Medical Law, Ethics, and Bioethics for Ambulatory Care
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1 Medical Law, Ethics, and Bioethics for Ambulatory Care Fourth Edition MARCIA (MARTI) A. LEWIS, EdD, RN, CMA-AC Associate Dean, Mathematics, Science and Health Occupations Instructor, Medical Assisting Olympic College Bremerton, Washington CAROL D. TAMPARO, PhD, CMA-A Dean, Business and Allied Health Lake Washington Technical College Kirkland, Washington F. A. DAVIS COMPANY Philadelphia
2 III Contents Vignettes 1 Chapter I Medical Law, Ethics, and Bioethics 9 Law 10 Ethics 10 Bioethics 10 Ethical Issues in Modern Medicine 11 Comparing Law, Ethics, and Bioethics 12 The Importance of Medical Law, Ethics, and Bioethics 13 Codes of Ethics 14 An Ethics Check 16 Characteristics of a Professional Ambulatory Health Care Employee 17 Chapter 2 Medical Practice Management 21 Solé Proprietors 23 Partnerships 25 Professionals Service Corporations 26 Group Practices 28 Health Maintenance Organizations 33 Other Business Arrangements 34 A Word of Caution 36 General Liability 37 Employers' Responsibilities to Employees 39 Summary 39 Chapter 3 The Employees in Ambulatory Health Care 41 Licensed Personnel (Nurses) 43 ix
3 X Medical Law, Ethicand Bioethics for Ambulatory Care Nonlicensed Personnel 45 Other Employees 47 Considerations for Ambulatory Health Care Employees 48 Summary 49 Chapter 4 Legal Guidelines for Ambulatory Care 51 Sources of Law 53 Types of Law 54 Controlled Substances Act and Regulations 59 Drug Schedules 62 Issuing Prescriptions 62 Types of Court 63 Subpoenas 66 TheTrial Process 67 ExpertWitness 68 Summary 69 Chapter 5 Regulations and Professional Liability for the Health Care Professional 71 Medical Practice Acts 72 Professional Liability 74 Standard of Care 75 Confidentiality 75 Physician Liability for Client Injury 76 Contracts 77 Torts 79 Doctrine of Respondeat Superior 83 Statute of Limitations 84 Professional Liability or Malpractice Insurance 84 Alternatives to Litigation 87 Malpractice Prevention 87 Summary 88 Chapter 6 Public Duties 91 Births and Deaths 93 Communicable and Notifiable Diseases 97 Reportable Injuries 101 Eider Abuse 102
4 Contents xi Child Abuse 103 Evidence 104 Drug Abuse 105 Good Samaritan Laws 106 Chapter 7 Consent 109 Definition I 10 Informed and Uninformed Consent 111 The Doctrine of Informed Consent 111 Problems in Consent I 12 Implementing Consent 115 Chapter 8 Medical Records 121 Purposes 122 Problem-Oriented Medical Records 123 SOAP 123 Use of Records in Litigation 125 Computerired Medical Records 129 Fax Machines 129 Ownership of Medical Records 130 Retention of Medical Records 131 Storage of Medical Records 131 Micrographics 132 Chapter 9 Collection Practices 135 Truth in LendingAct 136 Collection Guidelines 137 Collection Do's 137 Collection Dont's 139 Collection Problems 139 Collection Agencies 140 Collections and Attitudes 141 Chapter 10 Employment Practices 143 Personnel Policies 144 Job Descriptions 144
5 X Medical Law, Ethic, and Bioethics for Ambulatory Care Benefits and Salaries 145 The Employment Process 145 Legal Implications 152 Summary 156 Chapter I I A Cultural Perspective for Ambulatory Health Care 159 Components of Cultural Diversity 160 Establishing a New Culture in Ambulatory Health Care 162 Summary 164 Chapter I 2 Allocation of Scarce Medical Resources 167 Macroallocation and Microallocation 169 The Influence of Politics, Economics, and Ethics on Health Care 170 Systems for Decisión Making 171 HowWouldYou Decide? 172 Chapter I 3 Genetic Engineering 175 Genetic Screening.Testing, and Counseling 177 Sterilization 180 Human Genome Project and GeneTherapy 181 Assisted Conception 182 Artificial Insemination 183 Legal and Ethical Implications of AIH and AID 184 InVitro Fertilization.GIFT.ZIFT.and ICSI 186 Legal and Ethical Implications of Assisted Conception 187 Surrogate Mothers 188 Legal and Ethical Implications of Surrogacy 189 Considerations for Ambulatory Care Employees 190 Chapter I 4 Abortion 193 Fetal Development 194 When Does Life Begin? 194 Methods of Abortion 197 Abortion and the Law 198
6 Contents xiü Ethics and Abortion 201 Fetal Tissue Research andtransplantation 204 Ambulatory Health Care Protocol 205 Chapter I 5 Acquired Immunodeficiency Syndrome 209 The Disease Process 209 Ethical Implications 215 Legal Implications 216 Implications for Ambulatory Health Care Employees 218 Chapter I 6 Life and Death 223 Choices in Life and Death 224 Choices in Dying 227 LivingWills, Advance Directives, and the Patient Self-Determination Act 228 Durable Power of Attorney for Health Care 230 Legal Definitions of Death 232 Legal Implications 233 Ethical Considerations 235 The Role of Health Professionals in Ambulatory Care 237 Chapter 3 7 Dying and Death 241 Suffering in Dying 242 Use of Medications 243 Psychologic Aspects of Dying 244 Physiologic Aspects of Dying 246 Stages of Grief 247 Hospice 248 Assisted Suicide 250 Uniform Anatomical GiftAct 252 Autopsy 253 The Role of the Physician and Ambulatory Health Care Professionals 253 Chapter i 8 Have a Care! 257
7 X V Medical Law, Ethic, and Bioethics for Ambulatory Care Epilogue 263 Appendix I Codes of Ethics 265 The Hippocratic Oath 265 The Geneva Convention Code of Medical Ethics 267 The Nuremberg Code 268 Declaration of Helsinki Recommendations Guiding Medical Doctors in Biomedical Research Involving Human Services,World Medical Association 270 Codes for Nurses 274 American Association of Medical Assistants 276 Principies of Medical Ethics: American Medical Association 277 A Patient's Bill of Rights: American Hospital Association 278 Appendix II Sample Documents for Choices about Health Care, Life, and Death 281 Washington State Health Care Directive 281 Washington State Durable Power of Attorney for Health Care 283 Uniform Donor Card 285
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