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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

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law and ethics
LAW AND ETHICS
  • FEBRUARY 3, 2009
slide2
LAW
  • Law is the basic framework of society and is the context for application of ethics
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
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
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
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
FRAUD & ABUSE
  • Medicare and Medicaid
  • Too few or too many services
  • Improperly coding services
  • Bribes and kickbacks
  • Self-referral
emtala
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
FUTILE TREATMENT
  • Terminal illness
  • Antibiotics for colds
  • Vanity surgery
end of life problem
END OF LIFE PROBLEM
  • Do everything possible
  • Let someone die
  • Help someone die
  • Euthanasia
end of life
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
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
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
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
INFORMED CONSENT
  • More than simple consent
  • Most states have statutes
  • This is about not loosing a lawsuit
what information
WHAT INFORMATION
  • Community Standard – reasonable provider
  • Reasonable Person Standard
  • Reasonable Patient – honest and complete answers to all questions
research
RESEARCH
  • Why we worry
    • Nuremberg Trials
    • Tuskegee Study
  • Institutional review boards
  • What does voluntary mean
  • Double blind studies
valid contract
VALID CONTRACT
  • Offer & Acceptance
  • Consideration (value on both sides)
  • Legal capacity to contract
  • Objective and Terms are lawful
breach of contract
BREACH OF CONTRACT
  • Rescission – go back to before the contract
  • Specific Performance
  • Damages
  • No specific performance for personal services contracts