1. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Law and Ethics The Physician-Patient Relationship Chapter 5

2. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Physician–Patient Relationship Both must agree to form relationship for there to be contract for services (implied contract) 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 Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 5.1 An Early Physician (Brian Warling/International Museum of Surgical Science, Chicago, IL)

4. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 5.2 The Physician–Patient Relationship

5. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Physician’s Rights Right to select patients he or she will see Right to refuse service to patients Right to determine type of service he or she will provide Right to be paid for services rendered Right to withdraw from relationship Right to vacation and time off

6. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Physician’s Responsibilities (AMA’s Statement of Principles) Human dignity Honesty Responsibility to society Confidentiality Continued study

7. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Physician’s Responsibilities (continued) Freedom of choice Responsibility to improve community Responsibility to patient is paramount Must support access to medical care for all people

8. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. 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

9. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. 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

10. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. 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

11. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. 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

12. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. 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)

13. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. 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

14. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 5.3 Needlestick Protection

15. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. 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 – Have patient state name

16. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. 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

17. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 5.4 Physician Explaining Laboratory Test Results to a Patient (Dana White/PhotoEdit, Inc.)

18. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Patient’s Rights Right to give informed consent Right to privacy Right to be informed of advantages and potential risks of treatment Right to refuse treatment Right to confidentiality – Privileged communication

19. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Confidentiality All information and records about treatment will be kept confidential by physician and staff unless consent to release is obtained Medical Patients Rights Act: all patients are entitled to have privacy respected and medical records handled confidentially

20. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Confidentiality (continued) Privileged communication: confidential information told to a physician or attorney by a patient HIPAA regulations must be observed (Chapter 10)

21. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Patient Self-Determination Acts Advanced directive Living will (including a “Do Not Resuscitate” order) Durable power of attorney Uniform Anatomical Gift Act

22. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 5.5 Sample Living Will

23. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 5.6 Sample Power of Attorney

24. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 5.6 (continued) Sample Power of Attorney

25. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Definition of Minors Minor: person under the age of maturity (18 in most states) In Loco parentis: person assigned by court to stand in place of parents

26. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Definition of Minors (continued) 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

27. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. 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 Provide informed consent

28. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Consent Voluntary agreement by patient to allow medically trained person to touch, examine, and perform treatment Two types – Informed (expressed) consent – Implied consent

29. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. 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

30. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 5.7 Patient Signs a Consent Form

31. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. 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

32. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Implied Consent Patient indicates by behavior that he or she accepts procedure (i.e., offers arm to have blood sample drawn) Consent is assumed in medical emergencies when patient cannot respond to give consent

33. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. 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

34. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Exceptions to Consent (continued) Not required to restore patients to original health Cannot elicit cure for every patient Cannot guarantee successful results of every treatment

35. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. 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

36. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Role of Health Care Consumer Do not self-medicate Be honest with physician Assist physician in prevention of medical errors