Legal, Ethical and Organizational Aspects of Medicine Flashcards
Legal obligations come from?
- Common law (judge)
- Statute law (legislation)
- Constitution of Canada
4 basic requirements of valid consent
- Voluntary
- Capable
- Specific
- Informed
What is the reasonable person test?
The physician must provide all information that would be needed “by a reasonable person in the patient’s position” to be able to make a decision
Forms of consent
- Verbal or written, although written is usually preferred
- Implied (e.g. a patient holding out their arm for an immunization) or expressed
Exceptions to Consent
- Emergencies
- Legislation
- Special Situations: public health emergencies (e.g. an epidemic or communicable disease treatment), warrant for information by police
Treatment without consent =
Battery
Treatment with poor or invalid consent =
Negligence
Capacity is the ability to
- Understand information relevant to a treatment decision
- Appreciate the reasonably foreseeable consequences of a decision or lack of a decision
For the appreciation needed for decision-making capacity, a person must:
- acknowledge the symptoms that affect them
- be able to assess how the various options would affect them
- be able to reach a decision, and make a choice, not based primarily upon delusional belief
___ is used for capacity assessments for co-decision-making applications
Form 3
____ is used for capacity assessments for guardianship and/or trusteeship application
Form 4
Substitute decision-makers must follow the following principles when giving informed consent
- act in accordance with wishes previously expressed by the patient while capable
- if wishes unknown, act in the patient’s best interest, taking the following into account:
1. values and beliefs held by the patient while capable
2. whether well-being is likely to improve with vs. without treatment
3. whether the expected benefit outweighs the risk of harm
4. whether a less intrusive treatment would be as beneficial as the one proposed
What are instructional advance directives?
- Allow patients to exert control over their care once they are no longer capable
- The patient sets out their decisions about future health care, including who they would allow to make treatment decisions on their behalf and what types of interventions they would want
- Takes effect once the patient is in capable with respect to treatment decisions
What is the age of consent?
- No age of consent in all provinces and territories except Quebec; consent depends on patient’s decision-making capacity
- Quebec has a specific age of consent, but common law and case law deem underage legal minors capable, allowing these individuals to make their own choices
- Infants and children are assumed to lack mature decision-making capacity for consent but they should still be involved (i.e. be provided with information appropriate to their comprehension level)
- Adolescents are usually treated as adults
What is a Power of Attorney for Personal Care
A legal document in which one person gives another the authority to make personal care decisions (health care, nutrition, shelter, clothing, hygiene, and safety) on their behalf if they become mentally incapable
What is a Guardian of the Person
Someone who is appointed by the Court to make decisions on behalf of an incapable person in some or all areas of personal care, in the absence of a POA for personal care
What is a Continuing Power of Attorney for Property
Legal document in which a person gives another the legal authority to make decisions about their finances if they become unable to make those decisions
What is a Guardian of Property
Someone who is appointed by the Public Guardian and Trustee or the Courts to look after an incapable person’s property or finances
What is a Public Guardian and Trustee
Acts as a SDM of last resort on behalf of mentally incapable people who do not have another individual to act on their behalf
What is defined as a medical error?
Medical error may be defined as ‘preventable adverse events (AEs)’ caused by the patient’s medical care and not the patient’s underlying illness; some errors may be identified before they harm the patient, so not all error is truly ‘adverse’
Exceptions to Truth-Telling
A patient may waive their right to know the truth about their situation (i.e. decline information that would normally be disclosed) when:
- the patient clearly declines to be informed
- a strong cultural component exists that should be respected and acknowledged
- the patient may wish others to be informed and make the medical decisions for them
Breaking Bad News framework?
- SPIKES
- SETTING and LISTENING SKILL
- Patient PERCEPTIONS of condition and seriousness
- INVITATION from patient to receive information
- KNOWLEDGE – provide medical facts
- Explore EMOTIONS and EMPATHIZE
- STRATEGY and SUMMARY
What is standard/duty of care
Standard/duty of care is defined as one that would reasonably be expected under similar circumstances of an ordinary, prudent physician of the same training, experience, specialization, and standing
What is negligence?
Negligence or malpractice is a form of failure on the part of the physician in fulfilling their fiduciary duty in providing appropriate care and leading to harm of the patient (and/or abuse of patient’s trust)
Four Basic Elements for Action Against a Physician to Succeed in Negligence
- A duty of care owed to the patient (i.e.doctor/patient relationship must be established)
- A breach of the duty of care
- Some harm or injury to the patient
- The harm or injury must have been caused by the breach of the duty of care
Legislation has defined specific instances where public interest overrides the patient’s right to confidentiality; varies by province, but may include:
- suspected child abuse or neglect - report to local child welfare authorities (e.g. Children’s Aid Society)
- fitness to drive a vehicle or fly an airplane - report to provincial Ministry of Transportation
- Communicable diseases - report to local public health authority
- Improper conduct of other physicians or health professionals - report to College or regulatory body of the health professional (sexual impropriety by physicians is required reporting in some provinces)
- Vital statistics must be reported; reporting varies by province (e.g. in Ontario, births are required to be reported within 30 d to Office of Registrar General or local municipality; death certificates must be completed by a MD then forwarded to municipal authorities)
- reporting to coroners
When does duty to protect/warn apply?
- there is an imminent risk
- to an identifiable person or group
- of serious bodily harm or death
