Agenda – Seminar 2

Medical Law and Ethics, Third EditionBonnie F. Fremgen

Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.

Agenda – Seminar 2

• Email: Please add me to your “allowed sender” list so that you do not miss important messages. [email protected]

• Discussion Board Assignments– Crafting a response to discussion questions

• Unit 2 Quiz this week! Complete a study guide where you define all terms in bold from the assigned reading.

• “Option 1” Discussion Questions• Overview of Chapter 3 & 4 Material




Discussion Board Questions• Question: Using the Three-Step Ethics Model (pages

15-16) from your text, evaluate the ethical dilemma associated with the refusal of a blood transfusion. (Jehovah’s Witnesses exception)




Crafting a Discussion Board Initial Response

• Think about the question: Brainstorm

• Come up with a list of points/ideas that are most relevant to the question

• Elaborate on each of those points in a separate paragraph.

• Write a short introduction and a conclusion paragraph.

• Make a “roadmap” in your introductory paragraph.




Example: A “Thought Question”• Question: Do you think different health care disciplines with differing Codes of

Ethics can work together seamlessly? Why or why not? • Think: what are the potential problems of using different sets of ethics in the same

area of professional practice? Are there any similarities between ethical codes? What types of problems could potentially arise?

• After thinking for a while, discussing with a friend, or googling search terms such as “healthcare ethical code disputes” or “medical nursing ethics code problems,” come up with a list.

• You decide that overall, different healthcare disciplines can work together seamlessly. Your brainstorm list states the following reasons:

– Few potential problems could arise, because the disciplines are very compartmentalized in practice and there is very little interaction between the disciplines.

– The ethical codes used across the healthcare profession are very similar.– The only opportunity for problems to arise are when the ethical codes are immensely

different. Come up with an example.

• Your first paragraph should look like the previous bullet point (your roadmap).




Review of Unit 1 Seminar

•Ethics: Branch of philosophy related to morals, moral principles, and moral judgment

•Medical Law: Addresses legal rights and obligations that affect patients and protect individual rights, including rights of health care employees. Provides yardstick to measure or judge actions. Punishes unlawful actions

•Bioethics: Moral dilemmas and issues resulting from advanced medicine and medical research relating to life




Medical Law and Ethics

Importance of the Legal System for the Physician

Chapter 3




Medical Practice Acts

•Establish examining boards

•Provide baseline for practice of medicine

•Determine prerequisites for licensure

•Forbid practice of medicine without a license

•Specify conditions for renewal, suspension, and revocation of licenses

•Vary from state to state




Licensure of Physician

•Examination– National Board Medical Examination (NBME)– Federal Licensing Examination (FLEX)– U.S. Medical Licensing Examination (USMLE)

•Endorsement•Reciprocity •Registration




When Valid License Is Not Needed by a Physician

•When employed by federal medical facilities (but must be a licensed physician)

• In an emergency

•While establishing residency

•When engaged solely in research




Revocation and Suspension

•Unprofessional conduct: falsifying records, gross immorality

•Commission of a crime: Medicare/Medicaid fraud, rape, murder, larceny, narcotics conviction

•Personal incapacity: physical or mental incapacity




Licensure and Certification of Allied Health Professionals

•Licensure: graduate from accredited school and pass national exam of competency

•Certification: meet standards set by accreditation body and pass national exam of competency




Accreditation•Voluntary request of official review by

accrediting agency•Examine policy and procedures of agency•Must demonstrate that the institution maintains

high standards•Examples: JCAHO (The Joint Commission on

the Accreditation of Healthcare Organizations) and CAAHEP (The Commission on Accreditation of Allied Health Education Programs)




Standard of Care

•Ordinary skill and care that must be used by medical practitioners

•Must provide same knowledge, care, and skill that similarly trained physician would provide under same circumstances

•Perform as “reasonable and prudent” person would perform




Prudent Person Rule

•Must provide following information to patient:– Diagnosis– Risk and consequences of treatment– Expected benefits of treatment or procedure– Alternative treatments– Prognosis if no treatment– Cost and expected pain– Follow acceptable standard of care




Confidentiality

•Keeping private all information about patient

•No disclosure without written consent

•Medical Patient Rights Act: gives all patients right to have privacy respected and records held confidential




Statute of Limitations

•Period of time patient has to file lawsuit

•Usually one to three years

•Discovery Rule: begins when problem discovered




Good Samaritan Laws

•State laws help protect health care professionals and ordinary citizens from liability while giving care in emergency

•No one is required to provide aid•Only required to act within limits of acquired

skill and training •Once you start you must continue until help

arrives or you physically cannot continue




Respondeat Superior

• “Let the master answer”

•Employer liable for acts of employee within scope of employment




Employee’s Duty to Carry Out Orders

•Duty to interpret and carry out orders

•Duty to clarify ambiguous or erroneous orders

•Duty to decline orders that appear dangerous for patient and to notify physician




Scope of Practice

•Must understand and work within scope of practice for discipline

•Must understand and practice within guidelines of profession

•Must understand and follow chain of command so no employee makes decision he or she is unqualified to make




Employer’s Duty to Employees

•Responsibility to provide safe environment for employees and staff

•Most have liability insurance to cover accidents and unforeseen incidents

•May bond employees who handle money

•Some have liability insurance for auto if used for work-related business




Risk Management

•A practice used to control or minimize incidence of problem behavior that might result in injury to patients and employees and liability for physician/employer– Identify risk behaviors and practices– Develop and follow plan of action to eliminate

problem behavior– Address corrective actions in policy and procedure

books and employee handbooks




Medical Law and Ethics

Medical Practice and Allied Health Professionals

Chapter 4




Today’s Health Care Environment

• Major changes in past 15–20 years– Increased life expectancy = more older adults– Technological discoveries

• Preventative care and patient education stressed (but not funded)

• Government legislation

• Fixed-payment plans—medical care for a fixed monthly fee

• Third-party payers




Managed Care Organization (MCO)

•Gatekeeper

•Health Maintenance Organization (HMO)

•Preferred Provider Organization (PPO)

•Exclusive Provider Organization (EPO)




Federal Assistance Programs

•Medicare– Health care coverage for elderly or seriously

disabled or with end stage renal disease or other debilitating ailments regardless of wealth or income

– Rationing of health care




Medicaid

•Medicaid: A joint Federal–State program

•Federal program implemented by individual states

•Financial assistance to insure poor and indigent

•Rationing takes place

•Not all providers accept Medicaid coverage




Diagnostic Related Groups (DRGs)

•Classifies Medicare patient by illness

• 467 illness categories

•Hospitals receive preset sum for treatment of category regardless of “bed days” used

•Discourages treatment of severely ill patients; patients often are discharged before ready




Ethical Considerationsof Managed Care

•Wealthy may have greater access to care and treatment than poor patients

•Must provide minimum standard of care to everyone

•Patients must be fully informed of consequences of obtaining health care elsewhere

•Bait-and-switch•Profit more important than patient




Types of Medical Practice

•Solo practice

•Sole proprietorship

•Partnership

•Associate practice

•Group practice

•Professional corporation




Ethics of Fee Splitting

•Fee splitting: one physician offers to pay another for referral (unethical and illegal)

•Fee splitting vs. referrals•Franchise: business run by individual to whom

franchisor grants exclusive right to market product or service in certain market area (ethical)

•Franchisees: persons or companies that hold a franchise




Medical Specialty Boards

•Over 23 specialty boards

•Seek to improve quality of medical care

•Encourage physicians to further education and training

•Evaluate candidates who apply and pass exam

•Board-certify those who pass




•American College of Surgeons– Fellow of American College of Surgeons (FACS)

•American College of Physicians – Fellow of American College of Physicians (FACP)

Medical Specialty Boards (continued)




Allied Health Professionals

• Licensed personnel– Registered nurse– Nurse practitioner– Licensed practical nurse– Pharmacist

•Certified personnel– Physician assistant– Medical assistant– Medical transcriptionist– Lab technician– Lab technologist




Conscience Clause

•Enacted by several states

•Employees may have a moral or religious objection to assisting with certain procedures (sterilization, abortion)

•Employee cannot be discriminated against under the state’s statute




Discussion• What does it mean to be a health care professional? • Why is it important for a healthcare professional to include his/her

medical specialty and initials indicating their degree after their name?

• How should health care professionals conduct themselves? • Besides these general standards, what standards might specific

careers or professions require? Why? • What personal qualities do you think would be successful in

various health professions? • How can differing personal attributes contribute to a strong

professional team? • Give an example of how various health professionals work

together as a team to provide quality patient care.

Documents

Agenda – Seminar 2