Chapters 3, 4, and 13 (Johns) Flashcards
This has pushed mankind to develop means to prevent and cure illness, but also to prolong the process of dying with advances in medicine such as artificial body organs, exotic machines, and powerful medications.
The Human Struggle to Survive
The mercy killing of the hopelessly ill, injured, or incapacitated.
Euthanasia
Intentional commision of an act which results in death, such as administration of a lethal dose of medication.
Active euthanasia
When life-saving treatment, such as a respirator, is withdrawn or withheld.
Passive Euthanasia
An action in which a physiscian voluntarily aids a patient in bringing about his or her own death.
Physician-assisted suicide
The suffering person makes the decision to die.
Voluntary euthanasia
Someone other than the incurable person makes the decision to terminate life.
Involuntary euthanasia
“Every human being of adult years has a right to determine what shall be done with his own body; and the surgeon who performs an operation without his patient’s consent commits an assault for which he is liable for damages.”
Schloendorff v. Society of New York Hospital
Announced every human being of adult years and sound mind has the right to determine what shall be done with his or her own body.
In re Storar
- Announced that the constitutional right to privacy protects patient’s right to self-determination.
- A state’s interest does not justify interference with one’s right to refuse treatment.
In re Quinlan
- Saikewicz, an elderly, mentally ill patient with leukemia was allowed to refuse treatment.
- Decided that questions of life and death with regard to an incompetent should be the responsibility of the courts.
- Disapproved of “any attempt to shift ultimate decision-making responsibility away from duly established courts of proper jurisdiction to any committee, panel, or group.”
Superintendent of Belchertown State School v. Saikewicz
Established that “no code” orders are valid to prevent the use of artificial resuscitative measures on incompetent terminally ill patients.
In re Dinnerstein
Held that a patient’s mental impairment and his or her medical prognosis, with or without treatment, must be considered prior to seeking judicial approval to withdraw or withhold treatment from an incompetent patient.
In re Spring
- In end-of-life dilemmas, court involvement is only mandated in these situations.
- Family members disagree as to an incompetent’s wishes.
- Physicians disagree on the prognosis.
- A patient’s wishes are unknown becease he or she has always been incompetent.
- Evidence exists of wrongful motives or malpractice.
The definition of death.
- Irreversible cessation of brain function.
- AMA 1974: “irreversible cessation of all brain functions including the brain stem.”
The types of evidence courts will accept to prove that a patient would have wanted to reject the prolongation of their life by artifical means.
- Persistence of statements regarding an individual’s beliefs.
- Their commitment to those beliefs.
- The seriousness of the statements made.
- Inferences drawn from surrounding circumstances.
After the Cruzan decision, states were encouraged to do what?
- Draft legislation (laws) regarding end-of-life decision making.
This court case distinguised between refusing treatment and assisting suicide. It recognized the state’s interests in:
- Prohibiting intentional killing
- Preserving life
- Preventing suicide
- Maintaining physician’s role as a healer
- Protecting vulnerable people from indifference, prejudice, and psychological and financial pressure to end their lives
Quill v. Vacco
- In this case, the court held that assisted suicide is not a liberty protected by the Constitution’s due process clause.
- A majority of states now ban assisted suicide.
Washington v. Glucksberg
- Legals physician-assisted suicide in the state of Oregon.
- Allows a terminally ill Oregon resident to obtain a lethal dose of medication from their physician.
- Prohibits the physician or any person other than the patient to directly administer the medication that will end the patient’s life.
Oregon’s Death with Dignity Act
- Patients have the right to create advance directives.
- Healthcare providers who receive federal funds from Medicare must comply with these regulations.
Patient Self-Determination Act of 1990 (PSDA)
- A guideline for caregivers describing a patient’s wishes for medical care in the even of incapacitation or inability to make decisions.
Advance Directive
An instrument or legal document that describes treatments an individual wishes or does not wish to receive, should he or she become incapacitated, and unable to communicate treatment decisions.
Living will
- A legal device that permits one individual known as the “principal” to give another person, known as the “attorney-in-fact,” authority to act on his or her behalf. The attorney-in-fact is authorized to handle banking and real estate affairs, incur expenses, pay bills, etc.
- In healthcare, an agent makes health and personal care decisions for the patient in the event the patient becomes unable to make his or her own decisions.
Durable Power of Attorney
An agent who acts on behalf of a patient who lacks the capacity to participate in a particular decision.
Surrogate decision maker
A form of surrogate decision-making where the surrogate attempts to establish what decision the patient would have made if that patient were competent to do so.
Substituted judgment
A legal mechanism by which the court declares a person incompetent, and appoints a guardian.
Guardianship
A document that allows a person to appoint a healthcare agent to make treatment decisions in the event he or she becomes incompetent, and is unable to decisions for himself or herself.
Health care proxy
Occurs when the physician recognizes the effect of treatment will be of no benefit to the patient.
Futility of treatment
Situations in which withdrawal of treatment should be considered.
- The patient is in a terminal condition
- There is a reasonable expectation of imminent death
- The patient is in a noncognitive state, with no reasonable possibility of regaining cognitive function
- Restoration of cardiac function would only last for a brief period
It may be the duty to provide this in the immediate aftermath of cardiopulmonary arrest; However, there is no duty to continue its use once it becomes futile.
Life-support equipment
- This case ruled it was unconstitutional for Jeb Bush, the governor of Florida, to attempt to circumvent the right to privacy of Terry Schiavo, a Florida woman in a persistent vegetative state.
Bush v. Schiavo
- Orders given by a physician, indicated that in the event of a cardiac or respiratory arrest, “no” resuscitative measures should be used.
- Given when quality of life has been so diminished that “heroid” rescue methods are no longer in the patient’s best interests.
Do-not-resuscitate (DNR) orders
An advisory body with multidisciplinary membership from the hospital and the community, whose purpose is to facilitate the discussion and resolution of ethical issues arising in the patient care setting.
Healthcare ethics committee
Who should be included in a healthcare ethics committee
- Ethicists
- Educators
- Caregivers
- Legal advisors
- Political leaders
- Religious leaders
- Corporate leaders
The goals of a healthcare ethics committee
- Supportive guidance to patients, families, and decision makers
- Review of cases (as requested) when there are conflicts in basic values
- Provide assistance in clarifying situations that are ethical, legal, or religious in nature and extend beyond the scope of daily practice
- Help in clarifying issues and discussing alternatives and comprimises
- Promoting the rights of patients
- Assisting the patient and family (as appopriate) in coming to consensus with the options that best meet the patient’s care needs
- Promote fair policies and procedures that maximize the likelihood of achieving good, patient-centered outcomes
- Enhance the ethical quality of both healthcare organizations and professionals
The functions of a healthcare ethics committe
- Development of policy and procedure
- Education (e.g. promoting patient rights)
- Consultations and conflict resolution
An ethics committee’s role in policy and procedure development
- Decide the goals and responsibilities of the ethics committee (e.g. which type of cases will be addressed)
- Determine the consultation process (e.g. how to access consultation services)
- Develop consultation guidelines
Groups that an ethics committee might reach out to as a part of its role as an educator
- Ethics committee members themselves
- The community
- Patients and families
- Staff (e.g. nursing homes, private physician offices, etc.)
The educational function of an ethics committee
- Include training in philosophy, religion, medicine, and law
- Include formal training and experience in clinical ethics
- Develop and distribute appropriate materials for committee members, caregivers, patients, and families.
- Promote patient rights
- Promote the right to ethics committee consultations
Ethics committee consultation and conflict resolution
- A resource for patients, family, and staff in resolving ethical dilemmas
- Provides guidance, not decisions
- Strives to achieve consensus when addressing care dilemmas
Who may request an ethics committee consultation?
- Patient
- Family member
- Staff
- Physician
- Etc.
Important factors to identify when conducting an ethics committee consultation
- Dilemma
- Facts
- Stakeholders
- Moral issues
- Legal issues
Language and framework for formally discussing ethical issues, taking into account the values and obligations of others
Ethics
The core ethical responsibilities of HIM professionals
To protect patient privacy, security, and confidential information and communication
The right of an individual to be left alone; It includes the freedom from observation or intrusion into one’s private affairs, and the right to maintain control over certain personal and health information
Privacy
Carries the responsibility for limiting disclosure of private matters; It includes the responsibility to use, disclose, or release such informatin only with the knowledge and consent of the individual
Confidentiality
Includes physical and electronic protection of the integrity, availavility, and confidentiality of computer-based information, and the resources used to enter, store, process, and communicate it; includes the means to control access and protect information from accidental or intentional disclosure
Security
HIPAA
Health Insurance Portability and Accountability Act
- Provided national standards for privacy and security
ARRA
American Recovery and Reinvestment Act
EHR
Electronic Health Record
RHIT and RHIA
Registered Health Information Technician and Registered Health Information Administrator
HIM
Health Information Management
AHIMA
American Health Information Management Association
ROI
Release of Information
PHR
Personal Health Record
NHIN
National Health Information Network
Use of a patient’s name and other information without the victem’s knowledge or consent, to obtain medical services or goods
Medical Identity Theft
Name at least four items, values, themes or concepts mentioned in AHIMA’s code of ethics
- Protect patient privacy and confidential information
- Bring honor to oneself, one’s peers, and the HIM profession
- Comply with laws, regulations, and policies
- Refuse to participate in or conceal unethical practices and procedures
- Advocate for change for the benefit of patients
- Advance HIM knowledge and quality by promoting and participating in research
- Commit to self-improvement through continuing education and life-long learning
- Recruit and mentor students, peers, and colleagues
