Medical Law and Ethics FIFTH EDITION The PhysicianPatient

Medical Law and Ethics FIFTH EDITION The Physician-Patient Relationship CHAPTER 5 Journal Topic: What rights does a physician have when practicing medicine and when accepting a patient. Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved

Learning Objectives 1. Define the key terms. 2. Describe the rights a physician has when practicing medicine and when accepting a patient. 3. Discuss the nine principles of medical ethics as designated by the American Medical Association (AMA). continued on next slide Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved

Learning Objectives 4. Summarize “A Patient’s Bill of Rights. ” 5. Understandard of care and how it is applied to the practice of medicine. 6. Discuss three patient selfdetermination acts. 7. Describe the difference between implied consent and informed consent. Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved

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 continued on next slide Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved

Physician–Patient Relationship • Patient must confide truthfully to physician § Physician is not liable if critical information withheld • Patient information is confidential § Includes overheard or read Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved

Physician's Rights • Right to select patients • Right to refuse service to patients • Right to determine type of services provided • Right to be paid for services rendered • Right to withdraw from relationship • Right to vacation and time off Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved

Physician's Responsibilities • AMA's Statement of Principles § § § Human dignity Honesty Responsibility to society Confidentiality Continued study continued on next slide Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved

Physician's Responsibilities • AMA's Statement of Principles § § Freedom of choice Responsibility to improve community Responsibility to patient is paramount Must support access to medical care for all people Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved

Physician's Duties • Patient welfare above financial interests • Professional courtesy • Report any unethical conduct by other physicians • Recommend second opinions when necessary continued on next slide Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved

Physician's Duties • Do not engage in sexual conduct with a patient during the physician-patient relationship • Do not treat family members except in emergencies Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved

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 Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved

Duty to Treat Indigent Patients • "Dumping crisis" § EMTALA § Requires patient stabilization in an emergency • Physician has right to select which patients to treat • Physician does not have right to drop or abandon patients once treatment is agreed upon Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved

Duty Not to Abandon a Patient • Once physician agrees to take care of patient, contract may not be improperly terminated • Physician may be charged with abandonment if formal notice of withdrawal is not given § Civil wrong, or tort • Physician must allow patient time to seek service of another physician continued on next slide Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved

Duty Not to Abandon a Patient • Licensed healthcare providers are also subject to this principle § Dentists § Physician assistants § Nurse practitioners Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved

Noncompliant and Incompetent Patients • Noncompliant § Fails or refuses to cooperate • Incompetent § Unable to provide for own needs § Status decided by court of law Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved

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 HIVpositive or has AIDS § Ethical dilemma § Report required regardless of consequence continued on next slide Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved

Duty to Treat Patients with AIDS • Ethical considerations § 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) Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved

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 Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved

Restrictions on HIV-Infected Healthcare Workers • Various recommendations, but no rules § AMA § American Academy of Orthopedic Surgeons § Federation of State Medical Boards • Strongest statement • Recommends names of HIV-infected healthcare workers be reported continued on next slide Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved

Restrictions on HIV-Infected Healthcare Workers • Various recommendations, but no rules § CDC • Testing all healthcare workers would be prohibitive • No ethical duty to disclose HIV status if no significant risk presented to patients Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved

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 Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved

Duty to Respect Confidentiality • Speak in low voice • Glass enclosure should separate front desk receptionist from waiting room • Sign-in sheet should consider protection from subsequent patients Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved

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 Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved

Patient's Rights • Right to confidentiality § Privileged communication • Right to give informed consent • Right to privacy • Right to be informed of advantages and potential risks of treatment • Right to refuse treatment Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved

Confidentiality • All information and records about treatment will be kept confidential by physician and staff unless consent to release is obtained § Breach of confidentiality is both unethical and illegal continued on next slide Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved

Confidentiality • Medical Patients Rights Act § All patients are entitled to have privacy respected and medical records handled confidentially • Privileged communication § Confidential information told to a physician or attorney by a patient • HIPAA regulations must be observed (Chapter 10) Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved

Patient Self-Determination Acts • Advanced directive § Living will • "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 Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved

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 • Parens patriae § State takes over care for minor continued on next slide Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved

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 continued on next slide Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved

Definition of Minors • Emancipated minor § Person in mid to late teens who legally lives outside parents' or guardian's control § Proof should be included in medical record Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved

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 Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved

Consent • Voluntary agreement by patient to allow medically trained person to touch, examine, and perform treatment • Two types § Informed (expressed) consent § Implied consent Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved

Doctrine of Informed 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 continued on next slide Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved

Doctrine of Informed Consent • Requires physician to explain in understandable language § § Diagnosis Nature of proposed treatment Advantages and risks of treatment Alternative treatments available to patient continued on next slide Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved

Doctrine of Informed Consent • Requires physician to explain in understandable language § Potential outcomes of treatment § What might occur—risk and benefits—if treatment is refused Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved

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 Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved

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 continued on next slide Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved

Exceptions to Consent • Not required to restore patients to original health • Cannot elicit cure for every patient • Cannot guarantee successful results of every treatment Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved

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 Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved

Role of Health Care Consumer • Do not self-medicate • Be honest with physician • Assist physician in prevention of medical errors Medical Law and Ethics, Fifth Edition Bonnie F. Fremgen Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved