Legal Ethics Study Guide

What bioethical principle is described by the right of a person to make one’s own decisions?

Autonomy

What amendment states that individuals have the right to make his/her own decisions about health care?

14th

What can occur if you do not get the patient’s consent?

Can be accused of assault, battery or may be liable for damages

What bioethical principle states “PA’s should act in the patient’s best interest”?

Beneficence - Doing good

Which bioethical principle requires knowledge of beliefs/ cultures/ values and preference?

Beneficence

Which bioethical principle states “First do no harm, requires PAs to avoid causing patient harm”?

Nonmaleficence

Which bioethical principle states “A fair distribution of resources/ benefits/ risks/ costs”?

Justice

Which bioethical principle: Order ankle X rays when Ottawa rules are positive (ankle injury) regardless of insurance or economic background.

Beneficence and Justice

Which bioethical principle: FNA of breast cyst that has not changed in 5 years which becomes infected after the procedure, you ask a peer to look at X Rays when you are not sure.

Nonmaleficence

Which bioethical principle: Allow a patient to say no to donating a kidney to sibling/ parent, informed consent and HIPPA.

Autonomy

Which bioethical principle: Allow a patient to say no to chemo for cancer.

Autonomy

Which bioethical principle: Tell a patient with strep they’re contagious.

Beneficence

Which bioethical principle: Provider washes hands between patients; Wears protective equipment.

Beneficence

Which Incivility: Late for class/zoom; Reading other courses notes during Class/Zoom.

Passive

Which incivility: Playing games during Class/Zoom; Texting during class/zoom; Surfing the web during class/zoom

Passive

Which incivility: Silent treatment of peers; Inappropriate dress/ not following dress code.

Passive

Which incivility: Failure to introduce oneself as a PA-S

Passive

Which incivility: Cheating on tests; Copying fellow student’s paper

Active

Which incivility: Taking medication samples; Destroying properties.

Active

Which incivility: Lies; Talking back; Physically attacking or verbally attacking

Active

Which incivility: Talking negatively insulting peers, supervisors; Vulgar language

Active

What is the purpose of the ethics committee?

Address legal ethics that arise during a patient’s care and treatment. Provide educational and consultative services to patients, families, and caregivers.

Is the ethics committee the decision maker?

NOOOOOOOO

What is the structure of the ethics committee?

Ethicist, Educator, Clinician and nurse, Legal advisor, Political leader, Clergy, Quality assurance, Corporate leader from business

What are the goals of the ethics committee?

• Committee provides support by providing guidance to patients, families and caregivers

• Review cases when there are conflicts

• Clarify issues that are ethical, legal, or religious in nature

• Discuss alternatives and compromises

• Promote the right of the patient

• Helps patients and family to come to a consensus on options that best meets the patients needs

• Promote the policies and procedures that achieve patient centered outcomes

• Enhance ethics for health care organizations and professionals

What are the Functions of the ethics committee?

• Develop policy and procedure guidelines assisting in ethical dilemma

• Provides staff and community education

• Helps with possible solutions for conflict resolution

• Case reviews

• Consultation (Provide patient, families, and healthcare providers with options)

  • Helps develop political advocacy policies

Which amendment states “hospital myst reveal its records of past acts of malpractice that has been performed in that hospital; identity of patient involved shall not be disclosed and privacy restrictions”?

Amendment 7 (article X section 25)

Which act states “Safeguard individual privacy; Provide individuals access to their own records; Establish privacy protection safety commission”?

Privacy act- Title 5

Which act states “ED are required to provide appropriate medical screening exam, Forbidden to “dump” patients from one emergency department to another”?

Emergency Medical Treatment and Active Labor Act

Which act states “Provide professional review bodies limited immunity from damages; Need to improve quality of medical care (dec the ability of incompetent physicians to move from state to state without disclosure of incompetence); Facilitating exchange of info among professionals conducting peer review?

Healthcare Quality

Which act states “Protect physicians improperly subjected to disciplinary actions”?

Healthcare Quality

Which act states “ Prohibits physicians who have ownership interest or compensation arrangements with clinical lab from referring Medicare patients to that lab; Requires medicare providers to report names and providers number of all physicians or their immediate relatives with ownership interests in provider entity”?

Ethics in Patient Referral Act

Which act states “Right to be informed of rights; Right to execute advance directives; Right to accept or refuse medical care; States required to provide description of state laws regarding advance directives to providers”?

Self Determination Act

Which act states “Protect privacy or patient info, confidentiality of patient info, security of patient info”?

HIPPA

Which act states “Gender discrimination prohibited, Fair wages for work performed”?

Equal Pay Act

Which act states “Employers with 15 or more employees; Prohibits employers from discriminating in the hiring process based on race, color, religion, sex, or national origin”?

Title VII

Which act states “A disability is a physical or mental impairment that substantially limits one or more major life activities; Prohibits discrimination against a person with a qualified disability”?

Americans with Disabilities (ADA)

Can the person be discriminated against on the basis of the disability if the individual with a disability can perform essential function with or without reasonable accomodation?

No

Which act “Prevents employers from giving preferential treatment to younger workers to the detriment of the older workers; Only applies to worker 40 and up and to workplaces with 20 or more employees; Does not prevent an employer from favoring older employees over younger employees”?

Age Discrimination in Employment Act

Which act “Provides regulation as to the duration of the workdays, breaks an employer must provide; Governs applicable salary and overtime requirements set out by the federal government (time and a half)”?

Fair Labor Standard Act (FLSA)

What is required for the certification of Florida Licensure of PAs?

Passing the PANCE/ PANRE and submitting CMEs (100 × 2 yrs)

What is required of licensing in Florida?

Must have license to practice; exception are PAs employed by the Federal government on a Federal instillation.

Regulated by the FL board of medicine, FL DOH, FL council on PAs

1 physician per 10 PAs; 18 y/o; Complete accredited PA program, pass boards, submit diploma, 2 letters recommendation

CANNOT be called doctor in medical setting

What can be seen as deceptive means to get your license?

Do NOT engage in cheating or other dishonest behavior that violates exam security before, during or after exam

Do NOT obtain or attempt to certification through deceptive means (misstatement of facts, omitting or falsifying CME records)

Shall NOT manufacture, modify, or reproduce NCCPA certificates

Do NOT pose as a PA-C unless certified

What are privileges with licensure?

Prescription privileges are based on supervising MD/DO medical area of training; “How you are allowed to practice medicine in the hospital”

Credentialing- What you can do based on education, training, or experience, you and physician agree upon

What is a legal document describing those treatments an individual wishes or does NOT wish to receive should they become incapacitated?

Living Will

What are requirements for a Living will?

Must be signed and dated by patient and 2 witnesses

*Witnesses cannot be designated health care agent; Witnesses verify person appears to be of sound mind and free from duress or undue influence

What are examples of when a Living will can be used?

When to withhold life support, ventilators, feeding tubes, hydration, CPR, Dialysis, DNR

What is a legal device that permits one individual (principal) to give another person (attorney in fact, primary agent) the authority to act on behalf of the principal regarding health care issues?

Durable power of attorney

What is not activated until the principal becomes incompetent or unable to make own decisions; Signed by the principal, primary agent and 2 witnesses?

Durable power of attorney

What is the intentional touching of another's person, in a socially impermissible manner, without that person’s consent?

Medical Battery

What are the six steps to serenity for teachers to help students work with difficult patients?

CALMER

What does CALMER stand for?

Catalyst for change (not responsible for it)
Altering your thoughts (to change your feelings)
Listen and then make a diagnosis (Dx)
Make an agreement with the patient
Education and follow up
Reach out and discuss your feelings after seeing the patient with trusted attendings, peers, or colleagues

What is CAGE used for ?

Alcohol (realize you need to stop)

What does CAGE stand for?

Cut down on your drinking
Annoyed if people criticize your drinking
Guilty about your drinking
Eye opener first thing in the morning for your hangover

What acronym is used to hand off patient to ER or inpatient?

5P’s or IPASS the BATON

What do the 5 P’s stand for?

Patient, Plan, Purpose, Problems, Precautions

What does IPASS the BATON stand for?

Introduction, patient, assessment, situation, safety concerns, background, actions, timing, ownership, next

What are the 5 right used for?

To prevent medical errors

What are the 5 rights?

Right patient, Right drug, Right dose, Right route, Right time

What is utilized to get the real reason for a bad outcome (risk management)?

5 Whys- Ask why 5 times to get the real reason for the bad outcome

What defines child abuse?

<18 year old; who has suffered intentional serious mental, emotional, sexual, or physical injury inflicted by a parent or guardian

What are the signs of child abuse ?

unexplained/ unexpected death, broken bones (especially spiral fractures), sudden/ unexpected emotional outbursts, agitation, withdrawal, bruises, welts, discoloration, burns, cigarette burns, malnourishment, hesitant to talk, story does not match up, untreated medical conditions

When must you report to DCF?

Head injury, bruises to neck/head, burns, fractures, bruises anywhere on child <5 yo, alleging sexual abuse, STI in a prepubescent child, malnutrition, medical neglect, serious emotional problems, sibling in a home where one or more child has died or been injured due to abuse

What are examples of abandonment?

Care was unreasonably discharged, Discharged against patient’s will, PA failed to arrange care by another provider, Foresight indicated that discharge might result in patient’s harm

If a PA decides to withdraw services, should they let the patient know?

YES they must provide the patient with reasonable notice

What are the standards of the Code of Ethics?

Honesty, respect for others, conscientiousness

What is expected in regards to impaired providers in the Code of Ethics?

PA’s have an ethical responsibility to protect patients and the public by identifying and assisting impaired colleagues. Should be able to recognize impairment in physician supervisors, PAs, or other health care providers and should seek assistance from appropriate resources to encourage these individuals to obtain treatment

Define impaired

Being unable to practice medicine with reasonable skill and safety because of physical or mental illness, loss of motor skills, or excessive use or abuse of drugs and alcohol

What are examples of unethical conduct as described by the Code of Ethics?

False advertising, knowingly using flawed data, Scheme designs to deny patients insurance benefits, Accept kickbacks, Enter into financial agreements that are clearly a conflict of interest, Cover up wrongdoing, Falsify records, Fraudulent activities (reimbursement)

What is the intent to defraud person/ entity by false or fraudulent pretenses, representations or promises and to obtain property from one or more such persons?

Fraud

What is necessary in order to obtain informed consent?

Patient must be competent; Be informed of all potential risks, benefits, and alternatives of a proposed procedure.

Is it the duty of the provider or hospital to disclose to the patient sufficient information prior to a procedure and obtain informed consent?

PROVIDER

When is a patient not considered competent?

If the court says otherwise or 2 physicians declare them incapacitated

Should the consent be written or oral? What could be considered without consent?

Written!!!! Battery !

What should be done if a patient is denying treatment (even life saving)?

A document must be signed stating why they refuse

When is informed consent done?

MUST be done prior to medical/ surgical procedures; Vaccines

What can be done in an emergency for consent?

Can assume consent is implied and proceed without written consent in the case of an emergency
Done when immediate treatment is required to preserve life/ prevent permanent impairment of health or if patient is unconscious or no representative is found

What is the unlawful killing of a person with the malice of forethought and the premeditated intent to kill?

Murder

Deliberate and premeditated killing of another with malice of forethought

First Degree Murder

Nancy Morrison is arrested for removing artificial life support causing a patient to die in the ICU.

First Degree Murder

Not deliberate nor premeditated (angel of death)

Second Degree Murder

Bruce gets into a fight beating up someone and they die from injuries

Second Degree Murder

What is the unlawful killing of another person without malice of forethought?

Manslaughter

Intentionally killing another person “in the heat of passion” which was caused by provocation of the victim, No premeditation

Voluntary Manslaughter

When death occurs as a result of a negligent act (reckless driving)

Involuntary Manslaughter

Provider takes the measures/ performs the life ending in a medical manner; typically utilizes medications to do

Assisted Suicide- Euthanasia

Patient is performing the act that ends their life

Patient Driven suicide
Most common: Fire arm - Drugs - Single car accidents

What is a form of conduct caused by heedlessness or carelessness that constitutes a departure from the standard or care generally imposed on reasonable members of society?

Negligence

What can be seen as negligence?

One has considered the consequences of an act and has not exercised his/her best judgement; One fails to guard against a risk that should be appreciated; One engages in certain behaviors expected in to involve unreasonable dangerous to others

What is the negligence or carelessness of a professional person?

Malpractice

What is Criminal negligence?

Reckless disregard for the safety of another (willful indifference to an injury that could follow an act)

What is the execution of an unlawful or improper act?

Malfeasance

Performing an elective abortion in 3rd trimester when prohibited by law?

Malfeasance

What is improperly performing ac act, resulting in injury to another?

Misfeasance

Surgery on the wrong site

Misfeasance

What is the failure to act when there is a duty to act as a reasonably prudent person would in similar circumstances?

Nonfeasance

Failing to order a diagnostic test or prescribe rx that should have been ordered under the cirsumstance

Nonfeasance

What are examples of Commission negligence?

Administration of the wrong med, Administering med to the wrong patient, Performing a surgical procedure without patient’s consent, Performing a surgical procedure on the wrong patient
UNINTENTIONAL

What are examples of Omission Negligence?

Failing to administer meds; Failing to order a diagnostic test; Failing to follow up on abnormal test results
More intentional; A reasonably prudent person would or would not do under given circumstances