100 cases.pdf

USMLE'"'MEDICAL ETHICS: THE IOOCASES YOU ARE MOST LIKELYTO SEEON THE EXAM OTHERBOOKSBY KAPLANMEDICAL USMT.ET\r Stcp Qbook,Third Edition USMLET\rStcp2 CK Qbook,ThirclEdition USMI-E'n'Step2 ClinicalSkills,Third Edition LrSN{l.F.rNr Stcp3 Qbook,Third ldition USMLE"MedicalEthics: The 100Cases YouAre Most Likelyto See on the Exam Conrad Fischer,M.D AssociateChief of Medicinefor Education SUNY DownstateSchoolof Medicine CaterinaOneto,M.D I(APtAN PUBLISHING New York Chicogo USMLE" is a registered trademarkof the Federation of StateMedicalBoards(FSMI3)of the United States,Inc., and the National Board of MedicalExaniners@(NBMEo), neither of which sponsorsor endorsesthis product This publication is designedto provide accurateand authoritativeinformation in regard to the sub.iectmatter covered.It is sold rvith the understandingthat the publisher is not engagedin renderinglegal,accounting,or otherprofessionalservice.Iflegal adviceor other expertassistance is required,the serviccsof a competentprofessionalshouldbe sought Editorial Director: fenniferFarthing Editor: CynthiaC Yazbek ProductionEditor: LeahStrauss ProductionArtist: Ellen Gurak Coverl)esigner:Carly Schnur O 2006by ConradFischer Publishedby KaplanPublishing,a division of Kaplan,Inc 888 SeventhAvenue NewYork,NY 10106 AIl rights reserved.The text ofthis publication,or anypart thereol may not be reproduced in any mannerwhatsoeverwithout written permissionfrom the publisher P r i n t c di n t h e U n i t e d\ t a r e 'o f A m e r i c a September 2006 10 | I 3-ISBN:978-I -4195- 4209- | l0-ISBN: l-4195-4209-5 Kaplan Publishingbooks are availableat specialquantity discountsto use for salespromotions, employeepremiums, or educationalpurposes.Pleasecall our Special Sales Departmentto order or for more informationat 800-6219621,ext.4444,ernailkaplanpubsales@kaplan.com, or write to KaplanPublishing,30 SouthWackerDrive,Suite2500, Chicago, IL 606067481 )of ther ;ard not To: her : Antonio Oneto Lawyer, Politician, Humanist, Fatheq and Loyal Frienil A man of honor and integrity c.o To: Truth C.F :d :s ), Contents I N T R O D U CA TN I ODH NO W T O USE THIS BOOK xiii ABOUTTHEAUTHOR .xv CHAPTER I Autonomy CHAPTER Competence andtheCapacityto Make Decisions Definitions .5 Minors P s y c h i a t rPi ca t i e n t s .8 Capacityto RefuseProcedures in an C)therwise Mentallyl)isabledPatient CHAPTER5lnformedConsent 11 A1lOptionsMust BeDescribed II All MajorAdverseEffectsMust Be Described l2 ConsentIs Requiredfor EachSpecificProcedure 13 Beneficence Is Not Sufficientto Eliminatethe Needfor Consent 13 Decisions MadeWhen CompetentAreValidWhen CapacityIs Lost 14 C o n s e nI ts I m p l i e di n a n E m e r g e n c y .5 The PersonPerforrning the Procedure ShouldObtainConsent l5 Telephone Consentls Valid 16 Pregnant WomenCan RefuseTherapy 17 InformedConsentfor a Never-Competent Person , 17 CHAPTER Confidentialityand Medical Records Confidentiality 19 t9 R e l e a soef l n f o r m a t i o n .2.0 Give Medical lnformation to the Patientliirst, Not the Family 21 Releaseof Information to Governnental Organizationsand the Courts ,.,, 2l BreakingConfidentialityto PreventHann to Others M e d i c a lR e c o r d s - .22 Correctins Medical Record Errors 23 - .22 CHAPTER Reproductive lssues C H A P T EO RrTg a n a n d T i s s u e D o n a t i o n C H A P T ER e Sp o r t a b l e l l l n e s s e s (STD$ CHAPTER l0 SexuallyTransmitted Diseases C H A P TlEl RM a l p r a c t i c e 41 45 47 5i 55 Definition .5 Deviationsfrom Local Standardsof Care Informed ConsentProtectionagainstLiability 57 56 Informed Refusalls as Important as Informed Consent 58 PatientsMust Fully lnform the Physicianof Their Medical Problems 59 R i s kM a n a g e m e n t 59 M e d i c a lE r r o r s 59 .tJ 25 27 33 35 37 37 37 38 38 CHAPTER D 1o 2c t o r / P a t i e n t R e l a t i o n s h i p l 4l 41 42 42 42 43 45 CHAPTERt4 Doctor/DoctorRelationship 7t CHAPTER E xf 5p e r i m e n t a t i o n 75 40 47 t9 49 50 52 i2 ;5 'o 9 PRACTTCEQUESTTONS A N S W E R S AENXDP L A N A T I O N S 7s .129 'l Chapter Autonomy Patient autonomy is the most fundamental principle underlying all health-care ethics Autonomy grants every competent adult patient the absolute right to what he wishes rvith his own health care The concept of autonorny is fundamental to the entirety of the U.S legal system and has complete acceptance as an operating principle of day_to_day decision making Justice cardozo set this as a clear legar precedent in 1914, in the case Schloendorffv Society of New york Hospital, 105 N.E 92 (1914) Justice Cardozo wrote, "Every human being of adult years and a sound '.rind has the right to determine what shall be done with his own body and a surgeon who performs an operation without his patient's consentcommits an assault,for which he is liable in damages,except in casesof emergency rvherethe patient is unconscious and where it is necessaryto operate before consent can be obtained." lustice cardozo was writing concerning the need for informed consent when a person undergoes surgery, ln this case it was made clear that to perform surgery on a patient without his direct consent was equivalent to assault and battery Patient autonomy is a concept derived fron the property rights issues that led to the Declaration of Independence, the U.S Constitution, and the Bill of Rights Autonomy over one's own medical care is seen in the same light as freedom of religior, freedom fron.r illegal search and seizure,freedom of speech,and freedom of assembly.These rights are so i n l r i , ' \ i c t o o u r c u l l u r e t h l t t h e y r r r c o n \ i d e r e da x i o m a l i c \ V i t h i n t h e l r r t3 y e a r r t h e y have been legally extended to cover the freedon to choose one's own form of health care Ior example, patients have the right to refuse undesired therapy, and they have the right to choosewhether or not they will participate in experimentation Each patient has the right to have his wishes carried out even in the event that he loses consciousnessor the caoacitv to make dccisions for himsell I(APTAN M ED I C A L ... USMI-E''n''Step2 ClinicalSkills,Third Edition LrSN{l.F.rNr Stcp3 Qbook,Third ldition USMLE"MedicalEthics: The 100Cases YouAre Most Likelyto See on the Exam Conrad Fischer,M.D AssociateChief of Medicinefor Education