Law and Medicine

Question 1

Laws

Answer 1

Statues –> laws

Case law –> decisions from the court rooms

Question 2

Ethics

Answer 2

Professions (oaths)
Best Practices
Local Culture
Personal Values

Question 3

Professional Values

Answer 3

first, do no harm (non-maleficence)
Respect patient (autonomy)
Benefit the patient (beneficence)
Use resources wisely (justice)
Be honest

Question 4

Dr. - Patient Relationship

Answer 4

based in ethics of personal and professional values

• reflects the locus of power
  
  • Paternalistic
  • Informative
  • deliberative (negotiated)

Question 5

When can you decline treatment?

Answer 5

Scope of practice (legal and ethical)
Clinical Skills (legal and ethical)
Exposure to infection (legal, not ethical)
Torture/Execution (ethical, legal?)
Referral (not legal or ethical to refuse referral)
Reproductive health (ethical and legal)

Question 6

Conscience Clause

Answer 6

legally permit professionals to NOT provide certain medical services, based on MD’s personal beliefs
- it is legal, but is it ethical?

Question 7

Proxy or surrogate

Answer 7

person appointed by person as decision maker

Question 8

Guardian or conservator

Answer 8

person appointed by courts as decision maker –> trumps everything else

Question 9

Substituted judgement

Answer 9

decisions based on patient preferences

- many sources of guidance (wills, AD, verbally)

Question 10

Best Interests

Answer 10

decisions based on what is best for patient

Question 11

Responsibility to treat

Answer 11

EMTALA –> legal obligation to treat and get patients stable regardless of what they have done
Good Samaritan –> do what you are trained for, legal exposure if you harm them or walk away

Question 12

Death with Dignity

Answer 12

legal in Oregon, Washington, Montana, Vermont, New Mexico
- self-administered medication
- requested more than used
- balance between autonomy and beneficence
- euthanasia is not legal
Intent and Double Effect

Question 13

Futility

Answer 13

non-beneficial care –> professionals are not obliged to provide care they judge to be non-beneficial

• assessing futility –> Goals of care?
• cost/benefit considerations

Question 14

Foregoing medical interventions

Answer 14

when an intervention is likely to offer little benefit to patient –> facilitated by dr-patient trusting relationship

Question 15

Resolving boundary issues

Answer 15

consultants/committees
courts
landmark cases

Question 16

Ethics committees

Answer 16

consulted when there is a difference in opinion

- findings are advisory –> give info back to Dr. and patient

Question 17

Conflicting interests

Answer 17

doing one thing IMPACTS another
- financial, intellectual
AVOID conflicts and disclose conflicts

Question 18

Competing interest

Answer 18

can arrange to do both

Question 19

Privacy

Answer 19

limited government role
- family decisions, planning
termination of life-sustaining treatment

Question 20

Confidentiality

Answer 20

government is involved
HIPAA
- EXCEPTIONS
public health reporting -> conditions/infections
at risk individuals -> Tarasoff, abuse, genetic conditions
impaired professionals -> goes to medical board
Minors -> sex, mental health, drug/alcohol

Question 21

Legal liability

Answer 21

Risk Management –> best interest of hospital not you
Scope of practice/competence
Informed consent
Negligence –> different than malpractice
Medical Errors –> different ways to deal with it
Harm