HAS 4400

1. HAS 4400 Session Ten

2. Chapter 11Relationship with the patient • Physician-patient • Hospital-patient

3. Physician-patient • Beginning the relationship • Contract to care for a certain population • Express contract • Implied contract • Nondiscrimination • Ending the relationship • Patient withdrawal • Transfer • Physician withdrawal • Unable to provide care • Abandonment

4. Hospital-Patient • Nondiscrimination statutes • Title VI CRA • ADA • The Rehabilitation Act of 1973 • The age Discrimination Act of 1975 • State Law • Attempts to require discrimination • Patient recruiting • Nonemergency Patients • Common law right to admission • Contractual right to admission • Hill-Burton Community service • Statutory Right to Admission • Reasons for nonadmission

5. The Emergency Medical Treatment and Active Labor Act (EMTALA) • Screening • Stabilization • Transfers • Penalties • Loss of Medicare entitlement • Law Suit

6. Discharge • False imprisonment • Habeas corpus • Discharge of patients needing additional care • Level of care • Disruptive patients • Recommended procedure (review) • Refusal to leave • Temporary releases • Escape

7. HAS 4400 Chapter Twelve Treatment, Authorization and Refusal Dr. Burton

8. Consent • Required Disclosure • Reasonable Physician • Reasonable Patient Batttery Informed Consent

9. Elements of Disclosure • Patient’s Medical Condition • Nature and purpose of the proposed procedure • Consequences and risks • Feasible accepted alternatives, including consequences of no treatment

10. Exceptions to the disclosure requirement • Emergencies • Therapeutic privilege • Patient waiver • Prior patient knowledge • Statutory exceptions

11. Responsibilityfor Obtaining Consent Limited Hospital Role Physician

12. Consent Forms Blanket Battery Detailed Challenges Capacity, Readability, Translation, Voluntariness, Withdrawal of consent

13. Right to Refuse(Bases) • Common Law • Freedom from nonconsensual invasion • Statutory rights • Living Wills, Durable powers of attorney, Hospice laws • Constitutional rights • Liberty interest protected by due process clause • Freedom of religion • Right to privacy

14. Involuntary Treatment • Threats to the Community • Impaired Capacity • Life of Others • Dependents • Criminal Law Enforcement • Civil Law Discovery • Other: • Preservation of Life • Prevention of Irrational Self-destruction • Protection of the Ethical Integrity of Health Care Providers • No Family Veto

15. Limits on Treatment • Inappropriate treatment • Medically unnecessary treatment • “Futile treatment” • Refusal to leave

16. Adults w/Decision Making capacity • Age of majority (18) • Not declared incompetent • Capable of understanding consequences • Limits on Authority to consent • Mayhem • Suicide • Illegal drugs or devices • Inappropriate treatment

17. Incapacitated Adults • W/ prior directive • W/O prior directive • Next of Kin • Guardian • Substituted judgment and best interests

18. Minors • Emergency care • Self-determination • Statutes • Emancipated minors • Mature minors • Limits on decisions (same rationale as adults) • Infants

19. Patient Self-Determination Act (PSDA) • Genesis Louis Kutner coined the term “living will” in 1969 California passed the Natural Death Act in the mid-seventies • PSDA implemented through Medicare/Medicaid Providers • Written info at time of admission. • the person’s rights under law to make health care decisions, including the right to accept or refuse treatment and right to complete state-allowed advanced directives, and • the provider’s written policies concerning implementation of those rights; • document in the patient’s medical record whether or not the person has completed an advance directive; • not discriminate or condition care based on whether or not the person has completed an advance directive; • ensure compliance with state laws concerning advance directives • provide education for staff and the community on issues concerning advance directives.

20. Advance directivesInstructional – living will/terminal care documentProxy – durable power of attorney

21. Assisted Suicide

22. Philosophy Statement Eval Form Student Name: _____________________ Course: ____________________ • Worldview • Guiding principles and values • Application of ethical principles • Ethical Approach to decision making • Focus as a health care professional **Written Expression Clarity Syntax/Grammar Editing