Medical-legal and Medical-legal and Ethical IssuesEthical Issues

Legal duties and ethical responsibilitiesLegal duties and ethical responsibilities

Liability / legal responsibilitiesLiability / legal responsibilities Perform systematic patient Perform systematic patient

assessmentassessment Provide appropriate medical careProvide appropriate medical care Accurate and complete Accurate and complete

documentationdocumentation

Ethics:Ethics:

MoralityMorality

Good and evilGood and evil

Right and wrongRight and wrong

Ethical Standards {not laws}Ethical Standards {not laws} Promptly respond to both the physical Promptly respond to both the physical

and emotional needs of every patientand emotional needs of every patient Treat all patients and their families Treat all patients and their families

with courtesy and respectwith courtesy and respect Maintain mastery of your skills and Maintain mastery of your skills and

base knowledgebase knowledge Continuing ED.Continuing ED.

Be critical of yourself and you Be critical of yourself and you performanceperformance

Always seek to learn and improveAlways seek to learn and improve Report honestly and be respectful of Report honestly and be respectful of

patient confidentiality.patient confidentiality. Be cooperative of co-workers and Be cooperative of co-workers and

colleaguescolleagues

Legal SystemLegal System

Constitutional LawConstitutional Law Based on the constitutionBased on the constitution

Common lawCommon law Case or judge-made lawCase or judge-made law Society’s acceptance of customs Society’s acceptance of customs

and norms over timeand norms over time

Legislative lawLegislative law Statutory lawStatutory law Made by legislative bodiesMade by legislative bodies

Administrative lawAdministrative law Regulatory lawRegulatory law Enacted by an administrative or Enacted by an administrative or

governmental agencygovernmental agency

Administrative agencies such as Administrative agencies such as OSHA produce rules and OSHA produce rules and regulations necessary to regulations necessary to implementimplement

Civil LawCivil Law

Criminal LawCriminal Law

Scope of practiceScope of practice

NegligenceNegligence

Duty to actDuty to act

Breach of dutyBreach of duty Violation of standard of careViolation of standard of care

Malfeasance; misconduct or wrong-doingMalfeasance; misconduct or wrong-doing

Misfeasance; inappropriate action or Misfeasance; inappropriate action or intentionally give incorrect advise intentionally give incorrect advise

From Wikipedia, the From Wikipedia, the free encyclopedia free encyclopedia Res ipsa loquitur “the thing that speaks for itself”Res ipsa loquitur “the thing that speaks for itself” A Latin phrase that literally means, "the thing speaks for itself". In A Latin phrase that literally means, "the thing speaks for itself". In

the the common lawcommon law of of negligencenegligence, the doctrine of , the doctrine of res ipsa loquiturres ipsa loquitur states that the elements of states that the elements of duty of careduty of care and and breachbreach can be can be sometimes inferred from the very nature of the accident, even sometimes inferred from the very nature of the accident, even without direct evidence of how any defendant behaved. Although without direct evidence of how any defendant behaved. Although modern formulations differ by jurisdiction, the common law modern formulations differ by jurisdiction, the common law originally stated that the accident must satisfy the following originally stated that the accident must satisfy the following conditions:conditions:

... a "duty" exists for a person to act "reasonably"; and ... a "duty" exists for a person to act "reasonably"; and ... a "breach" of this duty occurs because a person acted outside this ... a "breach" of this duty occurs because a person acted outside this

duty, or "unreasonably"; and duty, or "unreasonably"; and ... there was "causation in fact"...the result would not have occurred ... there was "causation in fact"...the result would not have occurred

"but for" the "breach" of this duty; and "but for" the "breach" of this duty; and ... there were actual ... there were actual damagesdamages suffered by the plaintiff who did suffered by the plaintiff who did

nothing wrong (i.e., no contributory negligence). nothing wrong (i.e., no contributory negligence). Upon a proof of Upon a proof of res ipsa loquiturres ipsa loquitur, the plaintiff need only establish the , the plaintiff need only establish the

remaining two elements of negligence -- namely, that the plaintiff remaining two elements of negligence -- namely, that the plaintiff suffered damages, of which the accident was the legal cause.suffered damages, of which the accident was the legal cause.

http://www.lectlaw.com/http://www.lectlaw.com/def/d003.htmdef/d003.htm

Actual damagesActual damages When damages, which have been When damages, which have been

suffered by someone as a result of suffered by someone as a result of another's wrongdoing, can be precisely another's wrongdoing, can be precisely measured, they are called actual measured, they are called actual damages. Examples of actual damages damages. Examples of actual damages are: are:

Loss of income because of an injury * Loss of income because of an injury * medical expenses * costs of repairing medical expenses * costs of repairing damaged property, and * specific damaged property, and * specific business losses occurring because of a business losses occurring because of a breach of a contract. breach of a contract.

http://legal-http://legal-dictionary.thefreedictionary.codictionary.thefreedictionary.com/proximate+causem/proximate+causeProximate causeProximate cause An act from which an injury results as a natural, direct, uninterrupted An act from which an injury results as a natural, direct, uninterrupted

consequence and without which the injury would not have occurred.consequence and without which the injury would not have occurred. Proximate cause is the primary cause of an injury. It is not necessarily the Proximate cause is the primary cause of an injury. It is not necessarily the

closest cause in time or space nor the first event that sets in motion a closest cause in time or space nor the first event that sets in motion a sequence of events leading to an injury. Proximate cause produces particular, sequence of events leading to an injury. Proximate cause produces particular, foreseeable consequences without the intervention of any independent or foreseeable consequences without the intervention of any independent or unforeseeable cause. It is also known as legal cause.unforeseeable cause. It is also known as legal cause.

To help determine the proximate cause of an injury in Negligence or other To help determine the proximate cause of an injury in Negligence or other tort cases, courts have devised the "but for" or "sine qua non" rule, which tort cases, courts have devised the "but for" or "sine qua non" rule, which considers whether the injury would not have occurred but for the defendant's considers whether the injury would not have occurred but for the defendant's negligent act. A finding that an injury would not have occurred but for a negligent act. A finding that an injury would not have occurred but for a defendant's act establishes that the particular act or omission is the defendant's act establishes that the particular act or omission is the proximate cause of the harm, but it does not necessarily establish liability proximate cause of the harm, but it does not necessarily establish liability since a variety of other factors can come into play in tort actions.since a variety of other factors can come into play in tort actions.

Some jurisdictions apply the "substantial factor" formula to determine Some jurisdictions apply the "substantial factor" formula to determine proximate cause. This rule considers whether the defendant's conduct was a proximate cause. This rule considers whether the defendant's conduct was a substantial factor in producing the harm. If the act was a substantial factor in substantial factor in producing the harm. If the act was a substantial factor in bringing about the damage, then the defendant will be held liable unless she bringing about the damage, then the defendant will be held liable unless she can raise a sufficient defense to rebut the claims.can raise a sufficient defense to rebut the claims.

Defenses to charges of negligenceDefenses to charges of negligence Good Samaritan lawsGood Samaritan laws Governmental ImmunitiesGovernmental Immunities Statue of LimitationsStatue of Limitations Contributory or Comparative Contributory or Comparative

negligencenegligence

http://www.the-injury-http://www.the-injury-lawyer-directory.com/lawyer-directory.com/negligence.htmlnegligence.htmlContributory NegligenceContributory Negligence

Historically, contributory negligence was a Historically, contributory negligence was a common law defense available in tort actions.  common law defense available in tort actions.  In the past, if two people were in an accident, In the past, if two people were in an accident, the injured person could only recover for his/her the injured person could only recover for his/her injuries and damages if they did not contribute injuries and damages if they did not contribute to the accident in any way.  This approach was to the accident in any way.  This approach was based on a policy originally established in based on a policy originally established in England that stated a person who negligently England that stated a person who negligently causes harm to another cannot be held liable if causes harm to another cannot be held liable if that injured individual contributed to his own that injured individual contributed to his own suffering and injury, even if it was only a very suffering and injury, even if it was only a very slight factor. slight factor.

http://www.the-injury-http://www.the-injury-lawyer-directory.com/lawyer-directory.com/negligence.htmlnegligence.htmlComparative NegligenceComparative Negligence

In a In a comparative negligence comparative negligence system, the system, the injured party may still recover some of his or injured party may still recover some of his or her damages even if he or she was partially her damages even if he or she was partially to blame for causing the accident.  Plaintiff’s to blame for causing the accident.  Plaintiff’s financial recovery may be reduced, or even financial recovery may be reduced, or even prohibited, depending how plaintiff’s actions prohibited, depending how plaintiff’s actions caused or contributed to the accident.  In caused or contributed to the accident.  In states using a comparative negligence states using a comparative negligence system, a jury or judge determines the system, a jury or judge determines the proportion of fault to be assigned to each proportion of fault to be assigned to each responsible party. responsible party.

Special liability concernsSpecial liability concerns Liability of medical directionLiability of medical directionBorrowed servant doctrineBorrowed servant doctrine Malpractice A principle under which Malpractice A principle under which

the party usually liable for a person's the party usually liable for a person's actions–eg, a hospital responsible for a actions–eg, a hospital responsible for a nurse, is absolved of that responsibility nurse, is absolved of that responsibility when that person is asked to do when that person is asked to do something–eg, by a surgeon, which is something–eg, by a surgeon, which is outside of the bounds of hospital outside of the bounds of hospital policy. policy.

Violation of a patient’s civil rightsViolation of a patient’s civil rightsCivil Rights:Civil Rights:The rights belonging to an individual by The rights belonging to an individual by

virtue of citizenship, especially the virtue of citizenship, especially the fundamental freedoms and privileges fundamental freedoms and privileges guaranteed by the 13th and 14th guaranteed by the 13th and 14th Amendments to the U.S. Constitution and Amendments to the U.S. Constitution and by subsequent acts of Congress, including by subsequent acts of Congress, including civil liberties, due process, equal civil liberties, due process, equal protection of the laws, and freedom from protection of the laws, and freedom from discrimination. discrimination.

Off DutyOff Duty

ConfidentialityConfidentialityConsentConsent InformedInformed ExpressedExpressed ImpliedImplied Minor Minor Refusal of ServiceRefusal of ServiceDNRDNRReporting requirementsReporting requirementsDocumentation Documentation