1. Medical Law and Ethics, Third Edition Bonnie F. Fremgen The Physician–Patient and Physician-society relationship Chapter 5

2. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Physician–Patient Relationship Both must agree to form relationship for there to be contract for services Under contract for services, patient can expect doctor to provide medical service for as long as necessary Patient must confide truthfully to physician

3. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Physician’s Legal entitlements (rights) entitled to select patients he or she will see entitled to refuse service to patients entitled to type of service he or she will provide entitled to payment for treatment entitled to withdraw from relationship entitled to vacation and time off

4. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Physician’s Responsibilities Human dignity Honesty Responsibility to society Confidentiality Continued study Freedom of choice Responsibility to improve community

5. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Professional Practice Responsibilities Duties During a Medical Emergency – Cannot ethically or legally turn away patient in an emergency situation – If unable to treat patient, then must call for emergency assistance – Patients cannot be turned away if indigent or uninsured

6. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Duty to Treat Indigent Patients “Dumping crisis” Physician has right to select which patients to treat Physician does not have right to drop or abandon patients once he or she agrees to treat them

7. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Duty Not to Abandon a Patient Once physician agrees to take care of patient, contract may not be terminated improperly Physician may be charged with abandonment if formal notice of withdrawal is not given Physician must allow patient time to seek service of another physician

8. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Duty to Tell the Truth Many believe principles of justice apply when dealing with truth-telling Try to determine the “just” action for patient Just action may be at variance with obligation of confidentiality Confidentiality may be overridden when life or safety of patient is endangered

9. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Confidentiality All information and records about treatment will be kept confidential by physician and staff Medical Patients Rights Act: all patients are entitled to have privacy respected and medical records handled confidentially Privileged communication: confidential information told to a physician or attorney by a patient

10. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Consent Voluntary agreement by patient to allow medically trained person to touch, examine, and perform treatment Two types – Informed consent – Implied consent

11. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Informed or Expressed Consent Patient agrees to course of treatment after being told consequences of having or not having certain procedures and treatments Signature indicates patient understands limits or risks involved as explained by physician

12. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Doctrine of Informed Consent Requires physician to explain in understandable language – Advantages and risks of treatment – Alternative treatments available to patient – Potential outcomes of treatment – What might occur—risk and benefits—if treatment is refused

13. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Implied Consent Patient indicates by behavior that he or she accepts procedure Consent is assumed in medical emergencies when patient cannot respond to give consent

14. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Patient Self-Determination Acts Advanced directive Living will Durable power of attorney Uniform Anatomical Gift Act

15. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Definition of Minors Minor: person under the age of maturity (18 in most states) Loco parentis: person assigned by court to stand in place of parents Mature minor: person in mid to late teens who, for health care purposes, is considered mature enough to comprehend physician recommendations and give informed consent Emancipated minor: person in mid to late teens who legally lives outside parents’ or guardian’s control

16. Medical Law and Ethics, Third Edition Bonnie F. Fremgen ADDITIONAL SLIDES Chapter 5

17. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Duty to Treat Patients with AIDS Unethical to refuse to treat, work with, or provide housing for person who is HIV-positive or has AIDS Physician, by law, must make full report to state about any patient who is HIV-positive or has AIDS

18. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Ethical Considerations When Treating AIDS Patients Persuade patient to inform his or her partner(s) Notify authorities if concerned that patient will not inform others As last resort, notify patient’s partner(s)

19. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Exposure of Health Care Workers to Patient’s Blood A 0.3 percent risk of contracting HIV after blood exposure, according to the CDC HIV testing of patient’s blood allowed in some states

20. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Duty to Properly Identify Patients Identify patient both by stating his or her name and examining any other identification – Arm band – Driver’s license – Use discretion with patient sign-in sheets to protect confidentiality

21. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Patient’s Rights Right to give consent Right to privacy Right to be informed of advantages and potential risks of treatment Right to refuse treatment Right to confidentiality – Privileged communication

22. Medical Law and Ethics, Third Edition Bonnie F. Fremgen The Patient’s Responsibilities Follow physician’s instructions Make follow-up appointments and monitor treatment and medication use if requested by physician Be honest Pay for medical services

23. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Role of Health Care Consumer Do not self-medicate Be honest with physician Assist physician in prevention of medical errors

24. Medical Law and Ethics, Third Edition Bonnie F. Fremgen A living will Figure 5-3

25. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Power of attorney for health care Figure 5-4

26. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Exceptions to Consent Need not inform of commonly known risks Need not inform if disclosure of risks may be detrimental to patient Need not inform if patient asks physician not to disclose risks Not required to restore patients to original health Cannot elicit cure for every patient Cannot guarantee successful results of every treatment

27. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Refusal to Grant Consent Adult patients conscious and mentally capable have right to refuse any medical or surgical treatment Refusal must be honored no matter what patient’s reasoning Failure to respect right of refusal could result in liability for assault and battery

28. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Protection for the Health Care Worker (continued) Use caution if you have an open sore Wear protective apparel (gloves and goggles) when testing blood products