Law and Medicine Flashcards
Laws
Statues –> laws
Case law –> decisions from the court rooms
Ethics
Professions (oaths)
Best Practices
Local Culture
Personal Values
Professional Values
first, do no harm (non-maleficence) Respect patient (autonomy) Benefit the patient (beneficence) Use resources wisely (justice) Be honest
Dr. - Patient Relationship
based in ethics of personal and professional values
- reflects the locus of power
- Paternalistic
- Informative
- deliberative (negotiated)
When can you decline treatment?
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)
Conscience Clause
legally permit professionals to NOT provide certain medical services, based on MD’s personal beliefs
- it is legal, but is it ethical?
Proxy or surrogate
person appointed by person as decision maker
Guardian or conservator
person appointed by courts as decision maker –> trumps everything else
Substituted judgement
decisions based on patient preferences
- many sources of guidance (wills, AD, verbally)
Best Interests
decisions based on what is best for patient
Responsibility to treat
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
Death with Dignity
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
Futility
non-beneficial care –> professionals are not obliged to provide care they judge to be non-beneficial
- assessing futility –> Goals of care?
- cost/benefit considerations
Foregoing medical interventions
when an intervention is likely to offer little benefit to patient –> facilitated by dr-patient trusting relationship
Resolving boundary issues
consultants/committees
courts
landmark cases
Ethics committees
consulted when there is a difference in opinion
- findings are advisory –> give info back to Dr. and patient
Conflicting interests
doing one thing IMPACTS another
- financial, intellectual
AVOID conflicts and disclose conflicts
Competing interest
can arrange to do both
Privacy
limited government role
- family decisions, planning
termination of life-sustaining treatment
Confidentiality
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
Legal liability
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
