Medicine and Ethics – COP MLE 114 (Comprehensive Notes)

Introduction

• Importance for healthcare professionals to understand medical laws and ethics
  • Protects patients, public, and themselves from legal liability
  • Ensures safe, ethical delivery of care

Core Learning Objectives

• Differentiate criminal vs. civil law
• Identify and explain the Four Ds of Negligence
• Define abandonment and describe how to avoid it

Major Classifications of Law

• Criminal Law – protects the public from harmful acts
  • Misdemeanor: punishable by fines or ≤1 year in jail (e.g.
  • traffic violations
  • disturbing the peace
  • petty theft)
  • Felony: serious crime; imprisonment in state/federal prison or death penalty (e.g.
  • murder
  • rape
  • robbery)
  • Practicing medicine without a license = felony
  • Avoidance: obtain/maintain valid license & stay within scope
  • Conviction can lead to imprisonment, fines, loss of licensure, loss of employment, permanent record
• Civil Law – governs relationships between individuals & government
  • Primary branches for health care: Tort, Contract, Administrative
• International Law – addresses disputes between nations
• Military Law – governs armed forces personnel

Civil Law Sub-Categories

1. Tort Law

• A tort = wrongful act causing harm to another
• In medicine: must be actual injury/damage to patient
• Two main types:
  • Intentional Torts
  • Assault (threat of harm)
  • Battery (unauthorized touching)
  • False imprisonment (unlawful restraint)
  • Defamation of character (slander & libel)
  • Fraud
  • Invasion of privacy
  • Unintentional Torts
  • Negligence: failure to exercise standard of care

Four Ds of Negligence

1. Duty – established physician-patient relationship
2. Dereliction (neglect) of duty – deviation from standard
3. Direct Cause – breach caused patient’s injury
4. Damages – quantifiable injuries/losses suffered by patient

Examples (Critical-Thinking Scenarios)

• Assault: staff threatens to slap a yelling patient
• Battery: hospital circumcises newborn against mother’s wishes (\$1\,000,000 lawsuit)
• False Imprisonment: 12-y/o involuntarily held; later found to have viral encephalitis
• Defamation: calling patient “malingerer” in referral letter
• Invasion of Privacy: posting identifiable patient photo online
• Negligence: wrong-site surgery—amputating right arm instead of injured left arm

2. Contract Law

• Enforceable agreements between ≥2 parties
• Forms: Implied or Expressed
• Four elements: Offer, Acceptance, Consideration, Competence
• Breach of contract = failure to meet terms
• Terminating physician-patient contract requires:
  • Written notice (certified, return receipt)
  • 30 days for patient to secure new provider
  • Copy retained in patient file
  • Failure → claim of abandonment

3. Administrative Law

• Regulations issued by governmental agencies (e.g. CMS, OSHA, FDA)
• Healthcare workers frequently encounter tort & contract disputes under civil law

Abandonment

• Improper unilateral termination of care by physician
• Avoidance:
  • Follow formal termination procedure (see above)
  • Provide emergency coverage until transfer of care

Standards of Care

• Physician Standard: what a “reasonable & prudent” physician would do with available resources; must avoid undue risk
• Medical Assistant (MA) Standard: perform only tasks within training & scope; physicians liable for MA’s actions (Respondeat Superior – “let the master answer”)
  • MAs may NOT
  • Diagnose conditions
  • Interpret ECGs
  • Prescribe medications
  • Violations can lead to malpractice suits, license action against supervising physician, employment loss

Professional Misconduct & Malpractice Classifications

• Malfeasance – performing unlawful/wrongful act
• Misfeasance – lawful act performed improperly
• Nonfeasance – failure to perform required act
• Professional misconduct = unreasonable lack of skill leading to patient harm

Damages in Malpractice Suits (Table 3-2)

• Punitive – punish defendant; high fines (e.g. toxin dumping)
• Nominal – small monetary penalty; symbolic (e.g. weekly apology letters)
• Compensatory – reimburse plaintiff for losses (e.g. medical bills, rehab)

Insurance Coverage

• Claims-made: covers claims filed during policy year
• Occurrence: covers events occurring during policy year, regardless of filing date
• Extended tail coverage available for entire career
• General Liability: covers employees broadly
• Professional Liability: can be purchased by MAs individually

Legal Doctrines

• Res Ipsa Loquitur – “the thing speaks for itself”; negligence so obvious no further proof needed
• Statute of Limitations
  • Sets filing window for lawsuits; varies by state
  • Clock often starts when injury discovered, not when treatment occurred
• Good Samaritan Laws
  • Shield providers from liability during emergency aid if within scope
  • Aim: encourage CPR/first aid
  • Vermont = only state mandating aid

Defamation of Character Review

• Definition: statement harming reputation
• Slander – spoken; Libel – written
• Even true statements may be defamatory if made with malice
• MA must avoid gossip or unverified comments about patients, colleagues, employers

Practice Questions (Key Takeaways)

• Criminal law ≠ civil law
• MAs cannot diagnose/treat
• Torts = wrongful acts causing harm
• Prevention easier than defense of negligence
• Standard of care applies to all patients
• Res Ipsa Loquitur: obvious breach requires no further explanation
• Assault = threat; Battery = actual harm
• 4 Ds of negligence do NOT include defamation

Ethical & Practical Implications

• Adhering to scope & standard maintains patient trust and safety
• Proper documentation & communication reduce liability risk
• Ethical duty aligned with legal obligations: beneficence, non-maleficence, autonomy, justice

Connections to Previous Principles

• Informed consent parallels contract law (offer = procedure, acceptance = patient signature)
• HIPAA intersects with invasion of privacy & defamation concerns
• Risk-management strategies (incident reports, QA programs) derive from malpractice precedent

Numerical & Statistical References

• Standard termination notice: 30-day transition period
• Misdemeanor max imprisonment: 1 year
• Sample lawsuit: \$1\,000,000 battery claim for unauthorized circumcision