Flashcards: Patient Rights, Health Equity, and Medical Ethics

Page 1: Currency Features and Federal Reserve Note

• The transcript on Page 1 shows a scanned Federal Reserve Note with several printed elements. Key elements identified include:
  • The designation: FEDERAL RESERVE NOTE.
  • A statement indicating legal tender: "This note is legal tender for all debts, public and private" (as shown in the transcript).
  • National identifiers: references to the United States of America and related denomination markings present on typical U.S. currency.
  • Denomination cues visible in the scan include words like ONE and related numerals, as well as elements like ONE HUNDRED DOLLARS (as suggested by the visible fragments in the text) though the exact printed denomination is unclear due to scanning/overlaid characters.
  • Serial-like text: strings such as DB 33533527 C and other alphanumeric markings echo typical serial numbers and treasury seals found on Federal Reserve Notes.
  • The page emphasizes common features of U.S. currency design: denomination display, federal seal, and government affixed text.
• Practical takeaway for studying: recognize that a typical Federal Reserve Note contains the following categories of information and security/identity cues—and these cues appear repeatedly in exam-style notes.
• Real-world relevance: understanding currency design helps in fields like economics, finance, history, and public policy; also relevant for discussions of monetary policy and financial literacy.

Page 2: Prompt or Discussion Question

• Page 2 contains a rhetorical prompt: "Who do you love the most?"
• Potential exam or discussion use:
  • Could be used to prompt ethical reflections or patient-care scenarios (e.g., who should be prioritized in decision-making under pressure, or ensuring patient-centered care considerations).
• Note for context: no additional course material is provided here beyond the question prompt.

Page 3: Patient's Rights and Responsibilities (General, NY State Hospital Rights)

• Patient's Rights (general list)
  • Right to: appropriate medical care and humane treatment.
  • Right to informed consent.
  • Right to privacy and confidentiality.
  • Right to access information and health education.
  • Right to choose healthcare provider and facility.
  • Right to self-determination.
  • Right to religious belief.
  • Right to medical records.
  • Right to leave and refuse diagnostics and medical treatment.
  • Right to refuse participation in medical research.
  • Right to correspondence and to receive visitors.
  • Right to express grievances.
  • Right to be informed of rights and obligations as a patient.
• Patient's Responsibilities (to complement rights)
  • Know rights and responsibilities.
  • Provide accurate and complete information.
  • Report unexpected health changes.
  • Understand the purpose and cost of treatment.
  • Accept consequences of own informed consent.
  • Settle financial obligations.
  • Respect the rights and property of others.
  • Exhaust grievance mechanism.
• NY State hospital-specific patient rights (as listed in the transcript)
  • Hospitals must provide assistance if patients do not understand rights or need help (including an interpreter).
  • Right to receive treatment without discrimination (race, color, religion, sex, gender identity, national origin, disability, sexual orientation, age, or payment source).
  • Right to considerate and respectful care in a clean, safe environment; emergency care must be available.
  • Right to know the doctor in charge and the staff involved in care; right to refuse treatment, examination, or observation by any staff member.
  • Right to identify a caregiver to be involved in discharge planning and post-discharge care information.
  • Right to complete information about diagnosis, treatment, and prognosis.
  • Right to information needed for informed consent, including risks and benefits of procedures or treatments.
  • Right to information for an informed consent regarding an order not to resuscitate; ability to designate someone to grant this consent if too ill; request pamphlet on health care decisions.
  • Right to refuse treatment and to be informed of potential health effects.
  • Right to refuse participation in research with a full explanation.
  • Right to privacy and confidentiality of all information and records.
  • Right to participate in treatment and discharge decisions; hospital must provide written discharge plan and guidance on appealing discharge.
  • Right to review medical records without charge and to obtain copies at a reasonable fee; no denial of copy due to inability to pay.
  • Right to receive an itemized bill and an explanation of charges.
  • Right to view standard charges and participating health plans.
  • Right to challenge unexpected bills via Independent Dispute Resolution.
  • Right to complain without fear of reprisals and to receive a written response; if unsatisfied, can contact NYS Health Department.
  • Right to designate visitors (family members/adults) as allowed by ability to receive visitors.
  • Right to make known wishes regarding anatomical gifts; eligibility and enrollment options include NYS Donate Life Registry or written documentation (e.g., health care proxy, will, donor card, or other signed paper).
  • Note: Public Health Law (PHL) 2803(1)(g) and 10 NYCRR 405.7, 405.7(a)(1), 405.7(c) provide regulatory grounding.
• Takeaway: Hospitals in NYS enumerate a comprehensive set of patient rights and discharge-planning processes to ensure informed consent, confidentiality, non-discrimination, and avenues for redress.
• Ethical note: These rights anchor patient autonomy, informed consent, and respect for patient values across clinical decisions and end-of-life care considerations.

Page 4: AMA Code of Medical Ethics – Patient Rights and Physician Responsibilities

• Key rights and expectations articulated by AMA Ethics (a)–(i):
  • (a) Courtesy, respect, dignity, and timely, responsive attention to patient needs.
  • (b) Access to information about benefits, risks, and costs of appropriate treatment alternatives, including risks/costs of forgoing treatment; physician guidance based on professional judgment.
  • (c) Ability to ask questions about health status or treatments and receive answers.
  • (d) Capacity to make decisions about care and have those decisions respected; patients with decision-making capacity may accept or refuse interventions.
  • (e) Privacy and confidentiality of patient information.
  • (f) Right to obtain copies or summaries of medical records.
  • (g) Right to obtain a second opinion.
  • (h) Be advised of any conflicts of interest the physician may have regarding care.
  • (i) Continuity of care: expect coordination of medically indicated care with other professionals and that care is not discontinued without reasonable notice and assistance in arranging alternatives.
• Relevance to practice: These points inform physician-patient relationships, shared decision-making, and ethical governance in clinical settings.

Page 5: Clinical Practice Reflections – Advocating for Patients

• Practical advocacy notes for healthcare professionals:
  • Advocate for patients’ rights; many patients are unaware of their rights in the hospital.
  • Do not coerce patients; respect their autonomy and decisions.
  • Avoid pushing patients into signing documents; ensure they understand what is happening with explicit physician explanation.
  • Example vignette: A patient who had a stroke faced disbelief by an caregiver; the clinician sought escalation to the MD to ensure proper care.
  • Another example: Incarcerated patient requiring oxygen and hospice care; issues included identifying the patient properly and ensuring appropriate placement.
  • Core principle: Always align actions with patient-informed consent and physician guidance; avoid acting without clear, informed discussion.
• Practical implications: Emphasizes communication, advocacy, and patient autonomy in ethically complex situations (acute stroke, jail patients, hospice decisions).

Page 6: Social Determinants and Inequality in Healthcare

• Core topics:
  • Race and culture
  • Ethnicity
  • Gender and sexual inequality; sexual identity
  • Economic disparity
  • Disabilities (mobility, hearing, sight)
• Narrative cue: Story Time – mentions of suprapubic/Clearlake experiences, family dynamics, and historical injustices (e.g., “Uncle Tom” references) to illustrate inequity.
• Educational takeaway: These determinants influence access to care, quality of care, and health outcomes; culturally competent care requires recognizing these factors.

Page 7: Health Disparities – Literacy, Access, and Morbidity/Mortality by Group

• Health disparities and determinants highlighted:
  • Low health literacy and poor access to health care are more prevalent in certain populations.
  • Low-income groups show higher hospitalization rates for asthma complications among Black and Mexican American children, compared to White children (ATI reference).
  • Infant gestational age and morbidity/mortality vary by race/ethnicity; minority populations show higher risk:
  • African American women have a higher preterm birth rate: $11.1\%$.
  • Native Americans and Alaska Natives have infant mortality rates $60\%$ higher than Caucasian counterparts.
  • Hispanic children are about $30\%$ more likely to be obese than Caucasians, contributing to chronic diseases.
  • Consequences include elevated rates of heart disease, cancer, and homicide-related deaths among minority groups.
• Conceptual takeaway: Addressing disparities requires attention to social determinants, access, literacy, and culturally tailored interventions.

Page 8: Insurance, Race/Ethnicity, and Perceptions of Fairness in Healthcare

• Nonelderly uninsured by race/ethnicity (2006) – conceptual breakdown:
  • Total uninsured: $46.5\text{ million}$.
  • National risk of being uninsured: $18\%$.
  • By race/ethnicity (illustrative values from the chart):
  • White (non-Latino): uninsured around $13\%$.
  • Latino: uninsured around $33\%$.
  • African American (non-Latino): uninsured around $22\%$.
  • Two or More Races: around $15\%$.
  • Asian/Pacific Islander: around $17\%$.
  • American Indian/Alaska Native: rate shown as a range with notable variability (some values shown near $1\%-36\%$ depending on subgroup/data, reflecting high variance in uninsured status).
• Medically disenfranchised patients' perspectives:
  • 49% of the general U.S. population believes patients are treated fairly.
  • > 52% of medically disenfranchised patients believe the healthcare system is rigged against them.
  • Within affected subgroups, belief in fairness is lower: $27\%$ Black Americans, $34\%$ LGBTQ Americans, $27\%$ Latinx Americans, $23\%$ of those with low socioeconomic status.
  • About half of medically disenfranchised patients have interrupted care due to fear of not being understood.
• Takeaway: Systemic mistrust is higher among marginalized groups; there is a gap between perceived fairness and actual patient experiences. Implication for practice: prioritize culturally competent communication, patient advocacy, and transparent billing processes.

Page 9: Spiritual, Dietary, Language, and Cultural Considerations in Care

• Faith preferences:
  • Can you pray with your patients? Nursing interventions focus on identification, restoration, and reconnection of clients and families to spiritual strength (as per the cited reference).
• Dietary and cultural practices:
  • Dietary accommodations: Jewish/Kosher, Muslim/Halal, Seventh-day Adventist (SDA) restrictions (e.g., no caffeine, no pork, no clams).
• Communication and language access:
  • Official interpreter services must be provided; reliance on informal translators (e.g., Spanish-speaking RNs) is common but not a substitute for formal translation services.
  • Language support may extend to other languages (Greek, Punjabi, etc.).
• Cultural preferences in care:
  • Preferences such as Muslim women preferring female providers; large family presence; family involvement in care decisions; family may care for the patient; consider death rituals (family wailing, etc.).
• Practical implication: Health equity requires accommodating faith-based needs, dietary laws, language access, and culturally nuanced