Health Law IV Flashcards
Who is allowed to forego a life sustaining procedure in Iowa?
A qualified individual
What is a “qualified individual” in terms of refusing care?
- A person who has executed a declaration
- Has signed a DNR
What are the two qualifications of a DNR order that must be met?
- Attending has declared “terminal condition”
- Confirmed and documented by a second physician
What qualifies as a “life sustaining procedure”? What are the two qualifications that must be met?
Any medical procedure, tx, or intervention meeting BOTH of the following:
- Uses mechanical or artificial means to sustain, restore, or supplant a spontaneous function
- When applied to a patient in a terminal condition, would serve only to prolong the dying process
Life sustaining procedures does not include nutrition or hydration, except under what three conditions?
- from IV catheter
- Intubation
- When deemed necessary for comfort care or to alleviate pain
What is the legal definition of a terminal condition? (2)
- An incurable or irreversible condition that, without the administration of a life-sustaining procedure, will, in the opinion of the attending, result in death within a relatively short period of time
- State of permanent unconsciousness
What are the two qualifications that must be met to have a terminal condition based on a permanent state of unconsciousness?
- To a reasonable degree of medical certainty (not 100%)
- There can be no recovery
What are the two criteria that must be met to be competent enough to make a declaration?
- Declarant’s condition must be terminal
- Declarant is unable to make own decision
True or false: a competent adult may issue a declarant at any time
True–but declaration is only given effect if met conditions
What are the two things that a documented declaration of terminal decision must have?
- Signed by a declarant
- Contain a date of execution
How many people must witness the declaration of terminal illness?
2 people
True or false: when signing a declarant, the two witnesses must both be present at the same time
True
Who cannot be a witness to a declarant?
- at least 1 witness cannot be related
- Neither witness is health care provider, an employee of a health care provider, or under 18
True or false: a witness to a declarant can be a health care provider, or an employee of a health care provider
False
True or false: a witness of a declarant cannot be under 18 yo
True
True or false: the two witnesses to a declarant can be related to the patient
False–at least 1 witness cannot be related
What is the reasoning behind not allowing a doctor to be a witness of a declaration?
Dr may be influenced to have patient sign declarant
True or false: as a physician, you can never sign a declarant as a witness
False–as long as you’re not acting in medical provider capacity, you can
Does a living will made in another state have effect in Iowa?
Yes, but needs to meet state requirements
What should be done with a declaration?
Give to physician
If a person does not have a living will, specific steps must be taken before what can be done? (2)
- Before a person can be removed from life support
- Before life support may be withheld
What are the steps that must be taken before you can withhold or withdraw life support in a patient without a living will?
- Person must suffer terminal condition
- Attending must consult with, and obtain written consent
- Surrogate must be guided by the wishes of the patient
- Perform action with a witness
What is the order of people who can give consent for an incapacitated patient? (6)
- Designated attorney
- Guardian
- Spouse
- Adult children
- Parent
- Adult sibling
What happens when adult children disagree on treatment of a patient?
Majority rules
Can a patient’s power of attorney defer to a family member
Yes
What should be done if a patient’s power of attorney is in apparent disagreement with the patient’s wishes?
Do what is in the patient’s wishes
What is the role of a decision maker at the end of life care?
Must be guided by patient’s wishes
What must be done if you, as the attending, do not feel comfortable complying with a patient request?
Must take all steps to transfer care to another physician
What steps should be taken if a patient’s living will seems out of date?
Follow it still
What is the difference between a durable power of attorney, and a power of attorney?
Durable = can make medical decisions
An attorney in fact cannot be whom? (2)
- Attending physician
- Employee of attending physician
Can a durable power of attorney make financial decision in place of the patient?
No–only medical
What qualifies as “health care decision”?
-Involve care or tx to maintain pts health or mental condition
Do “health care decision” include decisions about withdrawing nutrition or hydration via IV or intubation?
No
Do “health care decision” include decisions about withdrawing oral food?
No
How many witness must there be to sign a durable power of attorney? Who does not qualify, and what are the criteria that must be met regarding this?
- 2 people (one unrelated)
- In presence of each other and the patient
- Cannot be less than 18, or the attending physician/employee
True or false: if all the criteria are met, then the attorney in fact takes priority over all others
True
Can an attorney in fact look at a patient’s medical record?
Yes, just as the patient could, but not STD related info unless pt specified
True or false: a durable power of attorney can only be withdrawn if there is documentation of it
False–just verbal
What is meant by the term liable?
- Is responsible for
- Has exposure to
What is negligence?
Not acting as a reasonably careful physician
Who defines a “reasonable person”?
Jury
What is a “tort”, in legal terms?
Wrongful act, for which a civil charge can be maintained
What is the difference between a civil and criminal lawsuit?
- Criminal = law was violated
- Civil = damage was done, but no law was violated
What is the difference between the goal for a criminal case vs a civil case?
Criminal = Effect justice, and dispense punishment for crimes committed
Civil = Make restitution to wronged party
Is the 5th amendment applicable in civil cases
No
What is the burden of proof needed to win a civil case? Criminal?
Civil = Preponderance of evidence
Criminal = beyond a reasonable doubt
Which has the right to a speedy trial: civil or criminal suits?
Criminal
What is the statute of limitations on medical cases in Iowa?
within 2 years of realizing damage
What are the three parties that determine settling vs suit?
- dr
- insurance
- attorney
How are lawyers paid with criminal vs civil cases?
Civil = contingency Criminal = hourly
