1. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Pearson's Comprehensive Medical Assisting Administrative and Clinical Competencies Second Edition CHAPTERCHAPTER CHAPTER 3 3 Medical Law and Ethics Lesson 2: Patient/Physician Relationship

2. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Lesson Objectives Upon completion of this lesson, students should be able to … Discuss informed consent.

3. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Physician Rights A physician and patient form a contract when there is a service and fee that is paid The patient must confide truthfully in the physician in order to receive proper treatment If the physician does not know all the facts, there could be serious consequences

4. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Critical Thinking Questions 1.Does a physician have to treat every patient that comes into the office? 2.When might the physician choose not to treat a patient?

5. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Physician Rights Physicians have the right to: –Select the patients they wish to treat –State the types of services they will provide –State the hours their offices will be open –Determine where their offices will be located –Expect payment for the treatment given –Take vacations and time off from practices

6. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Patient Rights Patients have the right to: –Approve or give consent for all treatment –Expect the standard of care –Expect confidentiality by the physician and employees –Privacy

7. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Patient Obligations Patients have an obligation to: –Follow instructions given by the physician –Pay the physician for the services –Truthfully give the physician all information required

8. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Informed Consent Involves informing the patient about the possible consequences of both having and not having certain procedures and treatments –The physician must carefully explain that, in some cases, the treatment may even make the patient’s condition worse

9. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan There are exceptions to the Doctrine of Informed Consent that are unique to each state. Doctrine of Informed Consent Explanation of advantages and risks to the treatment Alternatives available to the patient Potential outcomes to the treatment What might occur if there is no treatment The use of understandable language

10. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Common Exceptions to Informed Consent A physician does not have to inform a patient about risks that are commonly known If the physician feels the disclosure of risks may be detrimental to the patient, then he or she is not responsible for disclosing them If the patient requests the physician to not disclose the risks, then the physician is not responsible for failing to do so

11. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Implied Consent When a patient is seen for a routine examination for medical treatment, there is implied consent that the physician will touch the person during the examination –Battery: touching someone without the person’s consent –In a routine examination, there is no crime, since there is implied consent

12. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Implied Consent Also occurs when there is an emergency situation and the patient cannot understand the explanation or sign a consent form –The physician is protected by law when providing emergency care –The physician may not delegate gaining informed consent to another, except in an emergency

13. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan How Protective is an Informed Consent? Anyone can sue anyone if they want However, if…. –the physician has carefully explained the treatment, –the patient acknowledges understanding the explanation and risks involved, and –the patient signs the consent form ….there is some protection. Still, patients sue physicians when the treatment fails

14. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Refusal of Treatment Patients have the right to refuse treatment Reasons for refusing treatment include: –Religion –Personal beliefs –Personal choice

15. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Rights of Minors Minor: Under 18 in most states (though this varies in some states) Minors are unable to give consent for treatment Exceptions –Pregnancy –Request for birth control information –Abortion –Testing and treatment for sexually transmitted diseases –Problems with substance abuse –Need for psychiatric care

16. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Categories of Minors Who Can Give Consent Mature minors: A young person who possesses a maturity to understand the nature and consequences of the treatment in spite of young age Emancipated minors that –live on their own –are married –are self-supporting –are in the armed forces –any combination of the above conditions Rules vary from state to state

17. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan When does a minor have the right to confidentiality? Who is financially responsible? Who is the minor’s legal guardian? For more information on the rights of emancipated minors by state, click here or go to http://www.jlc.org/factsheets/emancipationus Legal Implications to Consider When Treating a Minor

18. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Situation #1 Think About It! Situation #1 A teenager is seeking birth control. She has the right to confidentiality. The girl cannot pay for services. How does your office get payment?

19. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Think About It! Situation #2 A teenager living with her mother needs treatment for an STI. The patient has a right to confidentiality. The parents are divorced and the father has financial responsibility for care and treatment.

20. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Patient Self-Determination Act Documents that provide protection to both the patient and physician

21. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Requirements of Health Care Institutions Provide patients a written summary of their health care decision-making rights Give written policy with respect to recognizing advance directives Ask and document if patients have an advance directive Educate staff and community about advance directives Never discriminate based on whether patients have advance directives

22. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Living Will Allows patients to request that life-sustaining treatments and nutritional support not be used to prolong their life Gives patients the legal right to direct the type of care they wish to receive when death is imminent Protects physicians and hospitals when they follow the patient’s wishes Copy of living will should be kept with the patient’s records

23. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Durable Power of Attorney (DPOA) Allows an agent or representative to act on behalf of the patient Can be for health care only or other legal things Agent may be a spouse, grown child, friend, or an attorney

24. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Durable Power of Attorney (DPOA) Used when a patient becomes mentally incapacitated Document is in effect until the patient cancels it or until the patient is able to make their own decisions again

25. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Critical Thinking Questions 1.What are the potential implications of not having a DPOA? 2.Are there disadvantages to having a DPOA?

26. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Uniform Anatomical Gift Act Allows a person 18 years or older and of sound mind to make a gift of any or all parts of their body for the purposes of organ transplantation or medical research A physician who is not involved in the transplant will determine the time of death No money is allowed to change hands for organ donations Donor carries a card signed by 2 witnesses The family can make this decision in some cases

27. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Uniform Anatomical Gift Act Each day about 19 people die for lack of an organ donation There about 95,000 individuals waiting on the organ donation list For information on organ transplants click here or visit www.organdonor.gov

28. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Critical Thinking Question 1.What are the potential controversies to organ donation?

29. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Questions?