Chapter 4 and 5 ethics

The written assent of a patient to receive a proposed treatment; adequate information is essential for the patient to give truly informed consent

informed consent

T or F

Imaging professionals may be required to witness the signing of a written informed consent form

True

Who is ultimately responsible for the informed consent process

physician

Procedures requiring informed consent

invasive procedures

other procedures established by the facility

Review box 4-1 on page 74.

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The ability to make appropriate choices and consider their consequences

competence

A person who may be involved in the determination of competence and in the informed consent process

surrogate

Possible surrogates include:

parent

individual named by the patient while competent

person or persons appointed by the courts

The concept that patients are to be treated as individuals and informed about procedures to facilitate appropriate decisions

autonomy

When is acceptable to treat a patient without informed consent of their lawful surrogate

Emergencies

Review PowerPoint slide 5 ch. 4

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What helps ensure patient autonomy

The Patient Self-Determination Act of 1991

Should you respect the patient's choice to refuse treatment

Yes

Who should questions concerning specifics of informed consent (alternatives, failure rate, risks, etc) be directed to

Patient's physician

Should imaging professionals allow themselves to be placed in the position of witnessing the patient's signature

Yes

Situations is which informed consent may have to be abandoned to save the patient's life

Emergency Exception

Criteria emergency situations must meet

Pt. Incapable of giving consent and lawful surrogate is unavailable

Danger to life or risk of serious impairment to health

Immediate treatment is necessary to avert these dangers

Document that is to be given when a patient is hospitalized

The Patient Care Partnership document

A predetermined (usually written) choice made to inform others of the ways in which the patient wishes to be treated while incompetent

advance directive

What do many mental health and nursing home facilities ask patients to have in case they become incompetent

Advanced directive or assigned surrogate

Failure to obtain consent may result in allegations of

Tort

Allegations of torts that may result from failure to obtain consent

Assault, battery, false imprisonment, negligence

Wrongs resulting from acts done with the intention of causing harm to another

intentional tort

What is the best tool to lessen or decrease the risk of allegations of intentional torts?

Communication with patients to ensure their understanding

Wrongs resulting from actions that were not intended to cause harm

unintentional torts

Deliberate act where in one person threatens to harm another person without consent and the victim perceives that the other person has the ability to carry out the threat

Assault

Touching to which the victim has not consented, even if the touching may benefit the patient

battery

T or F

If a patient is incompetent or requires restraints, the law allows providers to touch patients without consent within certain parameters

True

When a person is unlawfully confined within a fixed area. the confined person must be aware of the confinement, or must be harmed by the confinement

false imprisonment

T or F

For false imprisonment to be proved, plaintiffs must prove that they were restrained either physically or by threat or intimidation and that they did not consent to the restraint

True

The patient's capacity to consent to or refuse the procedure must be

Evaluated

What two concepts must be recognized if the patient is a minor

Parental permission and patient assent

T or F

Because laws are the same for every jurisdiction imaging professionals do not have to know the state of the law in their own state

False

Informed consent is absolutely necessary for many procedures in the imaging department, including

Contrast injection

T or F

Imaging professionals performed the study and have a duty to ensure that procedures are explained and consent is obtained before beginning the procedure

True

Consent form should be carefully written with input from

Physicians, technologists performing the studies, risk management, legal counsel

Name of the procedure

Brief explanation of the procedure with benefits and risks

Spaces for patient's name and name of the physician

Signature lines for the patient or surrogate, the physician explaining the procedure, and at least one witness

Date and time

Items included on consent form

Should a consent form be used in the place of oral explanation

No

Does simple consent required knowledge of the procedure

No

The most common unintentional tort encountered in medical imaging

Medical malpractice (negligence)

Four potentially conflicting rules that may guide the physicians or other healthcare providers in explaining the information to patients

Patient preference rule

Professional custom rule

Prudent person rule

Subjective substantial disclosure rule

What requires healthcare professionals to tell the patients what they want to know

Patient preference rule

What states that the healthcare professionals should give the patient information normally given to patients in similar situations

Professional custom rule

What measures the physician disclosure to the patient based on the patient's need for information to make decisions regarding treatment

Prudent person rule

What encourages the physician to disseminate all information important to the individual patient

Subjective substantial disclosure rule

Autonomy involves which of the following?

A. Informed consent

B. The self

C. Patient rights

D. All of the above

D. All of the above

Why is two-way communication between patients and imaging professionals important in imaging services

feedback to ensure the patient's understanding of the procedure and opportunity to question

The ability to make decisions concerning one's life

Competence

The appointment of a person to make decisions for another

surrogacy

Paternalism is defined as which of the following

A. mother like caretaking

B. Father like (God like) caretaking

C. Necessary.

D. None of the above.

b. father-like (God-like) caretaking

A prerogative invoked in limited circumstances when healthcare provide providers withhold information from a patient because they believe the information would have adverse effects on the patient's condition or health

Therapeutic privilege

T or F

Combining the prudent person rule and the subjective substantial disclosure role in most cases provides the information that the patient needs to make informed decision

True

T or F

Respect for the autonomy of the patient includes the ability of the patient to make choices.

True

T or F

Surrogacy is not an issue in respecting the patient's autonomy

False

T or F

truly informed consent may not be possible

True

T or F

Intentional torts can occur only if the perpetrator of the tort intends to do harm

False

T or F

Assault occurs when the victim is touched without giving consent

True

T or F

Battery cannot be found if the touching to which the patient has not consented is for the good of the patient

False

T or F

Immobilization devices used in the imaging department are considered restraints

False

T or F

Use of restraints of patients by imaging professionals is always an exception to the torts of assault and battery

False

T or F

Communication is the imaging professional's best tool to decrease risk of litigation for assault, battery, and false imprisonment

True

T or F

The legal duty to obtain informed consent lies with the imaging professional

False

T or F

Informed consent need not be given if an imaging professional does not feel the patient wants to know about the procedure

False

T or F

The duty of informed consent laws with physicians, so imaging professionals do not need to concern themselves

False

T or F

Consent forms may be used to obtain consent instead of an explanation of the procedure and its risks

False

T or F

For informed consent to be legally recognized, a patient signature on the form is sufficient

False

T or F

The professional standard of informed consent requires a physician to disclose the risk that a reasonable and prudent medical practitioner will disclose under the same or similar circumstances

True

T or F

An imaging professional does not need to be concerned with the law regarding inform consent in his or her jurisdiction, as long as the form is signed

False

Conformance with fact or reality

truthfulness

The obligation to tell the truth and not lie or deceive others

Veracity

Truthfulness is summed up in two commands:

Do not lie

You must communicate with those who have a right to the truth

a falsehood told to a person who has a reasonable expectation of the truth.

Lie

Conditions for the expectation of truth:

place of communication

roles of communicators

nature of the truth involved

T or F

Concealment of the truth is not necessarily a lie, and in certain situations the imaging professional does not have to tell the truth

True

What is not necessarily a lie, and in certain situations the imaging professional does not have to tell the truth

Concealment of the truth

A person has a right to the truth in the following situations:

During the informed consent process

When making decisions about treatment

When making important, nonmedical decisions

The duty owed by health care providers to protect the privacy of patient information.

Confidentiality

knowledge a person has a right or obligation to conceal.

secret

secret that arises from the fact that harm will follow if a particular knowledge is revealed.

obligatory secret

Types of obligatory secrets:

natural, promised, professional

Information that by its nature is harmful if revealed

Natural secret

Knowledge a person has promised to conceal

Promised secret

A secret maintained to protect the patient, society, and profession

professional secret

the most binding of the obligatory secrets is the

professional secret

When professional secrets are revealed, who is harmed

Patient and imaging professional

What describes the importance of professional secrecy in the hospital setting based on the nature of the knowledge, the implied promise of secrecy, and the good of society and the profession

Patient Bill of Rights and American Hospital Association

Exceptions to confidentiality

Wounds

Abuse

Communicable diseases

Accidents

Birth defects

Addictions

Family's need to know

Public's need to know

Third-party payers

What includes a requirement that only the minimum necessary information for the purpose of disclosure be released, rather than the entire record as was assumed in the past.

HIPAA

Patients may explicitly consent to the release of medical information in their records.

Patient authorization

Release of patient information to outside reviewers is governed by

State law as well as HIPAA

the most common outside requesters of medical information.

Third-party payers

Reporting of a variety of medical conditions and incidents referred to as statutory disclosures, required by state public health laws

Statutory duty to report

Statutory disclosures include the following:

Venereal disease

Contagious diseases (tuberculosis)

Wounds inflicted by violence

Poisonings

Industrial accidents

Abortions

Drug abuse

Abuse of children, elderly people, and people with disabilities

The obligation to disclose information to warn third parties of a risk of violence or contagious disease or some other risk

duty to warn third parties

T or F

All states now require physicians to report both HIV and AIDS to the state health department

True

Because of differences in statutes between jurisdictions, who may imaging professionals want to consult at their facilities to determine the law in their jurisdiction.

risk management or legal counsel

What mandates a specific patient right of access to his or her own records.

HIPAA

Under HIPAA, is patient permission necessary when required by law, billing purposes, organ and tissue donors, and public health risks

No

Do patients have the right to request a review of refusal to provide access

Yes

Do parents have rights of access to the their children's records

Yes (emancipation may differ)