Legal, Ethical and Organizational Aspects of Medicine

Question 1

Legal obligations come from?

Answer 1

• Common law (judge)
• Statute law (legislation)
• Constitution of Canada

Question 2

4 basic requirements of valid consent

Answer 2

1. Voluntary
2. Capable
3. Specific
4. Informed

Question 3

What is the reasonable person test?

Answer 3

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

Question 4

Forms of consent

Answer 4

• Verbal or written, although written is usually preferred

- Implied (e.g. a patient holding out their arm for an immunization) or expressed

Question 5

Exceptions to Consent

Answer 5

1. Emergencies
2. Legislation
3. Special Situations: public health emergencies (e.g. an epidemic or communicable disease treatment), warrant for information by police

Question 6

Treatment without consent =

Answer 6

Battery

Question 7

Treatment with poor or invalid consent =

Answer 7

Negligence

Question 8

Capacity is the ability to

Answer 8

• Understand information relevant to a treatment decision

- Appreciate the reasonably foreseeable consequences of a decision or lack of a decision

Question 9

For the appreciation needed for decision-making capacity, a person must:

Answer 9

• 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

Question 10

___ is used for capacity assessments for co-decision-making applications

Answer 10

Form 3

Question 11

____ is used for capacity assessments for guardianship and/or trusteeship application

Answer 11

Form 4

Question 12

Substitute decision-makers must follow the following principles when giving informed consent

Answer 12

• 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

Question 13

What are instructional advance directives?

Answer 13

• 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

Question 14

What is the age of consent?

Answer 14

• 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

Question 15

What is a Power of Attorney for Personal Care

Answer 15

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

Question 16

What is a Guardian of the Person

Answer 16

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

Question 17

What is a Continuing Power of Attorney for Property

Answer 17

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

Question 18

What is a Guardian of Property

Answer 18

Someone who is appointed by the Public Guardian and Trustee or the Courts to look after an incapable person’s property or finances

Question 19

What is a Public Guardian and Trustee

Answer 19

Acts as a SDM of last resort on behalf of mentally incapable people who do not have another individual to act on their behalf

Question 20

What is defined as a medical error?

Answer 20

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’

Question 21

Exceptions to Truth-Telling

Answer 21

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

Question 22

Breaking Bad News framework?

Answer 22

• 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

Question 23

What is standard/duty of care

Answer 23

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

Question 24

What is negligence?

Answer 24

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)

Question 25

Four Basic Elements for Action Against a Physician to Succeed in Negligence

Answer 25

1. A duty of care owed to the patient (i.e.doctor/patient relationship must be established)
2. A breach of the duty of care
3. Some harm or injury to the patient
4. The harm or injury must have been caused by the breach of the duty of care

Question 26

Legislation has defined specific instances where public interest overrides the patient’s right to confidentiality; varies by province, but may include:

Answer 26

1. suspected child abuse or neglect - report to local child welfare authorities (e.g. Children’s Aid Society)
2. fitness to drive a vehicle or fly an airplane - report to provincial Ministry of Transportation
3. Communicable diseases - report to local public health authority
4. 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)
5. 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)
6. reporting to coroners

Question 27

When does duty to protect/warn apply?

Answer 27

1. there is an imminent risk
2. to an identifiable person or group
3. of serious bodily harm or death