Medical Law and Ethics

Medical Law and Ethics Chapter 5 The Physician-Patient Relationship

Physician–Patient Relationship • Both must agree to form relationship for there to be contract for services (implied contract) • Under contract for services, patient can expect doctor to provide medical service for as long as necessary • Patient must confide truthfully to physician

Physician’s Rights • Right to select patients he or she will see • Right to refuse service to patients • Right to determine type of service he or she will provide • Right to be paid for services rendered • Right to withdraw from relationship • Right to vacation and time off

Physician’s Responsibilities (AMA’s Statement of Principles) • Human dignity • Honesty • Responsibility to society • Confidentiality • Continued study

Physician’s Responsibilities • Freedom of choice • Responsibility to improve community • Responsibility to patient is paramount • Must support access to medical care for all people

Professional Practice Responsibilities • Duties during a Medical emergency • Cannot ethically or legally turn away patient in an emergency situation • If unable to treat patient, then must call for emergency assistance • Patients cannot be turned away if indigent or uninsured

Duty to Treat Indigent Patients • “Dumping crisis” • Physician has right to select which patients to treat • Physician does not have right to drop or abandon patients once he or she agrees to treat them

Duty Not to Abandon a Patient • Once physician agrees to take care of patient, contract may not be terminated improperly • Physician may be charged with abandonment if formal notice of withdrawal is not given • Physician must allow patient time to seek service of another physician

Duty to Treat Patients with AIDS • Unethical to refuse to treat, work with, or provide housing for person who is HIV-positive or has AIDS • Physician, by law, must make full report to state about any patient who is HIV-positive or has AIDS

Ethical Considerations when Treating AIDS Patients • Persuade patient to inform his or her partner(s) • Notify authorities if concerned that patient will not inform others • As last resort, notify patient’s partner(s)

Exposure of Health Care Workers to Patient’s Blood • A 0.3 percent risk of contracting HIV after blood exposure, according to the CDC • HIV testing of patient’s blood allowed in some states

Duty to Properly Identify Patients • Identify patient both by stating his or her name and examining any other identification • Arm band • Driver’s license • Use discretion with patient sign-in sheets to protect confidentiality • Have patient state name

Duty to Tell the Truth • Many believe principles of justice apply when dealing with truth-telling • Try to determine the “just” action for patient • Just action may be at variance with obligation of confidentiality • Confidentiality may be overridden when life or safety of patient is endangered

Patient’s Rights • Right to give informed consent • Right to privacy • Right to be informed of advantages and potential risks of treatment • Right to refuse treatment • Right to confidentiality • Privileged communication

Confidentiality • All information and records about treatment will be kept confidential by physician and staff unless consent to release is obtained • Medical Patients Rights Act: all patients are entitled to have privacy respected and medical records handled confidentially

Confidentiality • Privileged communication: confidential information told to a physician or attorney by a patient • HIPAA regulations must be observed (Chapter 10)

Patient Self-Determination Acts • Advanced directive • Living will (including a “Do Not Resuscitate” order) • Durable power of attorney • Uniform Anatomical Gift Act - Patient may revoke these documents - Family may consent on the deceased patient’s behalf

Definition of Minors • Minor: person under the age of maturity (18 in most states) • In Loco parentis: person assigned by court to stand in place of parents

Definition of Minors • Mature minor: person in mid to late teens who, for health care purposes, is considered mature enough to comprehend physician recommendations and give informed consent • Emancipated minor: person in mid to late teens who legally lives outside parents’ or guardian’s control

The Patient’s Responsibilities • Follow physician’s instructions • Make follow-up appointments and monitor treatment and medication use if requested by physician • Be honest • Pay for medical services • Provide informed consent

Consent • Voluntary agreement by patient to allow medically trained person to touch, examine, and perform treatment • Two types • Informed (expressed) consent • Implied consent

Informed or Expressed Consent • Patient agrees to course of treatment after being told consequences of having or not having certain procedures and treatments • Signature indicates patient understands limits or risks involved as explained by physician

Doctrine of Informed Consent • Requires physician to explain in understandable language • Advantages and risks of treatment • Alternative treatments available to patient • Potential outcomes of treatment • What might occur—risk and benefits—if treatment is refused

Implied Consent • Patient indicates by behavior that he or she accepts procedure (i.e., offers arm to have blood sample drawn) • Consent is assumed in medical emergencies when patient cannot respond to give consent

Exceptions to Consent • Need not inform of commonly known risks • Need not inform if disclosure of risks may be detrimental to patient • Need not inform if patient asks physician not to disclose risks

Exceptions to Consent • Not required to restore patients to original health • Cannot elicit cure for every patient • Cannot guarantee successful results of every treatment

Refusal to Grant Consent • Adult patients conscious and mentally capable have right to refuse any medical or surgical treatment • Refusal must be honored no matter what patient’s reasoning • Failure to respect right of refusal could result in liability for assault and battery

Role of Health Care Consumer • Do not self-medicate • Be honest with physician • Assist physician in prevention of medical errors

Medical Law and Ethics