Ethics Term

AbuseChildren and Elderly:
– required to report abuse of children and elderly, even if the patients request nothing be said.

– NOT required to report it because the spouse may get beaten more.
Active abuse when the caregiver intentionally doesn’t provide care to the patient like not giving food or meds.
Abuse (Passive Type)when the caregiver unintentionally doesn’t provide care because they are overloaded with work.
Advance Directive Two components:
1. Living will
2. Durable power of attorney
Autonomy the right or capacity to make one’s own rational decisions, using one’s own value system, and act on those decisions, without undue coercion from other people or influences. Thus autonomy requires an adequate degree of freedom of thought and action.
Battery on a Patient an intentional act that leads to harm or offensive contact. when a physician goes in to remove a tumor and sees another one so he removes it without the patient’s permission.
Beneficence One should act in such a way that it produces beneficial results. Usually in health care, beneficence is interpreted as a health care professional’s duty to act in a manner that in their best judgment will benefit the patient.
Capitation when a patient is paid the same amount regardless of what kind of services the patient needs. Think of it as the insurance putting a cap on the amount you can make. It is seen in HMO
Child AbuseContact:
– local law enforcement first before submitting a written report to child protective services or department of children and family services.
Competency vs Capacity Competency= legal definition
Capacity= medical definition
–ability to make decisions on their own
Confidentiality required to maintain patient confidentiality even when it involves third-party payers. So if an insurance company asks for the patient’s file you gotta ask the patient.

Break Confidentiality if:
– they feel a patient will harm their own body, certain infectious diseases, & patients with epilepsy to the DMV.
Consent based on doctors experience– You must state your years of experience.
– You must fully answer every patient’s question regarding consent.
Contributory negligence it is when a patient voluntary neglects to follow advice leading to injury.
Doctor Assisted Suicide Assisted suicide involves helping a person kill him or herself. The main difference between this and euthanasia is that in assisted suicide the patient is in complete control of the process that leads to death because he/she is the person who performs the act of suicide. The other person simply helps (for example, providing the means for carrying out the action).
Double effect Action that has negative and positive consequences may be ethically justified if intention is to achieve positive effect
Due care provide care to the patient.
Emancipated minor – married or military
– living alone or homeless
– parent (16 yo mom)
– financially independent
– High school graduate
Euthanasia intentionally causing the death of a person, the motive being to benefit that person, honor his/her wishes, or protect him/her from further suffering. If the motive is other than the interests of the patient, then it does not qualify as euthanasia (i.e. cost-cutting, triage, etc.).
Active Euthanasia providing or doing something that directly causes the patient’s death. (i.e. giving lethal medication, withdrawing a ventilator when the patient is still paralyzed from medication, delivering carbon monoxide, etc.).
Passive Euthanasia when one has a treatment with a good chance of preventing or delaying a patient’s death and does not use it (i.e. withdrawing or withholding a ventilator in a patient with an underlying condition that makes it difficult or impossible to breathe without assistance, withdrawing or withholding medication necessary to keep the patient’s blood pressure up, not treating pneumonia in a patient with PVS, etc.).
Fidelity (loyalty and/or promise-keeping) – In some cases this term is used to describe a duty to be loyal. In other instances it is used to refer to the duty to keep one’s promises. With managed care contracts and the increase in institutional affiliations, more health care professionals are finding themselves in situations where they have to choose between honoring a contractual obligation or doing what they believe is in the patient’s best interests. They may also find that their obligations to different third parties conflict
Genetic Condition A physician has a duty to warn those who are established to be at a risk for inheriting the genetically susceptible.
Gross negligence Carelessness with intent to cause harm
Hospice Model – focus on quality of life (not life prolongation)
-symptomatic control (i.e. pain, N/V, anxiety, depression)
-interdisciplinary team (medical, nursing, psychosocial, spiritual, bereavement care)
-services provided at home, assisted living, or dedicated facility
-requires a survival prognosis of <6mo
Implied Consent used for when a patient is incapacitated; they pass out. When a patient comes into an urgent care facility it’s implied that they are going to get TX so if they pass out then you should treat them.
Intern regulation work hoursCant work > 80 hrs and 16 hr shifts
Medical ErrorsMC: Miscommunication between providers
Medicare Criteria1. All > 65
2. Medical disability > 2 years
3. CRenalF or ALS
Medicare Part ACovers:
– hospital care, inpatient
– SNF, nursing home
– hospice, home health
Medicare Part BCovers:
– medically needed services and supplies
– outpatient care (doc appt)
Medicare Part CCovers:
– combo of part A and b, C is coverage through PRIVATE insurance companies such as HMO
Medicare Part DCovers:
– drug coverage

– donut hole (max 3,750 covered, then out of pocket before)
Medical Equipment FailureReport to:
1st – FDA
Medical Studentslegal/ethical for students to practice medical procedures on recently deceased patients:
Yes- the attending physician must obtain permission from the family (or patient prior to death) before a student can perform procedures. The training must be a structured training sequence and performed under close supervision.
Minor Contraceptives useTry to convince them to get parental involvement
Minor’s RightsMinors do NOT need parental consent for… and any wishes to not involved parents MUST be followed.
1. Contraception
2. STD testing
3. Substance abuse treatment
4. Pregnancy
Negligence requirement it leads to injury
(Primum Non Nocere)
do no harm

“Above all, do no harm.”

1. A health care professional has a duty to avoid harming his/her patient.

2. A health care professional has a duty to prevent any harm to the patient
Parents refuse child to receive chemo if parents refuse consent for treatment for a non-emergent, but fatal medical condition the physician should obtain a court order
Paternalism Acting like a parent towards another. Paternalism is where person A decides to treat Person B in accordance with what Person A believes to be in Person B’s best interests, regardless of Person B’s wishes. This is done out of beneficent motives for Person B. Person A assumes that he/she knows what is best for person B. Paternalism weighs patient well-being more highly than patient autonomy. Furthermore, it does not recognize the subjectivity of well-being and individual values.

ignores patient’s autonomy
Patient refuses treatment Assess capacity
Psychological AbuseWhen a caretaker verbally insults, insults, or threatens harm
Physicians Error based on what a reasonably prudent physician would exercise the same scenario under similar circumstances.
Physician Impairment -inability to practice due to substance abuse
-must report to the physician health program or state board
-confidential assessment and remediation of potentially impaired colleague.
-required to have a long-term contingency contract involving random drug tests and treatment groups
Physician release pt requested recordswithin 30 days
Public Health Service Act HHS covers public health and medical response (emergency assistance, housing, human service). Allows government to respond to public emergencies
Rape VictimRape → 1st = sexual assault FORENSIC exam → HIV/STI PPX
STD patient refuses to tell partner It is your duty to warn an endangered third party if you try to convince someone that they should report their STD and use protection and they refuse.
Talking about a pt HIPAA violationViolation:
– City

Not a violation:
– state
True-abandonment a breach of contract and negligence and must provide written information so that the patients can have time to find a new provider
Violation of basic rights deprives the basic rights that are protected under state and federal law like the right of privacy to freedom of religion.


Cruzan Vs. Director Missouri Dep of Health Pts have the right to refuse life-sustaining tx
Johnson v. Kokemoor You must divulge the full extent of your experience if patient asks specifically about it.
Otherwise consent is not fully informed
Safer v. Pack established the rule that a physician has a duty to take reasonable steps to warn those known to be at risk of avoidable harm from a genetically transmissible condition
Schloendrff vs. society of NY hospital Informed consent and respondeant superior were established
Tarasoff vs. Regent of University of California Mental health professionals have a duty to protect individuals being threatened by a patient


Informed ConsentElements:
– Diagnosis
– Risks and Benefits
– Alternative Treatments
if both parents (who are divorced) have custody of a child only one parent needs to consent for treatment

Drug Trials

Phase I safety
Phase II involves subjects with disease
Phase III large scale testing
Phase IVpost-release surveillance
Phase V compares data found during the clinical trial with clinical data collected over several years following the release of the drug


Medicare “care for the elderly”- funded by social security taxes and is not need-based. Designed for 65+ year olds, people with certain disabilities, and people with end stage disease
Part A  (Hospital Insurance) covers most medically necessary hospital, skilled nursing facility, home health and hospice care. It is free if you have worked and paid Social Security taxes for at least 40 calendar quarters (10 years); you will pay a monthly premium if you have worked and paid taxes for less time.
Part B (Medical Insurance) covers most medically necessary doctors’ services, preventive care, durable medical equipment, hospital outpatient services, laboratory tests, x-rays, mental health care, and some home health and ambulance services. You pay a monthly premium for this coverage.
Part C part of Medicare policy that allows private health insurance companies to provide Medicare benefits. These Medicare private health plans, such as HMOs and PPOs, are known as Medicare Advantage plans. If you want, you can choose to get your Medicare coverage through a Medicare Advantage plan instead of Original Medicare.
Part D (outpatient Prescription Drug Insurance) is the part of Medicare that provides outpatient prescription drug coverage. Part D is provided only through private insurance companies that have contracts with the government—it is never provided directly by the government (like Original Medicare is).
Medicaid intended for low income coverage; it is also available for personas who are aged, blind, disabled, or certain people in families with dependent children regardless of financial burden.

Latin Medical Phrases

Res ipsa loquitur it is when a physician acts negligently to lead to an accident.
the thing speaks for itself

if a physician prescribes the wrong medication leading to injury or leaves a scalpel inside someone.

often arises in the “scalpel left behind” variety of case. For example, a person goes to a doctor with abdominal pains after having his appendix removed. X-rays show the patient has a metal object the size and shape of a scalpel in his abdomen. It requires no further explanation to show the surgeon who removed the appendix was negligent, as there is no legitimate reason for a doctor to leave a scalpel in a body at the end of an appendectomy.
Respondeat superior or vicarious liability it is when an employer is responsible for the actions of their employees. Both terms essentially mean the same thing.

(Latin: “let the master answer”; plural: respondeant superiores) is a legal doctrine which states that, in many circumstances, an employer is responsible for the actions of employees performed within the course of their employment. This rule is also called the master-servant rule, recognized in both common law and civil law jurisdictions.

In a broader scope, respondeat superior is based upon the concept of vicarious liability.
Volenti non fit injuria Person who knowingly puts himself at risk for danger cannot sue

Medical Regulations

Consolidated Omnibus Budget Reconciliation Act (COBRA) health benefit provisions amend the Employee Retirement Income Security Act, the Internal Revenue Code and the Public Health Service Act to require group health plans to provide a temporary continuation of group health coverage that otherwise might be terminated.
(emergency medical treatment and labor act)
a federal law that requires anyone coming to an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay

1.Any individual who comes and requests must receive a medical screening examination to determine whether an emergency medical condition exists. Examination and treatment cannot be delayed to inquire about methods of payment or insurance coverage. Emergency departments also must post signs that notify patients and visitors of their rights to a medical screening examination and treatment.

2.If an emergency medical condition exists, treatment must be provided until the emergency medical condition is resolved or stabilized. If the hospital does not have the capability to treat the emergency medical condition, an “appropriate” transfer of the patient to another hospital must be done in accordance with the EMTALA provisions.

3.Hospitals with specialized capabilities are obligated to accept transfers from hospitals who lack the capability to treat unstable emergency medial conditions.

A hospital must report to CMS or the state survey agency any time it has reason to believe it may have received an individual who has been transferred in an unstable emergency medical condition from another hospital in violation of EMTALA.

Not Enforced:
– When a patient comes into an ER asking for nonmedical emergency services like a shot or gathering criminal law cases. However, they must comply if they seek a medical screening exam.
if the insurance denies pay and the patient has emergency symptoms then they are required to be screened. If it turns out they have an emergency medical situation then you must treat them until they can be transferred to another facility.

Pt wants to leave:
– EMTALA says that examination should be offered to each ER patient that requests an examination or looks to have emergency medical condition.

But if a patient refuses then you have to make sure the refusal is written in writing and that the patient knows about the benefits of treatment and the risks about not getting treated.
Employee Retirement Income Security Act of 1974 (ERISA) a federal law that sets minimum standards for most voluntarily established pension and health plans in private industry to provide protection for individuals in these plans.
Federal Anti-Kickback statue made with intention to prohibit the practice of paying medical professionals solely to endorse and promote the use of certain medical devices and supplies.
-you must disclose any financial relationship you have with a product (i.e. getting royalties for a new device you helped invent)
Good samaritan law 1) Tx must be rendered in a true emergency
2) tx must be outside the hospital
3) tx must NOT be reimbursed
Newborns’ and Mothers’ Health Protection Act of 1996 (NMHPA) a federal law that affects the length of time a mother and newborn child are covered for a hospital stay in connection with childbirth.

In general, group health plans and health insurance issuers that are subject to NMHPA may NOT restrict benefits for a hospital stay in connection with childbirth to less than 48 hours following a vaginal delivery or 96 hours following a delivery by cesarean section
Patient self-determination act Hospitals/nursing home/home health/hospice/HMOs/health care institutions:
1) ask if have advance directive
2) inform patient of right to accept/refuse tx
3) incorporate advance directive into medical record

individual physicians don’t need to
Patient Safety and Quality Improvement Act of 2005 established a system of patient safety organizations and a national patient safety database. To encourage reporting and broad discussion of adverse events, near misses, and dangerous conditions, it also established privilege and confidentiality protections for Patient Safety Work Product
Stark Law Prohibits physician self-referral, specifically referring Medicare/Medicaid patients to a service that the physician/physician’s family member has a financial relationship with


Physician breach pt confidentiality to parent If pt health is at risk

Prevention Types

Primary Prevention Prevent onset of disease vaccinations, diet/exercise
Second Prevention Prevent progression of disease screening tests, HTN meds
Third Prevention Prevent complications of disease surgery, rehabilitation

Programs / Organizations

Healthcare Integrity and Protection Data Bank (HIPDB) United States Government program that the collects and discloses authorized users negative information on health care practitioners, including malpractice awards, loss of license or exclusion from participation in Medicare or Medicaid.
–primary goals of improving health care quality, protecting the public and reducing health care fraud and abuse
Health Maintenance Organization (HMO) an organization that provides or arranges managed care for health insurance, self-funded health care benefit plans, individuals, and other entities in the United States and acts as a liaison with health care providers (hospitals, doctors, etc.) on a prepaid basis.
JCAHO The Joint Commission (TJC) is a United States-based nonprofit tax-exempt 501(c) organization that accredits more than 20,000 health care organizations and programs in the United States. A majority of state governments recognize Joint Commission accreditation as a condition of licensure and the receipt of Medicaid reimbursement
National Committee for Quality Assurance (NCQA) non-profit organization in the United States that works to improve health care quality through the administration of evidence-based standards, measures, programs, and accreditation. The private, nonprofit organization operates on a formula of measure, analyze, and improve. And it aims to build consensus across the industry by working with policymakers, employers, doctors, and patients, as well as health plans.
Preferred Provider Organization (PPO) are one of the most popular types of plans in the Individual and Family market. PPO plans allow you to visit whatever in-network physician or healthcare provider you wish without first requiring a referral from a primary care physician.

Reportable in US

E.Coli (think food outbreaks)
AIDS (yes, and HIV)
***easily spread and/or dangerous diseases need to be reported


intentional torts
negligence Elements:
“4 D’s”
-Duty owed
-Duty Breached
-Damage to patient
-Direct causation
strict liability