Chapter Three Flashcards
What is a minor?
anyone younger than 18 years of age
all medical procedures for minors require what?
- require parental or gurdian consent
- This means that anyone younger than 18 years of age needs someone older to act as a surrogate decision maker to assume responsibility for doing what is best for the minor
Historically what is the age of automony?
18
What is autonomy?
Autonomy is a person’s abil- ity to make decisions concerning his or her own personal business, including health care.
What happens when a minor does not have a parent?
If the minor does not have a parent, such as in the case of a child whose parents have died or a child in the custody of the state (as with foster care), the courts will appoint a guardian ad litem
What is a guardian ad litem?
- This person acts as the legal guardian for all decision-making processes, including decisions regarding health care.
- There are also cases where parents assume the role of guardian ad litem for disabled children after they reach the age of majority or for their elderly parents who are no longer considered competent.
Reasonable and rational parents (or guardians) base their healthcare on what?
- base their healthcare deci- sions on family values, resources, and needs.
- Not all families will make the same decisions, because they have different values, different financial resources, and different needs.
What is the the duty of healthcare professionals?
- As healthcare professionals, our duty is to explain the various choices available and respect decisions made—regardless of personal opinions.
- We might not always agree with a family’s decisions, but our role is to advise, not judge
why might there be conflict between healthcare professional and families? What is an example
- A healthcare professional will sometimes feel that family decisions conflict with the best interests of the child.
- These instances may result from religious and cultural differences, and may involve minors who are facing an untimely death.
- Certain religions and cultures have strict guidelines regarding medical issues.
- For example, families that practice Jehovah’s Witness see blood transfusions as a violation of their religious practice
What does jehovah witness believe?
- believes that any blood that leaves one body should not be placed in another body and, further, that any blood that leaves the body should be discarded. Jehovah’s Witnesses will accept other types of fluid infusion, such as medications, just not blood.
- To follow this type of religious policy is an acceptable decision for an informed adult, but withholding a lifesaving procedure from a minor because of parental religious convictions is generally found to be an ethical and legal dilemma.
What happen in the prince v. common wealth of massachusetts case?
The court based the decision on the 1944 Supreme Court case of Prince v . Commonwealth of Massachusetts . In that case, the courts ruled that “[t]he right to practice religion freely does not include the liberty to expose . . . a child . . . to ill health or death . Parents may be free to become martyrs themselves . But it does not follow that they are free . . . to make martyrs of their children before the children reach the age of full and legal discretion when they can make the choice for themselves” (Prince v. Commonwealth of Massachusetts, 1944) .
What does the case of johnny illustrate?
healthcare professionals occasionally need to consult the legal system when there are conflicts between the decisions of the par- ents and what the medical community considers to be in the best interest of the child.
What is another know medical controverisal issue around children?
- For instance, due to religious or personal reasons, some parents might refuse to allow their child to become vaccinated.
- Most states require children to be fully vaccinated before they can enter the public school system, but parents with religious or secular convictions can opt out of this requirement in some states.
- The controversy around this issue continues as some parents who opted out due to concerns that vaccinations might be linked to development disorders, such as autism, learn that the research was fraudulent.
- In California, a measles outbreak resulted in legislation limiting vaccination exemptions to those with medical reasons (SB-277, 2016).
What happened in the phillips v. city of New york, 2015 court case?
- Two families in the state of New York challenged a law requiring vaccinations for public school students .
- The families cited exemption due to religious differences .
- The case started when the children were not allowed to attend school during a chicken pox outbreak because they were not vaccinated .
- The parents claimed it was a violation of their constitutional rights .
- The 2nd Circuit Court of Appeals dismissed the claim stating that their arguments were invalid (Phillips v. City of New York, 2015) .
If a woman goes into labor early, how does the medical community decide which procedures are helpful and which are harmful?
- A premature infant born at less than 23 weeks’ gestation is generally not resuscitated because the medical community agrees that quality of life for the infant would be poor.
- After 25 weeks, aggressive measures are taken to resuscitate the newborn.
- Between 23 and 25 weeks, the decision is left up to the parents and medical community based on various factors, including overall health of the newborn, trauma of the birth process, and resources of the family
- Asking parents to provide informed consent at this stage is problematic because of traumatic outcomes that are difficult to predict. The parents are asked to either give up a future child or face the possibility of raising a child with develop- mental and medical difficulties
Who was gregory messenger?
In Michigan, a man was accused of manslaughter after removing his son from a respirator that was preserving the premature infant’s life . Gregory Messenger and his wife were concerned that the baby, who was born 15 weeks premature, would have severe brain damage . The infant had been given a 50% chance of survival at the time of birth . Messenger and his wife had told doctors not to place the infant on life support, but the doctor in charge ordered a respirator to be used if the infant was active after delivery . Messenger was acquitted
In other cases, the parent or guardian might have a difficult time making decisions regarding options for their minor, especially when a minor requires life support. Making the decision to withdraw or withhold life support is never easy for a parent. What might the healthcare professionals might ask to do?
may be asked to provide guidance when it comes to this type of decision. It is always important to consider several factors, including the reason for the life support (e.g., tragic accident v. chronic illness).
At what age do minors have the capacity to make their own decisions?
The answer varies from state to state and depends on cer- tain variables, such as chosen procedures, medical conditions, and compliance with privacy laws.
What do most states consider someone incapable?
most states consider anyone 12 years of age and younger incapable of making informed medical decisions
What does title X do?
For example, many states allow minors to obtain contraceptives and prenatal care without parental consent or notification. Title X (10), a federal family planning program, specifically provides these ser- vices to minors
How do most states handle an abortion with minor?
- however, laws require parental consent and/or noti- fication of at least one parent before a minor can have an abortion
- The U.S. Supreme Court does grant minors a limited amount of privacy when it comes to abortion procedures.
- The recognition of this privacy allows for courts to bypass parental consent if it is decided that the minor is mature enough and under- stands the risks involved.
What are other cicumstances that allow for a waiver of parental consent for minors?
- These include emergency situations in which it is assumed the parents would pro- vide consent, sexual abuse instances where the parent is suspected to be involved in the abuse, and mental health or substance abuse services (minors can seek treatment without notifying parents).
- most states allow anyone older than 12 years of age to be tested and treated for sexually transmitted diseases, including HIV, without parental notification or consent
- Some states do require notifica- tion, and some states restrict the treatment allowed without parental consent
When are minors better suited to make medical decisions?
- minors with a chronic illness are often better suited to make medical decisions because of their experience.
- However, it is also important to consider the other factors, including stage of development, cogni- tive and emotional ability, and environment.
What is the mature minor doctrine?
- provides greater autonomy to minors older than 16 years of age who understand and consent to relatively simple medical procedures. This doctrine is a legal concept used by the courts, but a few states have passed it as a statut
- Even if healthcare professionals consider these fac- tors and believe a minor to be able to provide informed consent, the parents might not agree. If parents and minors do not agree on the course of medical action to be taken, the legal system may be called upon to intervene.
What happened with starchild abraham cherrix?
Sixteen-year-old Starchild Abraham Cherrix was diagnosed with Hodgkin’s disease . After an initial regimen of chemotherapy, he refused any further treatments, stating that he wished to try alternative medicine instead . His parents supported this decision, which led to an accusation of neglect . A juvenile court found Cherrix’s parents guilty of medical neglect and required that he return to conventional treatment . An appeal to a circuit court resulted in a reverse of this decision and allowed Cherrix and his family to work with an oncologist (a doctor specializing in cancer treatments) interested in alternative cancer treatments (Hester, n .d .) . After this case was settled, the state of Virginia added Abraham’s Law to permit parents to “refuse medical treatment or to choose alternative treatments for children aged 14 to 17 with a life-threatening medical condition, if the teenager seems to be mature, both the parents and the child have considered the treatment options available to them, and all agree that their choice is in the child’s best interest” (63 .2–100 of the Code of Virginia) .
What happened with cassandra c case?
In 2014, “Cassandra C” was diagnosed with Hodgkin’s Lymphoma . With proper treatment, there is an 85% survival rate with a Hodgkin’s Lymphoma diagnosis . Cassandra refused treatment options and explained that she wanted control over her body, including the right to refuse chemotherapy . After a review of her case, the state of Connecticut ruled that Cassandra was not mature enough to make medical decisions for herself . They did not accept Cassandra’s counsel’s arguments regarding the mature minor doctrine . After the ruling, the State took responsibility for Cassandra’s medical care (Feldman, 2015) .
- What is advance directives?
- DNR?
- Living will?
- Advance directives are legal documents outlining the health and welfare wishes of a patient if that patient is unable to communicate for himself or herself or is no longer considered competent.
- A do not resuscitate (DNR) order informs health- care professionals that patients do not want extreme measures taken to save their life during cardiac arrest.
- A living will is a legal document that indicates whether a patient wants to be placed on life-prolonging machines (also known as life support) if they are unable to communicate for themselves.
What is a power of attorney? What are the different types?
power of attorney (POA) is a written document that legally allows someone to make decisions on another’s behalf. There are several different types of POAs, including, but not limited to, healthcare proxy, healthcare agent, healthcare surgate, and POA for health care
how must advance directives be created and used?
- by a competent adult prior to the illness or injury.
- If an elderly patient has an advance directive in his or her medical record, this form will direct the healthcare professionals in decisions regarding medical care.
- It is important to note that in emergency situations, healthcare professionals might make decisions without the benefit of an existing advance directive or family input.
- If the patient does not have an advance directive, then the medical professionals and family members are left with the responsibility of determining what is best for the patient in cases of emergencies or serious illness
- In these cases, the medical professional will most likely use the ethical principle of beneficence (do no harm) in making medical decision
What is the biggest and ethical and legal issues surrounding the elderly?
- issue of competence->efers to an individual’s ability to make decisions necessary to live independently
- At this point, a family member or a healthcare professional working closely with the patient might need to appoint a guardian to make medical decisions for that patient.
Making medical decisions for an elderly parent or close friend is not always a simple task. What is often very emotional?
- The decision to withdraw or withhold medical treatment is often very emotional.
- Medical professionals must always take time to explain the options and provide as much information as possible during the decision-making process.
- For example, a grieving daughter might need to be reminded that cancer is the ultimate cause of death of a loved one, not the removal of the breathing tube.
- In other instances, the healthcare professional needs to respect the choices of family members even if they disagree.
What is your job as a healthcare professional?
- Your job as a healthcare professional is to serve the patient and his or her best interests, not to make healthcare or any other decisions for the patient.
- For example, an elderly patient might refuse chemotherapy or a difficult surgery because the patient feels he or she has lived a good life and would prefer to die without medical intervention. At all times, a healthcare professional must make sure a competent patient’s wishes are respected.
What is medicare?
is a federally sponsored program that provides healthcare coverage for adults 65 years of age and older, as well as some adults younger than 65 years of age with certain disabilities
How is medicare coverage divided?
- Part A helps cover the cost of inpatient care in hospitals, skilled nursing facilities, hospice, and home health care. The coverage of Part A generally comes at no cost to the patient because the patient and/or the patient’s spouse has already contributed income tax dollars toward the Medicare program. Those who do not qualify for Part A for free can choose from various plans that have a monthly premium associated with them.
- Part B covers other doctor expenses, including some preventive care, medical equipment, and rehabilitation services. There is usually a monthly premium associated with Part B. Those who are required to pay a monthly premium for Part A also pay a monthly premium for Part B.
- Parts C and D are optional and provide additional coverage, including prescription drugs. Because the Medicare program is federally funded, the benefits are provided equally across the nation.
What is medicaid?
- provides assistance to low-income individuals and families to pay for health care.
- The funding for Medicaid comes from the federal government, but the states choose who qualifies and how to distribute the coverage (Centers for Medicaid and Medi- care, 2011). Some states have chosen to expand their Medicaid programs to provide insurance options as required by the Affordable Care Act.
What is readmission?
healthcare facilities strive to avoid Medicare penalties associated with patients who return to the hospital shortly after their original discharge
How much it the US populated currently uses medicare for healthcare needs?
15%->The estimated number of Medicare beneficiaries is 44 million . This number is expected to rise to 79 million by 2030 .
What diagnosis for initial hospitalization has the highest readmission rates?
heart failure
human immunodeficiency virus (HIV) do?
attacks cells in the body that are responsible for fighting infection and disease, leaving the patient vulnerable to future diseases and making HIV impossible to fight.
human immunodeficiency virus (HIV) do?
attacks cells in the body that are responsible for fighting infection and disease, leaving the patient vulnerable to future diseases and making HIV impossible to fight.
HIV infection may lead to what?
AIDS, which stands for acquired immune deficiency syndrome. AIDS is the final stage for HIV patients. At this point, the body is unable to naturally fight infections, which leaves patients prone to developing illnesses that people with weakened immune systems are unable to fight, such as pneumonia and certain cancers
How is HIV spread?
through some bodily fluids, including blood, semen, breast milk, vaginal fluids, and rectal mucus. Other bodily fluids, such as urine and fecal matter, can contain the HIV virus, but unless it is mixed with additional bodily fluids, such as blood, it is not generally enough to spread the virus
How many peope are living with HIV, how many newly infected, how many dealths?
- 36.7 million
- 37.1.8 million
- 38.1.0 million
HIV is generally transmitted during the following activities:
■ Sexual contact
■ Pregnancy
■ Childbirth
■ Breastfeeding
■ Injected drug use
■ Occupational exposure
■ Blood transfusion
■ Organ transplant
Who is a greater risk for occupational exposure to HIV?
- Healthcare professionals are at a greater risk for occupational exposure to HIV because they often are exposed to bodily fluids.
- Healthcare professionals have con- tracted the HIV virus through needle sticks and from splashes of bodily fluids into their eyes, mouth, or open sores. Therefore, it is important for healthcare profes- sionals to take extra precautions, such as gloves and masks, to avoid exposure to HIV
What laws have been passed to protect ppl with HIV drom discrimination
Americans with Disabilities Act (ADA).
* Discrimination based on disabilities is unlawful under the ADA.
* The Supreme Court ruled that HIV infection meets the definition of disability and is therefore covered, which also extends to other state and federal laws
Health Insurance Portability and Accountability Act (HIPAA)
* has also helped in the prevention of discrimination against HIV/AIDS patients by keeping their medical condition confidential.
* If indi- viduals living with HIV/AIDS feel that their privacy rights have been violated, they may be eligible to file a complaint through the Office of Civil Rights
HIPAA regulations provide certain protections for people with HIV/AIDS:
- They limit the ability of insurance companies to exclude patients from coverage if they have a preexisting condition (e.g., HIV).
- They prevent group health plans from denying coverage or charging additional fees based on preexisting conditions, including those of family members.
- They guarantee certain small business employers the right to purchase health insurance
- They guarantee that employers and individuals who purchase health insurance
can renew the coverage, regardless of health conditions.
What is the Ryan White HIV/AIDS Program
- is a federal program administered by the Health Resources and Services Administration. It focuses on providing funding for health care and support services to patients with HIV/AIDS.
- there is federal legislation that attempts to meet the unmet health needs of people living with HIV/AIDS.
What is the Ryan White HIV/AIDS Program
- is a federal program administered by the Health Resources and Services Administration. It focuses on providing funding for health care and support services to patients with HIV/AIDS.
- there is federal legislation that attempts to meet the unmet health needs of people living with HIV/AIDS.
Who is ryan white?
- In 1984, at 13 years of age, Ryan White was diagnosed with AIDS . Other than being a hemophiliac, most would say he had led a normal life . When the diagnosis was pronounced, Ryan found himself in the sweeping storm of a political controversy and media attention . At that time, AIDS was still new to most people and there was little to no education about the condition .
- Ryan White and his mother fought AIDS-related discrimination and helped start promotion of AIDS awareness and education . They tirelessly fought for Ryan’s rights as an AIDS patient to attend school and have accessibility to health care . Incredibly, this child led the way to educating people around the world about AIDS and equality of health care .
- Ryan’s story has touched many, and in his honor the Ryan White CARE (Comprehensive AIDS Resources Emergency) Act was first signed into law in May 1996 by then-President Bill Clinton . Since then, it has been reauthorized four times (1996, 2000, 2006, and 2009), exhibiting the commitment to the legacy of Ryan White . It is now called the Ryan White HIV/AIDS Program .
- Sadly, Ryan never got to see the act signed into legislation . He died 6 months before the initial legislation was signed (Health Resources and Services Administration, n .d .) .
Why are federal laws written to protect patient with HIV
from discrim- ination and to ensure that they receive appropriate treatment.
How are Certain laws also require efforts toward preventing the spread of the disease itself
- Once a patient is diagnosed with HIV, he or she has a legal and ethical responsibility to inform others.
- Most states allow doctors to inform the infected patient’s spouse. Generally, the doctor will allow the patient time to inform the spouse, but the doctor has a legal responsibility to do so if the patient is unwilling.
- Doctors legally cannot contact other non-spousal sexual partners, so most states require that all HIV-positive patients inform past, present, and future sexual partners, as well as current healthcare providers.
- The local health department can notify sexual or needle-sharing partners that they may have been exposed to HIV without releasing the name of the contact.
- Besides past sexual or needle-sharing partners and current healthcare providers, HIV-positive patients are not required to share their status with anyone else—including their employer or coworkers.
the Centers for Disease Control and Prevention requires what?
equires health- care professionals to disclose their HIV status to patients. This policy is considered controversial by some because there have been only a limited number of instances when healthcare professionals have infected patients. However, as long as the risk for exposure exists, healthcare professionals have a legal and ethical obligation to disclose their HIV status to patients (AIDS.gov).
What is th doe v medlantic health care group
John Doe (plaintiff ) chose not to tell his employer, a cleaning company that provided services to the U .S . Department of State, that he was HIV-positive . A coworker at the State Department, Tijuana Goldring, also worked part-time as a receptionist at the Washington Health Center, which was owned by the Medlantic Health Care Group (defendant) . During a checkup at the Washington Health Center, Doe stopped by to say hello to Goldring . Goldring asked for the spelling of Doe’s last name so that she could send him a get-well card . Instead of sending a card, she used his last name to access his medical records, without Doe’s permission, and learned that he was HIV-positive . Goldring shared this news with fellow employees at the State Department . When Doe returned to work, he was teased, ridiculed, and shunned by fellow coworkers . After determining that Goldring was the source of the leaked information, Doe filed a lawsuit against Medlantic and Goldring, including invasion of privacy and breach of confidentiality . The jury found Medlantic responsible for the confidentiality breach and awarded Doe $250,000 .
some healthcare facilities previously refused or limited the hospital visitation rights of same-sex partners.. Who addressed this issue?
In 2010, President Obama issued a memorandum addressing this issue (Obama, 2012). He recommended that all healthcare facilities allow patients to designate and not deny visitation privileges on the basis of race, color, national origin, religion, sex, sexual orientation, gender identity, or disability. Allowing patients to have designated visitors provides comfort during a stressful time. If these visitations are restricted or denied, the patient might lose a necessary advocate.
What happened on June 26th, 2015?
- a Supreme Court ruling legalized same-sex marriage in all 50 states. This allows same-sex partners who choose to marry the same rights as others joined in traditional marriage.
- The recognition of partner rights is not the only legal or ethical issue present with patients who choose to identify with a gender different from their birth gender. Most medical records only allow patients to identify themselves as one gender. This can cause difficulty and confusion for those patients that might be in transition.
- There is a movement to provide more options in electronic medical records, but this will take time and adjustment by healthcare profes- sionals. In the meantime, the utilization of the DEAR (Dignity, Empathy, Autonomy, and Respect) principle can help healthcare professionals provide safe and ethical treatment to current patients with various gender identities.
What is our role as healthcare professionals
- to learn as much as we can about the cultures we encounter and to be respectful of our patients’ desires.
- It is not always possible to meet specific requests, but it is important to acknowledge the patient’s desires and either find a compro- mise or explain why their requests cannot be met.
What is the HELP model?
is recommended when working with culturally diverse populations
* Hear what the patient perceives to be the problem.
* Encourage the patient and healthcare professional to discuss the similarities and differences.
* List treatment options and make recommendations.
* Provide a chance to negotiate treatment.
What should healthcare professional should always be on the lookout for?
be on the lookout for any signs of neglect or abuse when treating all of their patients, but vulnerable populations deserve special attention
what are mandatory reporting laws
- the laws requiring healthcare professionals to report suspected cases of abuse
- These laws vary from state to state, but in general anyone involved in education, health care, or social work must complete training sessions regarding mandatory reporting.
What is child abuse?
- is physical, sexual, or emotional mistreatment or the neglect of a child.
- Any questionable injury of children must be reported, as must signs of neglect. Physicians and other healthcare professionals can be held responsible if they do not report cases of child abuse. On the other hand, if you are acting in the best interest of a child when you report suspected abuse, you cannot be held responsible if you are wrong. In other words, the healthcare professional cannot be sued for making a report regarding child abuse
What do most states require that suspected cases of abuse?
reported orally followed by a written report. Many states now require reporting of suspected child abuse from anyone, no matter their occupation. In these states, a person who suspects child abuse but does not report it can be held legally responsi- ble for not doing so.
What is elder abuse?
- includes intentional harm, neglect, exploitation, and abandonment of persons 60 years of age and older.
- This type of mandatory reporting is more commonly encountered by healthcare professionals who work in nursing homes or skilled nursing facilities. Healthcare professionals working in all fields should watch for signs of abuse and neglect when dealing with elderly patients. Elderly patients are also protected from abusive healthcare worker
What is domestric abuse?
- involves willful intimidation, assault, or other abusive behav- ior committed by one family member or intimate partner against another.
- These cases are often difficult to confirm, but if a healthcare professional suspects that a patient is involved in a domestic abuse situation, he or she should report these sus- picions to the proper authorities
- Reporting guidelines vary from state to state but generally include notification of a social worker or supervisor.
