HOSA Medical Law & Ethics

advance directives

legal documents that allow individuals to state what medical treatment they want or do not want in the event that they become incapacitated and are unable to express their wishes regarding medical care

civil law

A law that governs relationships between individuals and defines their legal rights.

informed consent

permission granted voluntarily by a person who is of sound mind and aware of all factors involved

Law

societal rules or regulations that are adviseable or obligatory to observe (mandatory, face civil or criminal liability).

Bioethics

the ethical implications of biomedical technology and its practices; life & death issues; local, organizational, personal, worldwide implications

Medical Ethics

"applied ethics;" the practical application of moral standards that concern benefiting the patient.

The Primary Duty

to protect our patients from harm

Medical Malpractice Acts

in all 50 states; define how medicine is practiced in a particular state.

Medical ethics 2

mandates that the welfare and confidentiality of the individual patients must be the chief concern

Malpractice

The failure if a professional to use the degree of skill and learning commonly expected in that individuals profession

Result of Malpractice

Injury, loss or damage to the person receiving care

Result of negligence

Injury to another person

Battery

Unlawful touching of another person without consent

Informed consent

Permission granted voluntarily by a person who is of sound mine after the procedure and all risks involved have been explained

Invasion of privacy

Unnecessarily exposing or revealing personal information without the persons consent

False imprisonment

Restraining an individual or restricting an individuals freedom

Abuse

Results in physical harm, pain, or mental anguish

Examples of abuse

Physical, verbal, psychological, sexual

Defamation

False statements either cause a person to be ridiculed or damage the persons reputation

Slander

When defamation occurs and the information is spoken

Libel

When defamation occurs and the information is written

Contract

An agreement between two or more parties

Part of contracts

Offer, acceptance, consideration

Implied contracts

Obligations that are understood without verbally expressed terms

Expressed contracts

Stated in distinct and clear language either orally or in writing

Legal disability

When someone doesn't have the legal capacity to form a contract.

Agent

When a person works under the direction or control of another person the person working under the employer

Privileged communications

All information given to health care personnel by a patient

Patients rights

The factors of care that patients can expect to retrieve

Patients bill of rights

Recognized by many health care facilities

Living wills

Documents that allow individuals to state what measures should or should not be taken to prolong life when death is expected

POA

Designation if health care surrogate / durable power of attorney

PSDA

Patient self-determination act

Patient self-determination act

Mandates all health care facilities receiving any type of federal aid comply with requirements.

Health Service Delivery

Transplantation and Anatomy Act 1979
Health Rights Commission Act 1991
Anti-Discrimination Act 1991
Workplace Health and Safety Act 1995
Information Privacy Act2009
Child Protection Act 1999
Civil Liability Act 2003
Powers of Attorney Act 1998
Guardianship and Administration Act 2000

Civil Law Remedies

Financial compensation (damages)
Injunction (order to stop doing something)
Specific performance (order to do something).

Reportable Deaths

(a) it is not known who the person is;
(b) the death was a violent or otherwise unnatural death;
(c) the death happened in suspicious circumstances;
(d) the death was not reasonably expected to be the outcome of a health procedure;
(e) the cause of death certificate has not been issued;
(f) the death was in care;
(g) the death was in custody;
(h) the person had not consulted a doctor within 3 months before the person's death.

Coronial Comments (Recommendations)

public health or safety; or
the administration of justice; or
ways to prevent deaths from happening in similar
circumstances in the future.

Passive Euthanasia

-Withdrawal of life-sustaining treatment allowing patient to die from natural causes.
-Withdrawal of treatment allowing patient to die of natural causes (PASSIVE)
-In response to a medical decision made in the best interests of the patient and in accordance with good medical practice (NON-VOLUNTARY)

Active Voluntary Euthanasia

•Actively assisting a person to die (ACTIVE)
•In response to a request, and with consent of the person (VOLUNTARY)
Unlawful in Australia
•amounts to aiding in suicide
•would also amount to murder
•consent to death immaterial
Criminal Code 1899 (Qld),

Assisted Suicide

Any person who—
(a) procures another to kill himself or herself; or
(b) counsels another to kill himself or herself and thereby induces the other person to do so; or
(c) aids another in killing himself or herself;
is guilty of a crime, and is liable to imprisonment for life.

Patient's Decision - Common Law Refusal

If an adult has the capacity to make a decision to refuse the commencement of life-sustaining medical treatment if it is required, or to have life sustaining treatment withdrawn, the law is clear.
A competent adult may refuse treatment even if that decision results in the adult's death.

Advance Health Directive

A direction in an advance health directive will only operate if:
•the person has impaired capacity (at the time the treatment is required);
Powers of Attorney Act 1998, s36(1)(a).
•the person has no reasonable prospect of regaining capacity for health matters; and
Powers of Attorney Act 1998, s36(2)(c).
•the person's medical condition falls within one of four categories.
i)the adult has a terminal illness
(ii) the adult is in a persistent vegetative state,
(iii) the adult is permanently unconscious
(iv) the adult has an illness or injury of such severity that there is no reasonable prospect that the adult will recover
Powers of Attorney Act 1998, s36(2)(a)(1)-(iv).

Organ Donation and Transplantation

Common Law Position
-Body parts cannot be removed from living person unless it is for therapeutic purposes
-Criminal offence of maiming
-Consent is irrelevant

Features of Criminal Law

•Parties to a criminal matter
•Initiation of the action
•Elements of a crime
•Standard of proof
•Presumption of innocence
•Liability rests with the accused

Elements of Negligence

1.The existence of a duty of care;
2.A breach of the standard of care;
3.Damage suffered which was reasonably foreseeable; and
4.The breach caused, or materially contributed to the damage (causation).

What is a duty of care?

A duty of care is owed in circumstances where there is a foreseeable risk of harm to another.
A court, when determining if a duty of care is owed, would consider the following:
-Neighbour principle
-Legally recognised relationships
-Reasonable forseeability of harm in the circumstances

Breach of Standard

Civil Liability Act 2003 (Qld), s 22.
(1)A professional does not breach a duty arising from the provision of a professional service if it is established that the professional acted in a way that (at the time the service was provided) was widely accepted by peer professional opinionby a significant number of respected practitioners in the field as competent professional practice.

Unprofessional conduct

Conduct that is of a lesser standard than that which might reasonably be expected of the health practitioner by the public or the practitioner's professional pee

Professional Misconduct

More serious impropriety and includes
Unprofessional conduct that is substantially below the standard reasonably expected
More than one instance of unprofessional conduct
Conduct, whether occurring in connection with the practice of the profession or not, that is inconsistent with the practitioner being a fit and proper person to hold registration

Queenlsand Civil and Administrative Tribunal

Action QCAT can take:
Counselling
Caution or reprimand
Impose a condition
A fine of less than $30,000
Suspension
Cancellation

Exceptions to the duty - Consent

-Express consent
Provided by patient ie patient requests certificate for employment purposes.
-Implied consent
Information given to other health care professionals/member of the health care team
-Reporting notifiable disease
-Reporting suspected child abuse

Documentation

If the information is not recorded on the health record, then the court will presume that it did not occur. The court will essentially view the record as regular, complete, and an accurate statement of the events, unless evidence can be submitted to the contrary.

Research Principles

Research merit and integrity
Justice
Beneficence
Respect

Merit and Integrity

Justifiable by its potential benefit
Based on a thorough study of current literature
Designed to ensure the respect for participants is not compromised

Justice

Selection and exclusion criteria for research participants is fair
No undue burden on the participants
No exploitation of participants
There is fair access to the benefits of the research

Respect

Having due regard for the welfare, beliefs, perceptions, customs and cultural heritage of those involved in the research
Privacy and confidentiality

NHMRC define scientific misconduct to mean

'fabrication, falsification, plagiarism, or other practices that seriously deviate from those that are commonly accepted within the scientific community'

Systems for Decision Making (allocation of scarce resources)

• Combination Criteria System: criteria satisfying; age, benefit the most, life expectancy, contribution to society
• Random Selection: "first come, first serve"
• No-treatment system: if all can't be treated then none will
• Pharmacogenomics: how genetics influence a medications effect

Laws

Societal rules or regulations that are advisable or obligatory to observe.

Ethics

A set of moral standards and a code for behavior that govern an individuals interactions with other individuals and within society.

It is a critical reflection about morality and the rational analysis of it.

Morality

What people do in fact believe to be right and good.

Roe v. Wade

Court case that was a landmark decision by the United States Supreme Court on the issue of abortion. Decided simultaneously with a companion case, Doe v. Bolton, the Court ruled 7-2 that a right to privacy under the due process clause of the 14th Amendment extended to a woman's decision to have an abortion, but that this right must be balanced against the state's two legitimate interests in regulating abortions: protecting prenatal life and protecting women's health.

Hippocratic oath

An oath historically taken by physicians. It is one of the most widely known of Greek medical texts. It requires a new physician to swear on a number of healing gods to uphold specific ethical standards.

The Geneva Convention Code of Medical Ethics

It is a declaration of a physician's dedication to the humanitarian goals of medicine, a declaration that was especially important in view of the medical crimes which had just been committed in Nazi Germany. The Declaration of Geneva was intended as a revision[2] of the Hippocratic Oath to a formulation of that oath's moral truths that could be comprehended and acknowledged in a modern way.

The Nuremberg Code

A set of research ethics principles for human experimentation set as a result of the Subsequent Nuremberg Trials at the end of the Second World War.

Declaration of Helsinki

A set of ethical principles regarding human experimentation developed for the medical community by the World Medical Association (WMA). It is widely regarded as the cornerstone document on human research ethics.

Medical Assistant Code of Ethics

Sets forth principles of ethical and moral conduct as they relate to the medical profession and the particular practice of medical assisting.

Principle of Medical Ethics (AMA)

Standards of conduct which define the essentials of honorable behavior for the physician.

Is it legal or in accordance with institutional or company policy?
Does it promote a win-win situation with as many individuals as possible? (balance)
-How does it make me feel? (Emotional toll on yourself)

Blanchard & Peale's The Power of Ethical Management on ethics that includes a three-step decision check:

Patient Bill of Rights

A list of guarantees for those receiving medical care. It may take the form of a law or a non-binding declaration. Typically a patient's bill of rights guarantees patients information, fair treatment, and autonomy over medical decisions, among other rights.

Qualities of an HCP

Tact, diligence & knowledge, caring & sensitivity, compassion, honesty & integrity.

Bond

An insurance contract by which a bonding agency guarantees payment of a specified sum to an employer in the event of a financial loss to the employer caused by the act of a specified employee; a legal obligation to pay specific sums.

Pluralistic

Referring to numerous distinct ethnic, religious, and cultural groups that coexist in society.

Burglary

Breaking and entering with intent to commit a felony.

Capitation

Health care providers are paid a fixed monthly fee for a range of services for each HMO member in their care.

Conglomerate

A corporation of a number of different companies operating in a number of different fields.

Co-payment

A medical expense that is a member's responsibility; usually a fixed amount of $5 to $20.

Deductible

A cost-sharing arrangement in which the member pays a set amount toward covered services before the insurer begins to make any payments. Typically, HMO members do not pay deductibles.

Fee-for-service

Pays providers for each service performed.

Gatekeeper

A term referring to HMO primary care providers responsible for referring members to specialists with the intent of matching the client's needs and preferences with the appropriate and cost-effective use of those specialists' services.

Group practice

Type of business management in which three or more individuals organize to render professional service and share the same equipment and personnel.

Health Maintenance Organization (HMO)

Prepaid health care services rendered by participating physicians and providers to an enrolled group of persons.

Joint venture

A type of business management where hospitals, physicians, and clinics form to offer client care.

Liability

The state of being liable, responsible, legally bound or obligated, as to make good any loss or damage that occurs.

Managed care

A type of health care plan; generally one of two types, namely HMO or preferred provider organization (PPO).

Opt-out option

Members or clients can seek treatment from providers outside the health care plan but pay more to do so.

Partnership

Type of business management involving the association of two or more individuals who are co-owners of their business.

Theft

Actual taking and carrying of someone else's personal property without consent or authority and with the intent to permanently deprive a person of it.

Pay for Performance (P4P)

A type of managed care to encourage providers to improve the quality of their clients' care, and reimburses them for their progress towards a fixed goal.

Sole proprietorship

Type of business management owned by a single individual.

Professional service corporation

Specific type of corporation in which licensed individuals organize to render a professional service to the public. Such licensed individuals include physicians, lawyers, and dentists.

Preferred Provider Organization (PPO)

A type of business agreement between a medical service provider and an insurer organization in which the fess for specific services are predetermined for an already established group of clients assigned to or selected by the provider.

Administer a drug

To introduce a drug into the body of a client.

Appellant

One who appeals a court decision to a higher court.

Arraignment

The procedure of calling someone before a court to answer a charge.

Civil case

Court action between private parties, corporations, government bodies, or other organizations. Compensation is usually monetary. Recovery of private rights is sought.

Closing arguments

Summary and last statements made by opposing attorneys at a hearing or trial.

Court of appeals

Court that reviews decisions made by a lower court; may reverse, remand, or affirm lower court decision.

Court order

An order issued only by a judge to appear or request certain records. The release of any records requested in a court order does not require the clients permission.