Medical Law and Ethics, Fourth Edition Bonnie F. Fremgen Copyright ©2012 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved

Medical Law and Ethics, Fourth EditionBonnie F. Fremgen

Copyright ©2012 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.

Medical Law and Ethics

The Physician-Patient Relationship

Chapter 5




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

Documents

Medical Law and Ethics, Fourth Edition Bonnie F. Fremgen Copyright ©2012 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved