Unit 3 (Autonomy & Consent)
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concept that patients are to be treated as individuals and informed about procedures to facilitate appropriate decisions:
For true autonomy to occur ______________ has to take place.
the informed consent process
consent signed upon entrance into the hospital:
two forms of a patient's agreement for a specific treatment (consent):
- informed "express" consent - detailed information
- implied - emergency situations and when pt behavior suggests compliance
protects professionals legally when administering health care in good faith:
Good Samaritan Law
what type of consent is necessary for a procedure that is considered experimental or which involves substantial risk?
- informed/express consent
- ex. myelogram, HSG, arteriogram, arthrogram, x-ray during pregnancy, etc.
who can sign informed consent for minors?
only parents or legal guardians
though informed consent must be signed by the parent/guardian, at what age does the text suggest that the minor should be included in the decision?
when it comes to informed consent, who may perform the procedure?
only the physician named in the consent form
when can informed consent permission be revoked by the patient?
at any time.
document established by the American Hospital Association which is to be given to hospitalized patients to help them understand the expectations, rights, and responsibilities regarding their health care:
the patient care partnership
the patient care partnership replaced what document and when?
- the patient's bill of rights
- published in 1973, revised in 1992, replaced in 2003.
name another document that describes the rights that consumers can expect, besides the patient care partnership:
U.S. Government Bill of Rights under the Affordable Care Act
List four rules for information delivery:
- 1. patient preference rule
- 2. professional custom rule
- 3. prudent person rule
- 4. subjective substantial disclosure rule
a rule that requires health care professionals to tell patients what
they want to know:
patient preference rule
a rule saying that the health care professional should give the patient the information normally given to patients in similar situations:
professional custom rule
a rule that measures the physician's disclosure to the patient based on the patient's need for information to make decisions regarding treatment:
- prudent person rule
- also called the reasonable patient standard
a rule that encourages the physician to disseminate all information important to the individual:
subjective substantial disclosure rule
the first formal legislation recognizing the basic human right of
all patients to refuse treatment:
Omnibus Budget Reconciliation Act (1990)
list, in a brief summary, the six requirements of the Patient Self-Determination Act:
- 1. give written information
- 2. document advance directive
- 3. implement policies of the advance directive
- 4. comply with state laws
- 5. eliminate discrimination against treatment decisions
- 6. provide public ethical/legal education about advance directives
imaging professionals are responsible for verifying the ___________ of informed consent.
though imaging professionals should be able to answer questions about the procedure, they should direct questions on the following topics to the physician:
- alternative therapies
- failure rate
- if they feel the questions are out of their field of expertise
maintenance of autonomy requires health care providers to respect all individuals, even:
those who are not currently capable of free choice
the ability to make choices and is a necessary element in informed consent:
entails the ability to make appropriate choices and consider their consequences:
questions regarding methods for determining competence and adequately informing patients who are incompetent often lead to:
a consideration of surrogacy
name some common obstacles to autonomy and informed consent:
- pressure due to concerns of health, future
- the intimidating environment of the department
- pressure from concerned family members or physicians
- repetition of information
name some common barriers to autonomy and informed consent:
- lack of communication
- nursing homes
- mental health facilities
give brief summaries of the seven points to maintaining autonomy:
- 1. mentally capable/legally competent?
- 2. any preferences expressed?
- 3. understanding of benefits/risks and given consent?
- 4. surrogate using appropriate standards of decision-making?
- 5. advanced directives?
- 6. if uncooperative, is there a specific reason?
- 7. are pt's rights being respected as much as ethically/legally possible?
what are the two exceptions to obtaining informed consent?
- emergency situation
- theraputic privilege
what are the three conditions that determine if a situation can be considered an "emergency" situation that can bypass informed consent?
- the patient must be incapable of giving consent and no lawful surrogate is available
- danger to life or risk of a serious impairment to health is apparent
- immediate treatment is necessary to avert these dangers
a prerogative invoked when a health care provider withholds information from a patient because they believe the information would have adverse effects on the patient's condition or health:
a written or oral statement by which a competent person makes known his or her treatment preferences and/or designates a surrogate decision maker in the event he or she should become unable to make medical decisions on his or her own behalf:
name the court decision that formed the basis for the concept of consent, when it took place, and what it established:
- Schloendorff v Society of N.Y. Hospitals
- established that violation of consent constitutes assault and battery
a general consent required of a patient for any procedure, in which knowledge of the procedure is not required:
filed to recover damages for personal injury or property damage occurring from negligent conduct or intentional misconduct:
name the two categories of torts:
name the most common "intentional torts" to occur in the imaging department:
- false imprisonment
- invasion of privacy
- defamation (libel/slander)
the best tool to decrease the risk of allegations of intentional torts:
communication with patients to ensure their understanding
give the requirements for a tort to be considered to be "intentional":
intentional interference with one's person, reputation, or property
a deliberate act wherein one person threatens to harm another person; threat of touching in an injurious way:
unlawful touching of a person without consent, even if touching may benefit patient:
unlawful or unjustifiable confinement of a person within a
when are hand or leg restraints used?
only when the patient's physician orders them
when confidentiality has not been maintained or when the patient’s body has been improperly and unnecessarily exposed or touched:
invasion of privacy
the malicious spreading of information that causes damage to one's character or loss of reputation:
concerning defamation, _________ is written information and __________ is verbal communication.
an intentional tort that can occur in home health when entering a patients home:
an intentional tort often caused by intentional misconduct and may be added to any of the other charges:
intentional infliction of emotional distress
list four legal criteria for the use of restraints:
- touching or restraint to which the patient has not consented is needed to protect the patient, health care team members, or the property of others.
- the restraint used is the least intrusive method possible.
- regular reassessment of the need to restrain occurs.
- the restraint is discontinued as soon as practicable.
list three things that should be communicated to parents before restraining a child:
- explain the necessity of immobilization to decrease exposure and get a quality exam.
- reassure that the immobilization equipment used is the least intrusive.
- guarantee that immobilization will be used only when necessary and discontinued as soon as possible
results from actions that were not intended to cause harm:
name the most commonly encountered unintentional tort in imaging:
medical malpractice/professional negligence
torts relating to speech:
quasi-intentional (quasi = resembling)
give some examples of quasi-intentional torts:
- defamation (libel/slander)
- invasion of privacy
- breach of confidentiality
an unintentional tort involving the omission of REASONABLE
CARE or caution:
The standard of REASONABLE CARE is based on:
the doctrine of the reasonably prudent person
requires that a person perform as any reasonable person would perform under similar circumstances:
the doctrine of the reasonably prudent person
failure to provide the appropriate standard of care:
professional negligence or malpractice
negligent acts that involve “reckless disregard for life or limb”:
an act of negligence in which the behavior of the injured party contributed to the injury:
applies when the hospital as an entity is negligent:
list four conditions to establishing malpractice:
- the defendant had a duty to provide care
- there was some loss or injury to the patient
- the defendant is the party responsible for the loss
- the loss is attributable to negligence or improper practice
legal doctrine of “the thing speaks for itself” where negligence and loss are so apparent that they would be obvious to anyone:
res ipsa loquitur
legal doctrine of “let the master respond” where the employer is liable for employees negligent acts:
legal doctrine where a physician may be liable for wrongful acts committed by hospital employees under the physician’s orders:
legal doctrine of borrowed servant
a rule where each person is liable for his or her own negligent conduct, and where the law does not allow the wrongdoer to escape responsibility even though someone else may be legally liable as well:
rule of personal responsibility
all 50 states have now recognized a legal duty for physicians to obtain informed consent and the information should include:
- alternative treatment options
- expected outcomes
give two standards of care are applied throughout the states:
- professional standard
- lay standard
to prove lack of informed consent:
- proof that a material risk existed that was unknown to the patient
- the risk was not disclosed
- disclosure of the risk would have led a reasonable patient to reject the medical procedure or choose a different course of treatment
- the patient was injured as a result of the lack of disclosure
failure to obtain consent may result in allegations of torts such as:
- false imprisonment
virtually all jurisdictions impose the duty of informed consent only on ___________; however, some have tried to impose the duty on the _____________.
American Academy of Pediatrics (AAP) recognizes two concepts:
- parental permission
- patient assent
list items that should always be included on a consent form:
- name of the procedure
- explanation of the procedure (benefits & risks)
- space for patient's name
- space for tech's name
- signature line for patient or surrogate, the person explaining the procedure and obtaining consent, and at least one witness
- date & time
- completion of the form within 24 hours of the procedure
what is the tech's duty in a situation in which a 13-year-old is pregnant, wants an abortion, and wants this information concealed from her mother?
the tech cannot say anything to the mother without the patient's consent.
a conformance with fact or reality:
the obligation to tell the truth and not to lie or deceive others:
a falsehood told to another who has a reasonable expectation of the truth:
name three components of a reasonable expectation of the truth:
- place of communication
- roles of the communicators
- nature of the truth involved
knowledge a person has a right or obligation to conceal:
a confidence or secret that will result in harm if it is revealed:
name the three types of obligatory secrets:
- natural - a secret that by its nature would be harmful if revealed
- promised - a secret that the receiver has promised to conceal
- professional - a secret maintained to protect the patient, society, and profession
name some exceptions to patient confidentiality:
- communicable diseases
- automobile accidents
- birth defects
- industrial accidents
- family’s need to know
- public’s need to know
- third-party payers
reporting varies according to
two factors, which are:
- policy of the facility
- state law
paraphrase the three goals of HIPAA:
- to protect and enhance consumer rights
- to improve quality of health care by restoring trust in the health care system
- to improve the efficiency and effectiveness of health care delivery
be familiar with the disclosures allowed without permission from the patient:
- to the patient
- to other health care providers for treatment purposes
- for payment of services
- for health care operations, including quality assurance information
- for appointment reminders, treatment alternatives and health-related benefits
- in the facility directory
- for clergy
- for individuals involved in payment of care
- for approved research projects
- required by law
- to other entities for billing purposes
- organ and tissue donors
- public health risks
be familiar with patient rights protected by HIPAA:
- the right to inspect and copy records
- the right to ask for information to be amended if believed to be inaccurate
- the right to ask what disclosures have been made
- the right to request restriction of information disclosure
- the right to request the method of communication
- the right to a paper copy of the privacy notice of the institution
who do we report to when there is a HIPAA violation?
- HIPAA does not provide a right to sue but instead provides a requirement to file a written complaint with the Secretary of Health and Human Services (HHS) through the Office of Civil
in patient authorization according to HIPAA, give three examples of presumed consent:
- treating providers
- transfer from one provider to another
- emergency treatment
when are a patient's rights to confidentiality waived, according to HIPAA?
when the patient puts their mental or physical state at issue in a lawsuit.
who governs implied consent by the patient’s agreement to treatment?
- in-house use of medical information (quality assurance committees)
- Joint Commission on Accreditation of Healthcare Organizations (JCAHO) inspections
- state institutional licensure reviewers
release of patient information to outside reviewers is governed by:
state laws as well as HIPAA which supersedes state law.
who are the most common outside requesters of medical information?
third party payers
HIPPA and state public laws require the reporting of various medical conditions such as:
- venereal disease
- contagious diseases such as tuberculosis
- wounds inflicted by violence
- industrial accidents
- drug abuse
- abuse of children, elderly people, and people with disabilities
the duty to warn third parties in cases of risk of violence or contagious disease is based on:
statute and the duty established through case law to warn identifiable third parties threatened by patients
what two states do not accept the legal duty to warn third parties regarding psychiatric dangerousness?
the rate of HIV infection through heterosexual genital contact is:
about .001 per exposure
name three common arguments in favor of disclosure of AIDS and HIV:
- longer-term partners may not yet have been infected.
- the transmission of the disease to unborn children.
- AIDS is incurable and therefore prevention is essential.
name the three steps of the AMA's position on third-party protection when it comes to AIDS and HIV patients:
- (1) attempt to persuade the infected individual to cease endangering the third party
- (2) If persuasion fails, notify authorities and
- (3) If authorities take no action, notify and counsel the endangered third party
which principle of the MSRT code of ethics requires technologists to work with HIV positive patients?
- principle 3:
- “The Radiologic Technologist delivers patient care and service unrestricted by concerns of personal attributes or the nature of the disease or illness, and without discrimination, regardless of sex, race, creed, religion, or socioeconomic status.”
name the exceptions to HIPAAs mandate about a specific patient's right of access to their own records:
- psychotherapy notes
- information compiled in anticipation of lawsuits
- other specific statutory exceptions
- records created in connection with correctional facilities
- criminal proceedings
- research questions
the duty of confidentiality applies to which forms of communication?
- oral communication
- written communication
- computer communication
- reproduction of records
- employee conduct
list some guidelines for the reproduction and faxing of patient information:
- make sure sender info is correct
- the receiving fax is in secure location.
- a patient release of information form allows faxing of the information.
- a cover sheet contains a confidentiality disclosure, including notice that the information is not to be disclosed to another party and, if received in error, should be destroyed and the sender notified.
the uttering or publishing of an unprivileged false statement that hurts another’s reputation:
defamation that is oral, where is at least negligence on the part of the publisher, and where harm must have resulted:
false statements that concern criminal activity, a loathsome disease, business, trade, or professional misdeeds or unchastity, and where no injury has to be proven:
slander per se
defamation that is written:
defamation that is written in which no harm has to be proven:
libel per se
much of the info in the power points was quite general or common sense, so i suggest you read the chapter and/or go over power point along with these cards. good luck!!
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