to health care costs annually include
• Application of more advanced and more types of technology.
• Growth in the population of older adults.
• Emphasis on specialty medicine.
• Increasing numbers of uninsured and underinsured.
• Labor intensity of health care services.
• Reimbursement system incentives.
• Fraud.
ACCESS: The availability of health care and the means to purchase health care services.
Government attempts to reform the health care system have been intended, largely, to increase access and lower costs—the latest attempt at reform was the Patient Protection and Affordable Care Act (PPACA) of 2010.
QUALITY: The degree of excellence of health care services offered.
What is the Agency for Healthcare Research and Quality (AHRQ)?
• The lead federal agency responsible for tracking and improving the quality, safety, efficiency, and effectiveness of health care for Americans.
Latest AHRQ report shows • Access to quality care still not universal. • Access to quality care often depends on individuals' type of health insurance. • Matters of urgent concern are hospital safety and hospital infections.
What health care advances have been forecast for the near future?
Rational drug design—use of computers to create drugs designed to attack specific diseased cells or to otherwise pinpoint delivery and enhance efficacy.
Continuing advancement in imaging equipment and techniques.
Minimally invasive surgery, such as highly developed arthroscopic and laparoscopic techniques, such as robotic surgery.
Genetic mapping and testing.
Gene therapy.
New and improved vaccines.
Artificial blood.
Xenotransplantation.
Use of stem cells.
Personalized medicine.
What are three additional areas where we should see improvement/advancement in the near future?
Use of stem cells.
Tissue engineering.
Health information technologies (HITs).
What health care system reforms have often been proposed, and my be inevitable in the near future?
Charge Medicare beneficiaries more.
Create a dedicated federal health tax to cover all government health spending, such as Medicare and Medicaid.
Eliminate the income tax exclusion for employer-paid insurance and replace it with a tax credit of lesser value.
Provide access to health insurance through public financing for Americans living at or below poverty levels.
Provide extensive education to consumers concerning living a healthy lifestyle.
Disclose and reward quality-based medical practice.
Support and reinvigorate through government financing the nation’s deteriorating public health system.
Require all Americans to have health insurance coverage, available through public and private plan options made available through state-run exchanges, where citizens could obtain coverage at a reasonable cost, or through government subsidies.
