Top 10 Ethics Traps
United States law considers the relationship fiduciary; i.e., physicians are expected Thus, providing health care, and being a doctor, is a moral enterprise . . patient will change plans and doctors if continuity costs more than $ per year. .. Angell M. Cost containment and the physician. JAMA. ; –7. The court ruled that an inadvertent lawyer-client relationship had been created, and thus .. The legal ethics class they took 10 or 20 years ago in law school?. Records and Disclosure of Information. the two years following the termination of the therapeutic relationship, is unethical. .. CHANGES IN LAWS AND ETHICS: Supervisors and supervisees are aware of and stay abreast of changes.
- 'Til Death Do Us Part: Does a Client Ever Stop Being a Client?
- Medical ethics
- Top 10 Ethics Traps
It is an offense to imply falsely that one is registered, but it is not an offense otherwise to engage in healing. Osteopaths, chiropractors, and acupuncturists may practice in the private sector.
The inclusive and integrated systems The inclusive and integrated systems are represented by countries such as India and China. In India the individual states regulate the practice of the health professions. A Medical Council maintains the Indian Medical Register, and any person on this register may practice anywhere in India.
There are also state medical registers for the individual states, and people in these registers are also in the Indian Medical Register.
Those who have obtained a degree from a university, usually M. Qualifications from many foreign countries are also recognized for entry to the registers.
China provides an example of an integrated system in which traditional Chinese doctors and Western-trained physicians often practice side by side. The country has also developed a system in which certain persons receive a short, intensive training course and then provide primary health care in areas otherwise not served by health care workers.
Legal restrictions on practice Determination of death The law generally supports customary medical practice and provides the medical profession with a great deal of autonomy.
A dramatic example is the determination of death and the issuance of a death certificate. In almost every country of the world, a physician declares a person dead and issues a death certificate after a determination of death is made in accordance with accepted medical standards. However, some confusion persists as to whether physicians should continue to be given the authority to declare a person dead if the medical profession were to adopt whole brain death as an acceptable definition of death instead of the past definition of irreversible cessation of respiration and heartbeat.
A mechanical ventilator can artificially maintain the respiration and circulation of a person whose functions would cease without such mechanical support. In the late s the potentials of organ transplantation from such persons were becoming realized, and the seeming futility of devoting limited medical resources to maintaining circulation under such circumstances was of growing concern. Physicians began proposing that irreversible cessation of brain activity be used as an alternative definition of death.
The law, in short, has continued to defer to medical practice in the definition of death itself, and it is likely to continue to do so as long as physicians base their determination of death on either permanent cessation of respiration and circulation or permanent cessation of all functions of the brain.
Termination of pregnancy Pregnancy termination remains a contentious medical procedure, even though it is a procedure about which women in many countries have been granted a constitutional right to decide. Physicians have broad legal authority and discretion in other controversial areas as well. In countries such as the United States, where the law permits termination of pregnancy prior to fetal viability, or thereafter, if the life or health of the pregnant woman is at stake, it is for the physician, and not the state, to determine whether or not an individual fetus is viable i.
When the Supreme Court declared that the decision to terminate a pregnancy was protected by the U. Constitution, the court emphasized that the decision should be made by a woman and her physician.
The law may restrict procedures like termination of pregnancy, sterilization, and even birth control to mature minors and adults; but it is generally left to the physician to determine if a patient is mature or competent to consent. In the U. In a 5—4 opinion, the Supreme Court permitted Congress to entirely outlaw this procedure on the basis that Congress could determine that its use undercut medical ethics and that other less-offensive procedures were available to safeguard the life and health of pregnant women seeking abortions.
Sudden death Unexpected deaths must be reported to public authorities so that a determination can be made as to whether the death was a homicide, a suicide, or an accident. It is up to an investigator, whether he or she is called a medical examiner or coroner or has some other title, to make a preliminary finding and then to refer the case to the police or prosecuting authorities if criminal activity is suspected. In most Western countries, this person has either legal training or medical training or both.
In the United States, some jurisdictions use an elected coroner who may or may not have medical training ; however, the trend is toward a medical examiner system in which a physician is appointed to the post. Coroners in London are qualified both in medicine and in law. The principal evidence received by the coroner is the report of the autopsy carried out on the body of the deceased.
Public reporting Physicians may also be expected to report certain patients or occurrences to public authorities. For example, some communicable diseases are required to be reported to public health officials. Suspected child abuse and gunshot wounds may have to be reported to an authority such as the child welfare authority or the police.
Public reporting tends to put the physician in the position of being an agent of the state rather than of his patient, making mandatory reporting an uncomfortable duty.
Principles of medical law and ethics – Knowledge for medical students and physicians
It is not surprising, therefore, that the incidence of public reporting is generally much lower by private physicians than it is in hospital emergency departments. In extreme cases, physicians may also have a duty to protect specific individuals who may be at serious or mortal risk from their patients. In the United States, for example, lawsuits against physicians for negligent injury are not considered unusual.
Malpracticeor professional negligence, is the failure of a health care provider for example, a physician, dentist, nurse, or pharmacist to exercise the ordinary care and skill a reasonably prudent, qualified person would exercise under the same or similar circumstances. The practitioner does not guarantee the outcome but must use diligence and ordinary skill in the treatment of a patient. A valid malpractice claim must have four elements: The plaintiff must prove each of these elements by a preponderance of evidence more likely than not to be true.
The practitioner must be shown to have a relationship to the patient which establishes a duty to exercise ordinary caremust have breached that duty as measured by the applicable standard of careand through the breach must have caused the patient physical and monetary damages.
The central concern for physicians is usually to establish the standard of care through expert testimony, which may simply be the testimony of another qualified physician. Such testimony is necessary because the standard of medical practice is not something a lay jury is familiar with.
Expert witnesses may themselves rely on the standards that have been set down by one or more medical speciality organizations such as the American College of Obstetricians and Gynecologists. These medical speciality organizations provide certification to physicians who have fulfilled postgraduate training and practice requirements in the speciality.
Medical specialty organizations maintain the standards necessary to practice in the specialities and provide reasonable assurance to patients that these standards will be upheld.
Nonconformance with such standards by a specialist is evidence of negligence, although it is not conclusively negligence the practitioner may have a valid excuse for not following custom, such as an emergency situation or lack of equipment.
Disciplinary action by public licensing authorities, however, is unusual. Implied consent The consent is not written, when a patient submits to health care agencies for medical examination or treatment. Patient attending the OPD of the hospital for consultation and treatment does not require written consent unless some complicated procedures are performed. Informed consent It may be oral or written, mostly written for future references.
The legal age for giving consent in India is 12 years.
'Til Death Do Us Part: Does a Client Ever Stop Being a Client? - hidden-facts.info
In sterilization, all consents should be taken from the partner also. Medicolegal cases brought by police. There are legal frameworks for treating someone who refuses treatment: The common law and the statutory law. It is generally injury to persons, usually arising out of an accident. Performing an operation without medical indication, leaving a forceps or gauze inside the abdomen during surgery come under this. A physician alone or in conjunction with others cannot make advertisements.
A medical practitioner can make a formal announcement in press regarding starting of practice, change of type of practice, changing address, temporary absence from duties, and resumption of practice Printing of self-photograph in letterhead or sign board Running an open medical shop Rebates and commission Practice of euthanasia.
Principles of medical law and ethics
For example, what if the former therapist and patient got married, were in a committed relationship, and had children? Would or should an ethics committee have the authority to interfere with a marriage or union among consenting adults?
What about our belief in the right to free association? What is the rationale for the prohibition against sex with patients? Many believe it is the power differential. Behnke points out that many relationships have significant power differentials, including partnerships and marriages, and that we often do in fact put our own interests above those of clients when we charge fees, for example. So, neither a power differential nor putting our own needs first is in and of itself unethical.
Rather, Behnke says, it is because we have a fiduciary relationship that is compromised and creates additional risks that are not a necessary part of the therapeutic relationship, making psychotherapy impossible. But fiduciary relationships are not static and change with time and circumstances.
Some would argue it is based on psychodynamic theory, and perhaps those who practice psychoanalytically have a higher standard. But interestingly, there is nothing in psychodynamic theory or psychoanalysis that would state such.
This would include taking patients on vacation and conducting analysis in hotel room beds. We tend to forget that that was a different time with different standards. Therefore, perhaps, our reactions could possibly be a way of denying and reacting against the behaviors of a previous era we find frankly embarrassing and indefensible. Another possibility is that, whereas all of us require structure of some kind, some of us need more structure and clear inflexible rules more than others.
Some fear that if they bend the rules just a little, they may go down a slippery slope and cross all reasonable bounds. To therapists who believe they are just one rigid rule away from harming their patients, I say maintain all the rules you need. However, not everyone requires such inflexibility. Attempting to impose such rigidity on everyone is not good practice. It is not good for our clients or the field. If we hold that belief to be literally true, then it would not apply only to sex.
We are responsible to protect our clients from harm to self and others. But if we make no distinction between current and long past, can we in this litigious society be sued for the actions of a long past client? Our clients grow mature and often leave us behind.