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applied ethics

the practical application of moral standards to the conduct of individuals involved in organizations that are meant to benefit the patient, such as medical ethics

bioethics

a branch of applied ethics, is a field resulting from modern medical advances and research

litigious

an excessive inclination to sue

laws

rules or actions prescribed by an authority such as the federal government and the court system that have a binding legal force

medical practice acts

laws established in all 50 states that define the practice of medicine as well as requirements and methods for licensure in a particular state

precedent

the decision of the court case acts as a model for any future cases in which the facts are the same

ethics

branch of philosophy related to morals, moral principles, and moral judgments

morality

the quality of being virtuous or practicing the right conduct

amoral

lacking or indifferent to moral standards

medical ethics

concerns questions related specifically to the practice of medicine

utilitarianism

an ethical theory based on the principle of what is the greatest good for the greatest number of people

cost/benefit analysis

justifies the means of achieving a goal

indigent

a person who is impoverished and without funds

rights-based ethics

a natural rights ethical theory, places the primary emphasis on a person's individual rights

duty-based ethics

based on absolute moral rules; focuses on performing one's duty to various people and institutions such as parents, employers, employees, and customers (patients)

justice-based ethics

based on an important moral restraint called "the veil of ignorance"; fair distribution of benefits and burdens

virtue-based ethics

based on the belief that we have a duty or responsibility to others; an emphasis on persons and not necessarily on the decisions or principles that are involved

fidelity

loyalty and faithfulness to others

sanctity of life

the sacredness of human life

tolerance

a respect for those whose opinions, practices, race, religion, and nationality differ from our own

integrity

the unwavering adherence to one's principles

empathy

the ability to understand the feelings of others without actually experiencing their pain or distress

sympathy

feeling sorry for or pitying someone else

compassion

the ability to have a gentle, caring attitude toward patients and fellow employees

due process

the entitlement of employees of the government and public companies to have certain procedures followed when they believe their rights are in jeopardy; the Fourteenth and Fifth Amendments provide for due process

sexual harassment or gender harassment

unwelcome sexual advances or requests for sexual favors as defined in the Equal Employment Opportunity Commission guidelines, which are part of the Title VII of the Amended Civil Rights Act of 1964

comparable worth

known as pay equity, is a theory that extends equal pay requirements to all persons who are doing equal work

principle of autonomy

the principle that people have the right to make decisions about their own life; includes the concept of "informed consent", whereas consent is granted by a person after the patient has received knowledge and understanding of potential risks and benefits

principle of beneficence

the principle of doing good

principle of nonmalfeasance

means "First, do no harm."

principle of justice

warns us that equals must be treated equally

bioethicists

specialists in the field of bioethics, give thought to ethical concerns that often examine the more abstract dimensions of ethical issues and dilemmas

quality assurance (QA)

gathering and evaluating information about the services provided, as well as the results achieved, and comparing this information with an accepted standard

medical etiquette

standards of professional behavior that physicians practice in their relationship and conduct with patients and other physicians

Federalism

1 Large Government- Federal Government
Many smaller local governments

Executive Branch

President and his cabinet
Has Veto power
Enforcing Laws

Judicial Branch

Judges- Supreme Court (Justices)
Interpret Laws
Constitutionality

Legislative Branch

Congress- Senate- House of Representatives
Make Laws
Amend Laws
2/3 majority vote can override a veto

Burden of Proof

Plaintiff has BOP in Civil cases
State/Prosecutor has BOP in Criminal cases
BOP is proving propondence of evidence in civil
beyond a reasonable doubt in criminal

Statutory Law

(Statutes) Laws written by the legislative branch

Regulatory Law

(Regulations) Laws written by agencies

Examples of intentional torts

Assault, Battery, False Imprisonment

Battery

Actual unconsented physical contact

Assault

Threat of bodily harm, placing someone in apprehension of imminent harm

Class Action Lawsuit

A lawsuit filed by one or more people on behalf of a larger group of people who are all affected by the same situation

Constitutional Law

Set up our system of government
Bill Of Rights- Freedoms- Prevents governments from interferring with our individual rights

Defamation Of Character

Harm to a person's reputation
False statements about a person

Embezzlement

Taking money of or property that has been entrusted to you

Expressed Contract

An agreement that clearly states all the terms

Fraud

Decieving another person, usually for personal gain

Implied Contract

Understood through actions

Lible

Written/printed defamation

Subpoena

A written command from the court for a person to appear in court

"Stare Decisis"

"Let the decision stand"

Slander

Spoken defamation

Intentional Tort

When a person has been intentionally or deliberately injured by another

Unintentional Tort

Negligence- Medical Malpractice
Duty of care- Fail to exercise reasonable care that results in harm

Tort

Civil injury or wrongful act that results in harm

False Imprisonment

Confining someone against their will

Invasion Of Privacy

Unauthorized publication of private information

Contract

Agreement between two or more people

Subpoena "Duces Tecum"

A court order requiring a witness to appear in court and to bring certain records/documents

Regulations

Rules or laws made by agencies

Statutes

Laws enacted by state and federal legislatures

Plaintiff

A person on group of people suing another person or group; the person who instigates the lawsuit

Defendant

Person or group of people sued civilly or prosecuted criminally in a court of law

Criminal Laws

Set up to protect the public from the handful acts of others

Case Law

Also known as Common Law
Based on decisions made by judges

Contract Law

Division of law that includes enforceable promises and agreements between two or more persons to do or not to do a particular thing

Common Law

Also known as Case Law
Based on decisions made by judges

Civil Law

Relationships between individuals or between individuals and the government, which are not criminal

Administrative Law

Branch of law that covers regulations set by government agencies

Breach Of Contract

The failure, without legal excuse, to perform any promise or to carry out any of the terms of an agreement; failure to perform a contractual duty

Breach

Neglect of an understanding between two parties; failing to perform a legal duty

Beyond A Reasonable Doubt

Evidence that is almost an absolute certainty that a person did commit a crime
99.9%

Checks And Balances

Separation between the three branches

Preponderance Of Evidence

Evidence showing that more likely than not the incident occured

Accreditation

p. 60

a voluntary process in which an agency is requested to officially review healthcare institutions, such as hospitals, nursing homes, and educational institutions, to determine compliance.

Bonding

p. 67

a special type of insurance that covers employees who handle financial statements, records, and cash.

Confidentiality

p. 62

refers to keeping private all information about a person (patient) and not disclosing it to a third party without the patient's written consent.

Discovery

p. 63

rule legal theory that provides that the statute of limitations begins to run at the time the injury is discovered or when the patient should have known of the injury.

Endorsement

p. 59

an approval or sanction.A state may grant a license by endorsement to applicants who have successfully passed the NBME exam.

Good Samaritan laws

p. 64

state laws that help protect healthcare professionals from liability while giving emergency care to accident victims.

Guardian ad litem

p. 63

court-appointed guardian to represent a minor or unborn child in litigation.

Incident report

p. 68

a means of documenting problem areas within a hospital or other medical facility.

Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

p. 60

an agency that oversees accreditation standards for:
• all types of hospitals (medical, psychiatric, long-term care, etc.)
• managed care oranizations (like HMOs)
• VNAs (visiting nurse associations)
• clinical laboratores

Prudent person rule

p. 62

also called the responsible person standard, means the healthcare professional must provide the information that a prudent, reasonable person would want before making a decision about treatment or refusal of treatment.
This would include:
• the diagnosis
• the risks and potential consequences of treatment
• the expected benefits of the treatment or procedure
• potential alternative treatments
• prognosis if no treatment is received
• that an acceptable standard of care is followed
• the costs, including the amount of expected pain

Reciprocity

p. 59

the cooperation of one state in granting a license to practice medicine to a physician already licensed in another state. Reciprocity can be applied to other licensed professionals, such as nurses and pharmacists.

Respondeat superior

p. 64

Latin phrase meaning "let the master answer" means the employer is responsible for the actions of the employee.

Revoke

p. 60

take away, as in revoke a license.

Risk management

p. 67

a practice to minimize the incidence of problem behavior that might result in injury to the patient and liability for the organization.

Scope of practice

p. 66

the activities a healthcare professional is allowed to perform as indicated in their license, certification, and/or training.

Standard of care

p. 61

the ordinary skill and care that medical practitioners use and that is commonly used by other medical practitioners in the same locality when caring for patients; what another medical professional would consider appropriate care in similar circumstances.

Statute of limitations

p. 63

the period of time that a patient has to file a lawsuit; typically 1 to 3 years. The time period begins when the problem is discovered or should have been discovered.

Tolling

p. 63

also known as running of the statute of limitations, means the time has expired.

List the four basic characteristics of state medical practice acts.

p. 57

• Establish the baseline for the practice of medicine in that state.
• Determine the prerequisites for licensure.
• Forbid the practice of medicine without a license.
• Specify the conditions for license renewal, suspension, and revocation.

Describe the three methods by which a state grants a license to practice medicine.

p. 58-59

• Examination—Each state offers its own examination for licensure.
• Endorsement—This is an approval or sanction granting a license by endorsement
to applicants who have successfully passed the National Board of Medical
Examination.
• Reciprocity—A license to practice medicine may be granted by a state that
accepts a medical license granted by another state.

Discuss conduct that may result in a physician's loss of license to practice medicine.

p. 60

Conduct that could result in the loss of a physician's license includes Medicare/
Medicaid fraud, rape, murder, larceny, narcotics conviction, and the inappropriate
use of drugs and alcohol.

Identify the difference between licensure and certification.

A license is granted by a state or federal entity. This provides the legal right
for a professional, such as a physician, to practice.
Certification is granted by a certification board and means that a person has
met the special requirements, such as additional education and training,
of the certifying board.

Discuss what the term standard of care means for a physician and what it means for someone in your profession (or your planned profession).

Standard of care, as it relates to the physician, is the ordinary skill and care that medical practitioners use and that is commonly used by other medical practitioners in the same locality when caring for patients. It is the care that another professional would find appropriate in similar circumstances.

Describe the importance of the discovery rule as it relates to the statute of limitations.

The discovery rule is the legal theory that provides that the statute of limitations
begins to run at the time the injury is discovered or when the patient should
have known of the injury.

Discuss the importance of the phrase respondeat superior as it relates to the physician.

This translates to "let the master answer." It means that the employer (physician)
is responsible for the actions of the employee.

Medi Tips
Chapter 3

p. 57 - Every state has a board set up to handle issues relating to physician registration.

p. 60 - If a physician continues to practice medicine without renewal of his or her license, under the law it is considered practicing medicine without a license.

p. 61 - The term "reasonable" is a broad, flexible word to make sure the decision is based on the facts of a particular situation rather than on abstract legal principles. It can mean fair, rational, or moderate. Reasonable care has been defined as "that degree of care a person of ordinary prudence would exercise in similar circumstances".

p. 63 - Do not discuss anything relating to a patient within earshot of others.

p. 63 - The statute of limitations is a state law that varies by state.

p. 64 - The Good Samaritan laws do not protect physicians or their employees from liability while practicing their profession in their work environment. The laws are meant to encourage medical professionals to assist with emergencies outside of the work setting. Always check the coverage of the Good Samaritan Law in your own state.

p. 65 - Even though the doctrine of respondeat superior mainly refers to the employer, in all states both the physician and the employee may be liable.

p. 66 - Healthcare workers have a duty to be assertive and question those orders that they believe are erroneous or appear to be harmful to the patient. They also have a duty to refuse to carry out orders that violate their own practice acts.

p. 67 - All employees must understand that there are limits to their authority when it comes to healthcare decisions. The ultimate decision always rests with the physician, provided it does not violate their professional practice.

p. 68 - Everyone in a healthcare institution - not just the risk manager - is responsible for risk management.

Medical Practice Acts

p. 57

Statues that govern the practice of medicine in that state. They establish:
• requirements for licensure
• duties of the licensed physician
• grounds on which the license may be revoked
• reports that must be made to the government
• define penalties for practicing without a license

Federal Licensing Examination
(FLEX)

p. 58

The official U.S. medical licensing exam.

National Board of Medical Examiners
(NBME)

p. 58

...

U.S. Medical Licensing Examination
(USMLSE)

p. 58

...

Registration

p. 59

Periodic (annual or biannual) renewal of a medical license. Requirements include:
• fee
• continuing medical education, measured in CME units (typically 75 hours in a 3 year period). This can be done through workshops, courses, seminars, self-instruction modules, teaching, reading approved medical literature.

Commission on Accreditation of Allied Health Education Programs
(CAAHEP)

p. 61

provides accreditation for programs such as medical assisting, emergency medical technicians (EMTs), physician assistants, and respiratory therapists, among others.

Employee's Duty to Carry Out Orders

p. 66

Healthcare workers have a duty to be assertive and question those orders that they believe are erroneous or appear to be harmful to the patient. They also have a duty to refuse to carry out orders that violate their own practice acts.

Employer's Duty to Employees

p. 67

...

Incident Report

p. 68

...

Medical Patient Rights Act

p. 62

Law passed by Congress that says all patients have the right to have their personal privacy respected and their medical records handled with confidentiality.
• no information can be shared without the patient's consent
• no information can be given over the phone without consent
• no records an be given to another person or physician without the patient's written permission (unless subpoenaed).
• information should be shared only on a need-to-know basis

Medical Licensure Exams


p. 58

NBME - National Board of Medical Examiners
FLEX - Federal Licensing Examination
USMLE - U.S. Medical Licensing Examination

Exceptions to State Medical License Requirement

p. 59

• physician employed by a federal medical facility (must be licensed but not necessarily by the state they are practicing in)
• a out-of-state physician providing emergency care
• physician waiting to qualify for residency
• research physician who does not practice patient-based medicine
• military physicians at military hospitals

Licensure

A license is granted by a state or federal entity. This provides the legal right for a professional, such as a physician, to practice.

Certification

Certification is granted by a certification board and means that a person has met the special requirements, such as additional education and training,of the certifying board.

administer a drug

To introduce a drug into the body of a client

appellant

One who appeals a court decision to a higher court

arraignment

The procedure of calling someone before a court to answer a charge

civil case

Court action between private parties, corporations, government bodies, or other organizations. Compensation is usually monetary. Recovery of private rights is sought.

closing arguments

Summary and last statements made by opposing attorneys at a hearing or trial

Controlled Substances Act

Federal law regulating the administration, dispensing, and prescription of particular substances that are categorized in five schedules.

court of appeals

Court that reviews decisions made by a lower court; may reverse, remand, modify, or affirm lower court decision.

court order

An order issued only by a judge to appear or to request certain records. The release of any records requested in a court order does not require the client's permission.

criminal case

Court action brought by the state against individual(s) or groups of people accused of committing a crime; punishment usually imprisonment or a fine; recovery of rights of society.

cross-examination

Examination of a witness by an opposing attorney at a hearing or trial.

defendant

The person or group accused in a court action.

deposition

A written record of oral testimony made before a public officer for use in a lawsuit.

direct examination

Examination of a witness by the attorney calling the witness at a hearing or trial.

dispense a drug

To deliver controlled substances in a bottle, box, or some other container to the client. Under the Controlled Substances Act, the definition also includes the administering of controlled substances.

examination of witness

Questioning of a witness by attorneys during a court action.

expert witness (medical)

Person trained in medicine who can testify in a court of law as to what the professional standard of care is in the same or similar communities.

felony

A serious crime such as murder, larceny, assault, or rape. The punishment is usually severe.

higher (superior) court

The court to which appeals of trial court decisions can be made; a court with broader judicial authority than a lower or inferior court.

judge

A public official who directs court proceedings, instructs the jury on the law governing the case, and pronounces sentence.

jury

Six to 12 individuals, usually randomly selected, who are administered an oath and serve in court proceedings to reach a fair verdict on the basis of the evidence presented.

law

Rule or regulation that is advisable or obligatory to observe.

litigation

A lawsuit; a contest in court.

lower (inferior) court

Usually the court in which a case is first presented to the trial court; a court with limited judicial authority.

misdemeanor

Type of crime less serious than a felony.

opening statements

Statements made by opposing attorneys at the beginning of a court action to outline what they hope to establish in the trial.

plaintiff

The person or group initiating the action in litigation.

prescribe a drug

To issue a drug order for a client.

probate (estate) court

State court that handles wills and settles estates.

sentencing

Imposition of punishment in a criminal proceeding.

small claims court

Special court intended to simplify and expedite the handling of small claims or debts.

subpoena

An order to appear in court under penalty for failure to do so.

subpoena duces tecum

A court order requiring a witness to appear and bring certain records or tangible items to a trial or deposition.

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