Ethical Conduct Flashcards
What is a fiduciary relationship?
Special legal term that acknowledges an unequal distribution of power between the two parties
Who is involved in a fiduciary relationship?
Patient & provider
What is fiduciary duty?
Duty to care, based on trust of the patient
When is fiduciary duty breaches?
When the provider violates trust by promoting his/her own self-interests or the interests of third parties
Examples of financial conflicts of interest
- Personal investments in medical facility, medical equipment, drug
- Pharmaceutical gifts/drug samples
- Reimbursement incentives (insurance - HMO, unnecessary tests/procedures)
- Production incentives
- Medical equipment or medication sales
Examples of personal & professional conflicts of interest
- Research & development of clinical guidelines
- CME sponsorship
- Learning/training of new procedures
- Treating employees, coworkers, ,family members
- Disclosure of medical errors
- Impaired professionals
What are the potentially problems assoc. w/ conflicts of interest?
- Pt. outcomes may be compromised
- Violates the integrity of medical judgement (pt. care)
- Undermines trust of the medical profession
How to manage conflicts of interest
- Reaffirm patient’s interests
- Develop conflict of interest policies @ work
- Disclose any potential conflicts
- Take precautions to protect patients
- Prohibit certain actions/situations
- Recognize/ask “is the patient being compromised” OR “ would the situation stand up to legal scrutiny?”
Patients have the right to do what regarding the consent form?
Challenge it’s validity
How do we minimize the risk that the consent form is challenged by the patient?
- Ensure form is readable, detailed, & procedure specific
- Ensure the form is witnessed
- Obtain consent on 2 separate occasions
- Emphasize the significance of the form to the pt.
- Document! (“pt agreed to proceed”, pt. education, pt. questions)
If the patient and/or surrogate is unable to consent, the provider…….
May initiate treatment
If a provider initiates treatment without consent in an emergency situation, the patient/surrogate should be updated and consent should be obtained
ASAP
If consent is obtained for a specific provider, can it be changed without patient notification?
No
- Patients may refuse or chose who performs a surgery or procedure
What is decisional capacity?
Patient has the ability to understand medical information, consider the situation and potential consequences as well as reason various medical options AND communicate a clear decision/choice
Who determines if a patient is incapacitated?
The treating physician(s) and/or psychologist
How many providers must sign off on deeming a patient incapacitated?
2
Is incapacity temporary or permanent?
It can be either
Once incapacitated, a surrogate decision-maker is needed such as…..
D-POA, guardian, family member, or “intimate” associate
A surrogate decision maker should base decisions on
- Patient’s expressed preferences about advanced directives
- Patient’s views on life, attitudes/beliefs about illness or certain medical procedures, etc.
- If patient’s wishes are unknown, decisions should be made in the pts. best interest (risk vs. benefit, QOL, etc.)
A surrogate decision maker’s decision may require
Involvement of the ethics committee
Informed consent/decision making in the context of minors involves
The patient to the level s/he is able to participate AND the parents/legal guardian
- Emancipated minors (e.g. military members, married individuals may consent
Minors may consent to the following in the state of WI
<18YO: Contraceptive care, pregnancy testing, STI dx & tx, rape, sexual assault
>14YO: HIV testing
>12YO: ADODA outpt eval or detox <72hrs (or <12 if parent cannot be found)
What entity requires consent from BOTH minor AND parent/guardian for individuals <18YO in WI
Abortion
- Unless they are emancipated
- There are exceptions: emergency, sexual assault, suicide risk, incest, parental abuse
What if a minor becomes a parent?
Minor child becomes “legal adult” for the newborn
