Ethical and Legal Issues in the Treatment of Older Adults Flashcards
autonomy
patient is able to make own decisions
beneficence
is treatment in the best interest of the patient
nonmaleficence
do no harm
tort
a civil wrong, other than a breach of contract including negligence, false imprisonment, assault and battery
informed consent was conceived from what?
the intentional tort of “battery”
intentional tort
no standard of care involved
informed consent
standard of care may apply
informed consent is usually treated as what?
negligent tort
types of torts
- negligence
- vicarious
- intentional
- strict
elements of informed consent
- describe procedure/treatment
- explain risks/benefits
- discuss alternative treatments
adequate consent requires that the patient has what?
capacity
capacity is determined by who?
a physician
competency is determined by who?
the courts
two standards for disclosure of informed consent
- physician-based
2. patient-based
physician-based standard for disclosure of informed consent
amount of disclosure based on what physicians would disclose given the same circumstances
problems with physician-based standard for disclosure of informed consent
- plaintiff has to produce expert testimony
2. based solely on physician discretion
patient-based standard for disclosure of informed consent
amount of disclosure determined by what the “reasonable patient” would want to know about the treatment
T/F: patient-based standard for disclosure of informed consent doesn’t require an expert testimony and by focusing on the patient, court believed that autonomy/self-determination preserved
true
T/F: states have used case law/statutes to pick one of the standards of informed consent or a hybrid of them
true
modalities to present information to patient
- verbal presentation
- discussion with physician
- written information
- pamphlets
- video/internet
- diagrams/charts
what is the preferred modality to present information to patients?
discussion with physician
what should be disclosed to patients?
- severe risk, low probability
- less severe, higher incidence
- risk specific to procedure
rule of thumb when it comes to disclosing risks to patients
- death
- serious injury
- limb/organ damage
- minor events that happen >5% of the time
what are the general risk that should be disclosed to patients?
- infection
- vascular/neurological injury
- death
Do Not Resuscitate (DNR) orders
order given by a physician to not attempt resuscitative protocol for someone in cardiopulmonary distress (no ACLS protocol)
when can a DNR be written?
after a physician discusses it with the patient or, if they lack capacity, a patient surrogate
types of DNR orders
- DNR
- DNI
- chemical code
- full code
DNI (do not intubate)
no invasive airway establishment
chemical code type of DNR
meds only
full code tyoe of DNR
all supportive measures
criteria for capacity
- ability to communicate a choice
- understanding relevant information
- appreciate the situation/consequences
- ability to reason about treatment
types of advance directives
- living will
2. durable power of attorney for health care
when does the living will take effect?
when patient lacks capacity
what does the living will outline?
the type of care the patient would like
problems with living wills
- it may not address the therapy that needs to be instituted
- language can be vague
- may not clearly indicate code status
legal definition of “terminal condition”
will result in death regardless of treatment
T/F: “terminal condition” usually requires 2 physicians to agree
true
durable power of attorney for health care provides what?
a surrogate to make active decisions
T/F: with durable power of attorney for health care, patient can still outline what they prefer as far as treatment modalities
true
regular durable POA controls what?
only finances
guardianship
a person is stripped of all their rights and declared incompetent by the court
emergency exception to informed consent can only be used when?
in the preservation of life… no more, no less
when can the “extension doctrine” be applied?
should be a life-threatening risk
when does the “extension doctrine” not apply?
- elective cases
2. when “extension” should be anticipated
therapeutic privilege
can only be obtained if it can be proved that an individual patient could not handle that disclosure
T/F: therapeutic privilege is very hard to prove
true
waiver of consent
should provide at least enough information, so that the general nature of the treatment is expressed so patient can understand what they are forgoing
informed refusal
patient should be told the risks/consequences of refusing treatment
