LAW AND ETHICS FEBRUARY 3, 2009

LAW Law is the basic framework of society and is the context for application of ethics

ETHICS Professions have codes of ethics that expect a higher standard of ethical behavior This generally should be to the benefit of patients and/or society – not the professional

ETHICS IN MEDICINE Respect for persons Autonomy Truth Confidentiality Fidelity - honest dealings Beneficence – charity & kindness Nonmalfeasance – first do no harm Justice – allocation of resources

ETHICS vs LAW Where ethics conflict with law, there is a price to pay for taking an ethical stand Is the ethical stand selfless or selfish

FIDUCIARY DUTY The professional must put the interests of the client before self-interest, and do what is best for the client This does not mean break the law, violate ethics, or work for free

FRAUD & ABUSE Medicare and Medicaid Too few or too many services Improperly coding services Bribes and kickbacks Self-referral

EMTALA Medical screening of everyone who comes to the ER If an emergency exists, treat or stabilize the patient Only transfer where the benefits outweigh the risks and the receiving facility accepts Huge fine for doctor and hospital

FUTILE TREATMENT Terminal illness Antibiotics for colds Vanity surgery

END OF LIFE PROBLEM Do everything possible Let someone die Help someone die Euthanasia

END OF LIFE Advanced medical directives –The patient when still competent Durable power of attorney –A substitute decision-maker Do-not-resuscitate Orders –The physician Custom –The family

CONSENT TO CARE You must have permission from a consenting adult to do anything to them Violating this is battery A patient may refuse consent

SUBSTITUTE CONSENT Not everyone can consent Talk only to those with the ability to consent If no one has the ability to consent, get a judge Parents have limited rights over their children Spouses have no authority over each other

EXCEPTIONS TO CONSENT EMERGENCY EXCEPTION –Preservation of life or limb –Patient is medically or legally incompetent STATUTORY EXCEPTIONS –Public Health Law –Mental Health law COURT ORDERED CARE

INFORMED CONSENT More than simple consent Most states have statutes This is about not loosing a lawsuit

WHAT INFORMATION Community Standard – reasonable provider Reasonable Person Standard Reasonable Patient – honest and complete answers to all questions

RESEARCH Why we worry –Nuremberg Trials –Tuskegee Study Institutional review boards What does voluntary mean Double blind studies

VALID CONTRACT Offer & Acceptance Consideration (value on both sides) Legal capacity to contract Objective and Terms are lawful

BREACH OF CONTRACT Rescission – go back to before the contract Specific Performance Damages No specific performance for personal services contracts