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LAW AND ETHICS

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

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  1. LAW AND ETHICS • FEBRUARY 3, 2009

  2. LAW • Law is the basic framework of society and is the context for application of ethics

  3. 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

  4. ETHICS IN MEDICINE Respect for persons Autonomy Truth Confidentiality Fidelity - honest dealings Beneficence – charity & kindness Nonmalfeasance – first do no harm Justice – allocation of resources

  5. 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

  6. 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

  7. FRAUD & ABUSE • Medicare and Medicaid • Too few or too many services • Improperly coding services • Bribes and kickbacks • Self-referral

  8. 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

  9. FUTILE TREATMENT • Terminal illness • Antibiotics for colds • Vanity surgery

  10. END OF LIFE PROBLEM • Do everything possible • Let someone die • Help someone die • Euthanasia

  11. 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

  12. 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

  13. 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

  14. 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

  15. INFORMED CONSENT • More than simple consent • Most states have statutes • This is about not loosing a lawsuit

  16. WHAT INFORMATION • Community Standard – reasonable provider • Reasonable Person Standard • Reasonable Patient – honest and complete answers to all questions

  17. RESEARCH • Why we worry • Nuremberg Trials • Tuskegee Study • Institutional review boards • What does voluntary mean • Double blind studies

  18. VALID CONTRACT • Offer & Acceptance • Consideration (value on both sides) • Legal capacity to contract • Objective and Terms are lawful

  19. BREACH OF CONTRACT • Rescission – go back to before the contract • Specific Performance • Damages • No specific performance for personal services contracts

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