Applied Ethics in Healthcare: Understanding Bioethics, Laws, and Ethical Principles, Exams of Nursing

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Chapter 1-13 Medical Law & Ethics 500 Correct Answered Questions GRADED A+>. applied ethics - Correct answerthe 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 - Correct answera branch of applied ethics, is a field resulting from modern medical advances and research litigious - Correct answeran excessive inclination to sue laws - Correct answerrules or actions prescribed by an authority such as the federal government and the court system that have a binding legal force medical practice acts - Correct answerlaws established in all 50 states that define the practice of medicine as well as requirements and methods for licensure in a particular state precedent - Correct answerthe decision of the court case acts as a model for any future cases in which the facts are the same ethics - Correct answerbranch of philosophy related to morals, moral principles, and moral judgments morality - Correct answerthe quality of being virtuous or practicing the right conduct amoral - Correct answerlacking or indifferent to moral standards medical ethics - Correct answerconcerns questions related specifically to the practice of medicine utilitarianism - Correct answeran ethical theory based on the principle of what is the greatest good for the greatest number of people cost/benefit analysis - Correct answerjustifies the means of achieving a goal indigent - Correct answera person who is impoverished and without funds rights-based ethics - Correct answera natural rights ethical theory, places the primary emphasis on a person's individual rights duty-based ethics - Correct answerbased 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 - Correct answerbased on an important moral restraint called "the veil of ignorance"; fair distribution of benefits and burdens virtue-based ethics - Correct answerbased 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 - Correct answerloyalty and faithfulness to others sanctity of life - Correct answerthe sacredness of human life tolerance - Correct answera respect for those whose opinions, practices, race, religion, and nationality differ from our own integrity - Correct answerthe unwavering adherence to one's principles empathy - Correct answerthe ability to understand the feelings of others without actually experiencing their pain or distress sympathy - Correct answerfeeling sorry for or pitying someone else compassion - Correct answerthe ability to have a gentle, caring attitude toward patients and fellow employees due process - Correct answerthe 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 - Correct answerunwelcome 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 - Correct answerknown as pay equity, is a theory that extends equal pay requirements to all persons who are doing equal work principle of autonomy - Correct answerthe 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 - Correct answerthe principle of doing good Subpoena "Duces Tecum" - Correct answerA court order requiring a witness to appear in court and to bring certain records/documents Regulations - Correct answerRules or laws made by agencies Statutes - Correct answerLaws enacted by state and federal legislatures Plaintiff - Correct answerA person on group of people suing another person or group; the person who instigates the lawsuit Defendant - Correct answerPerson or group of people sued civilly or prosecuted criminally in a court of law Criminal Laws - Correct answerSet up to protect the public from the handful acts of others Case Law - Correct answerAlso known as Common Law Based on decisions made by judges Contract Law - Correct answerDivision of law that includes enforceable promises and agreements between two or more persons to do or not to do a particular thing Common Law - Correct answerAlso known as Case Law Based on decisions made by judges Civil Law - Correct answerRelationships between individuals or between individuals and the government, which are not criminal Administrative Law - Correct answerBranch of law that covers regulations set by government agencies Breach Of Contract - Correct answerThe 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 - Correct answerNeglect of an understanding between two parties; failing to perform a legal duty Beyond A Reasonable Doubt - Correct answerEvidence that is almost an absolute certainty that a person did commit a crime 99.9% Checks And Balances - Correct answerSeparation between the three branches Preponderance Of Evidence - Correct answerEvidence showing that more likely than not the incident occured Accreditation p. 60 - Correct answera 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 - Correct answera special type of insurance that covers employees who handle financial statements, records, and cash. Confidentiality p. 62 - Correct answerrefers 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 - Correct answerrule 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 - Correct answeran 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 - Correct answerstate laws that help protect healthcare professionals from liability while giving emergency care to accident victims. Guardian ad litem p. 63 - Correct answercourt-appointed guardian to represent a minor or unborn child in litigation. Incident report p. 68 - Correct answera means of documenting problem areas within a hospital or other medical facility. Joint Commission on Accreditation of Healthcare Organizations (JCAHO) p. 60 - Correct answeran 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 - Correct answeralso 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 - Correct answerthe 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 - Correct answerLatin phrase meaning "let the master answer" means the employer is responsible for the actions of the employee. Revoke p. 60 - Correct answertake away, as in revoke a license. Risk management p. 67 - Correct answera 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 - Correct answerthe activities a healthcare professional is allowed to perform as indicated in their license, certification, and/or training. Standard of care 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 - Correct answerStatues 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 - Correct answerThe official U.S. medical licensing exam. National Board of Medical Examiners (NBME) p. 58 - Correct answer... U.S. Medical Licensing Examination (USMLSE) p. 58 - Correct answer... Registration p. 59 - Correct answerPeriodic (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 - Correct answerprovides 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 - Correct answerHealthcare 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 - Correct answer... Incident Report p. 68 - Correct answer... Medical Patient Rights Act p. 62 - Correct answerLaw 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 - Correct answerNBME - National Board of Medical Examiners FLEX - Federal Licensing Examination USMLE - U.S. Medical Licensing Examination Exceptions to State Medical License Requirement p. 59 - Correct answer• 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 - Correct answerA license is granted by a state or federal entity. This provides the legal right for a professional, such as a physician, to practice. Certification - Correct answerCertification 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 - Correct answerTo introduce a drug into the body of a client appellant - Correct answerOne who appeals a court decision to a higher court arraignment - Correct answerThe procedure of calling someone before a court to answer a charge civil case - Correct answerCourt action between private parties, corporations, government bodies, or other organizations. Compensation is usually monetary. Recovery of private rights is sought. closing arguments - Correct answerSummary and last statements made by opposing attorneys at a hearing or trial Controlled Substances Act - Correct answerFederal law regulating the administration, dispensing, and prescription of particular substances that are categorized in five schedules. court of appeals - Correct answerCourt that reviews decisions made by a lower court; may reverse, remand, modify, or affirm lower court decision. court order - Correct answerAn 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 - Correct answerCourt 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 - Correct answerExamination of a witness by an opposing attorney at a hearing or trial. defendant - Correct answerThe person or group accused in a court action. deposition - Correct answerA written record of oral testimony made before a public officer for use in a lawsuit. direct examination - Correct answerExamination of a witness by the attorney calling the witness at a hearing or trial. Accepting Gifts - Correct answerGifts to physicians from medical companies can be accetped only if they relate to the physician's medical practice. However, drug samples from pharmaceutical companies can be accepted for patient use. Conflict of interest - Correct answerPhysicians should not place their own financial interests above the patient's welfare. Professional Courtesy - Correct answerHistorically, there is an unwritten practice among many physicians taht they would not charge each toher for professional services. However, this practice has lost favor because many physicians are concerned about the lack of documentation when seeing a fellow physician free of charge. Reporting Unethical Conduct - Correct answerA physician should report any unethical conduct by other physicians. Second Opinions - Correct answerPhysicians should recommened that patients seek a second opinion whenever necessary. Sexual Conduct - Correct answerIt is unethical for the physician to engage in sexual conduct with a patient during the physician-patient relationship. Treating Family Members - Correct answerPhysicians should not treat members of their families except in an emergency. Dumping Crisis - Correct answerWhen a private hospital emergency room sends an indigent patient to a public hospital emergency room. The Comprehensive Omnibus Budget Reconciliation Act (COBRA) - Correct answercontains an amendment that prohibits "dumping" patients from on facility to another. It is now a federal offense to do this. This amendment does not mandate treatment, but it does require a hospital to stabilize a patient during an emergency situation. Abandonment - Correct answerwithdrawing emdical care from a patient without providing sufficient notice to the patient. Considered to be a civil wrong or tort and condsidered to be a breach of contract and even negligence. Certified Mail - Abandonment - Correct answerSending a letter by certified mail is the best method physicians can use to protect themseleves from a charge of abandoment when they have to sever a relationship with a patient. Against Medical Advice (AMA) - Correct answerwhen a noncompliant patient leaves a hospital without physician's permission Acquired Immunodeficiency Syndrome (AIDS) - Correct answeris a diease resulting in infections that occur as a result of exposure to the human immunodeficiency virus (HIV), which causes the immune system to break down. First documented in the US in 1980. Americans with Disabilites Act (ADA) - Correct answerA federal law, protects HIV and AIDS patients from discrimination. Prognosis - Correct answerPrediction for the course of their disease Medical Patients Rights Act - Correct answerprovides that all patients have the right to have their personal privacy respected and their medical records handled with confidentiality. Privileged Communication - Correct answerrefers to confidential information that has been told to a physician (or attorney) by the patient. Patient's Bill of Rights - Correct answerdescrbies the physician-patient relationship Self-Determination Documents or Advance Directives - Correct answerStates the patinet's intentions for healthcare-related decisions and in some cases name another person as proxy to make decisons for the patient. Proxy or Agent - Correct answera person who acts on behalf of another person Proxy Statement - Correct answeris the written authorization given by a person so that a second person can act for him or her. Advance Directive - Correct answeris a written statement in which people state the type and amount of care they wish to receive during a terminal illness and as death approaches. Living Will - Correct answerDocument that a person drafts before becoming incompetent orunable to make heathcare decisions. Durable Power of Attorney for Healthcare - Correct answerA legal doucment that empowers another person (proxy) to make healthcare decisions for an incompetent patient. It goes into effect after the person beomces incompetent and only pertains to healthcare decisons. Uniform Anatomical Gift Act - Correct answerAll states have some form of this law. It allows persons 18 years or older and of sound mind to make a gift of any part of their body for purposes of medical research or transplantation. Do not Resuscitate (DNR) Order - Correct answerThis is an order placed into a person's medical chart or medical record. It indicates taht the person does not wish to be resuscitated if breathing stops. Modified Rights of Terminally Ill Act - Correct answerwhich states that the person must be terminally ill and/or in a state of permanent unconsciousness. The patient must be in a state that is irreversible, untreatable, and incurable with the prospect of imminent death. Patient Self-Determination Act (PSDA) - Correct answerwas passed in 1991 and states that congress has stongly supported a person's right to self-determination before beoming incompetent. Minor - Correct answeris a person who has not reached the age of maturity, which in most states is 18. In loco parentis - Correct answerconsent of the parents or someone standing in for the parents principle of parens patriae authority - Correct answeroccurs when the state takes responsiblity from the parents for the care and custody of minors under the age of 18. mature minor - Correct answera person judged to be mature enought to understand teh physician's instructions. Such a minor may seek medical care for treatment of drug or alcohol abuse, contraception, venereal disease, and pregnancy. Emancipated Minor - Correct answera person between the ages of 15 and 18 who is either married, in the military, or self-supporting and no longer lives under teh care of a parent. Parental consent for medical care is not required. Proof of emancipation should be included in the medical record. Consent - Correct answeris the voluntary agreement that a patient gives to allow a medically trained person the permission to touch, examine, and perform a treatment. Informed or Expressed Consent - Correct answermeans taht the patient agrees to the proposed course of treatment after having been told about the possible consequences of having or not having certain procedures and treatments. The patients's signature on the consent form indicates that the patient understands the limits or risks involved in the pending treatment or surgery as explained by the physician. Affirmative defense p. 143 - Correct answerallows the defendant (usually physician or hospital) to present evidence that the patient's condition was the result of factors other than the defendant's negligence. • Denial (the most frequently used defense) • Assumption of risk • Contributory negligence p. 149-150 - Correct answerordering more tests and procedures and referring to specialists more often than necessary in order to protect oneself from a lawsuit. The result is patients have to undergo additional tests and procedures and the cost of healthcare increases. The over use of specialist can negatively impact the relationship with the PCP. Defensive medicine becomes problematic if a physician becomes reluctant to attempt more risky, but potentially effective procedure for fear of a lawsuit. Studies show that physicians with good bedside manner (talking unhurriedly, sitting on the bedside, holding the patient's hand) were much less likely to be sued (regardless of skill). This extends to all healthcare professionals and is why physicians hire employees who project a warm and caring attitude toward the patients. Dereliction p. 136 - Correct answerneglect, as in neglect of duty. Direct cause (or proximate cause) p. 136 & 137 - Correct answerthe continuous sequence of events, unbroken by any intervening cause, that produces an injury and without which the injury would not have occurred. Proximate cause means there were no intervening forces between the defendant's action(s) and the plaintiff's injury -- hence, a cause-and-effect relationship. Proximate cause refers to the last negligent act that contributed to a patient's injury, without which the injury would not have resulted. Duty p. 136 - Correct answerobligation or responsibility. Feasance p. 135 - Correct answerdoing an act or performing a duty. Federal Rules of Evidence p. 147 - Correct answerrules that govern the admissibility of evidence into federal court. Fraud p. 139 - Correct answerthe deliberate concealment of the facts from another person for unlawful or unfair gain. Illegal billing, referral kickbacks, dishonesty when conducting medical research, embezzlement, and the illegal sale of drugs are all forms of fraud. Frequently cited areas of medical related fraud are on p. 141. Law of agency p. 147 - Correct answerthe legal relationship formed between two people when one person agrees to perform work for another person. (This does not apply to pharmacists since they are not hired by the physicians.) In order to protect the physician/employer from liability for negligence under the doctrine of respondeat superior, the healthcare professional should: • Have a written job description that clearly defines the responsibilities, duties and skills necessary for the job. • Use extreme care when performing his or her job • Carry out only those procedures for which he or she is trained • Be honest about any errors or inability to perform a procedure Liable p. 145 - Correct answerlegal responsibility for one's own actions. Malfeasance p. 135 - Correct answerperforming an illegal act. Medical personnel must be especially aware of malfeasance when they offer advice such as "Try giving your child aspirin to bring down the fever." Malpractice p. 134 - Correct answerprofessional misconduct or demonstration of an unreasonable lack of skill with the result of injury, loss, or damage to the patient. A physician is held to a different but not higher standard of care than a nurse, medical assistant, physician assistant, or phlebotomist. Medication errors are one of the leading types of medical errors. Mediation p. 150 - Correct answerusing the opinion of a third party to resolve a civil dispute in a nonbinding decision. The mediator lists to both sides of the dispute and assists the parties in finding a solution. Misfeasance p. 135 - Correct answerthe improper performance of an otherwise proper or lawful act. Occurs when poor technique is used; such as when a phlebotomist performs veinipuncture and the patient suffers nerve damage. Negligence p. 134 - Correct answeran unintentional action that occurs when a person either performs or fails to perform an action that a "reasonable person" would or would not have committed in a similar situation. Nominal damages p. 139 - Correct answera slight or token payment awarded by the court. Nonfeasance p. 135 - Correct answerthe failure to perform an action when it is necessary. An example would be when a patient collapses in the office and a nurse trained in CPR fails to administer it. Occurrence insurance p. 149 - Correct answeralso called claims-incurred insurance, liability insurance that covers the insured party for all injuries and incidents that occurred while the policy was in effect (policy year), regardless of when they are reported to the insurer or when the claim is made. With this type of insurance it is important to clearly documetn when an event took place. Proximate p. 137 - Correct answerthe injury was closely (proximately) related to the defendant's negligence. Punitive damages or exemplary damages The plaintiff must prove that it is more likely than not that the defendant, (physician), has caused the injury. The burden of proof is on the plaintiff. Res Ipsa Loquitur (also called Res ipsa loquitur or RIL) p. 137 - Correct answerThis doctrine means "the thing speaks for itself" and refers to situations where the breach of duty is so obvious that it doesn't need further explanation. Under res ipsa, an exception to the burden of proof rule occurs, and the burden of proof now falls to the defendant. A judge decides if a case can be tried under ris ipsa; to do so three conditions must be present: 1. The injury could not have occurred without negligence. 2. The defendant had total and direct control over the cause of the injury, and the duty was within the scope of the duty owed to the patient or injured party. 3. The patient did not, and could not, contribute to the cause of injury. In order to have a civil malpractice lawsuit, the plaintiff (patient) must show that: 1. A relationship had been established 2. The relationship established a duty of the physician to the patient. 3. The duty required the physician to perform at a particular standard of care. 4. The duty was breached by the physician. 5. The patient received an injury as a result of the physician's breach of duty. 6. The physician's breach of duty was the proximate cause of injury to the patient. Types of Compensatory Damages p. 138-139 - Correct answer• Compensatory • Special compensatory or exemplary damages • Punitive • Nominal Special compensatory or exemplary damages p. 138 - Correct answerRefers to a monetary award to compensate the patient for losses that were not directly cased by the negligence. (Such as PT needed for atrophy that was a result of the injury.) Non-economic reasons include disfigurement, disability, loss of consortium. Wrongful-death statutes p. 139 - Correct answerIf a patient's death has been caused by the physician's negligence, the deceased person's dependents and heirs may sue for wrongful death. A plaintiff in a wrongful-death suit does not have to prove that he or she was completely dependent on the deceased person for support. The plaintiff must prove that the defendant's actions were the "proximate," or immediate cause of death. Notes - Correct answerp. 139 - There are no federal malpractice laws. Office of the inspector general (OIG) p. 141 - Correct answerThe OIG is one of the major players in the war against healthcare fraud. This office was created to protect programs under the Department of Health and Human Services (HHS) such as Medicare and Medicaid. The OIG reports problems to the Secretary of State and Congress makes recommendations on how to correct them. The Office of Counsel to the Inspector General p. 141 - Correct answer• Provides legal services to the OIG • Represents the OIG in civil cases tried under the False Claims Act. • Imposes money penalties on healthcare providers found guilty of fraud. • Issues fraud alerts Federal statutes to avoid waste, fraud, and abuse in healthcare p. 141 - Correct answerMajor areas of concern are: 1. Additional costs to federal healthcare programs 2. Quality of patient care 3. Access to care 4. Freedom of choice 5. Competition 6. Healthcare provider's abuse of professional judgement Violation of Statues p. 142 - Correct answerEx: In some states a "poison" label is required by law (statute) False Claims p. 142 - Correct answer• A claim for payment for services or supplies that were never provided • A claim using a diagnosis code other than the true diagnosis code to obtain reimbursement for services • A claim indicating a higher level of service that that which was provided. • A claim for a service that the provider knew was not necessary • A claim for services provided by an unlicensed individual Immunity for Charitable Organizations p. 143 - Correct answerAlmost all states now reject immunity for charitable organizations on the basis that immunity encourages neglect and irresponsibility. Defense to Malpractice Suits p. 143 - Correct answer... Denial Defense p. 143 - Correct answerThe most common kind of defense; the physician denies he or she performed the procedure. Statue of Limitations p. 145 - Correct answerThe rule of discovery does not "run" if fraud was involved to cover the infraction. Res Judicata p. 145 - Correct answerThis means "the thing that is decided." If a court decides a case, the plaintiff cannot bring a new lawsuit on the same subject against the same defendant. Fear of Lawsuits (under Civil Liability Cases) p. 145 - Correct answerFear of lawsuits has influenced the practice of medicine. Some hospitals or physicians are reluctant to withdraw or withhold treatment at the specific directive of a patient or family. Physical conditions of the Premises p. 146 - Correct answerAn institution may be liable when an accident occurs as the result of not following regulatory standards for maintaining a safe environment for patients. Lawsuits involving the physical condition of medical facilities have involved cases such as broken steps, malfunctioning elevators and doors, and defective carpets. • Follow safety practices and OSHA guidelines • Communicate clearly and within HIPAA • Document accurately and completely Tips for Writing Effective Cover Letters p. 157 - Correct answer• Don't duplicate the wording in your resume • Be positive • Write clearly and concisely • Don't use overblown or empty words to describe your abilities • Be truthful • Emphasize your skills as a team player • Incorporate specialized terminology • Research the organization • Read the letter aloud Show Off Your Writing Skills p. 58 - Correct answerDemonstrate business writing skills. Be concise, articulate, and convincing. See p. 158 Steps to correct an error in a medical record and why is it important to do it correctly? - Correct answerDraw a line through error so it is still legible, write above or below the correct information, note why the correction was made, date, time and initial, and have another witness the correction and add initials if possible - It's important because it may appear to be due to falsification or cover up of entries, could be interpreted as evidence of guilt in a medical malpractice case. Ownership of the "Physical Medical Record" - Correct answerIs owned by the entity that created it, physicians office, clinic, hospital Ownership of the "Content" of the record - Correct answerIs owned by the patient. What should the clinic employee do when requsted to release records to a third party? - Correct answerNeed written consent from the patient, Only the information requested should be released, check the specific dates and or time spans, check/verify name, check for authorization of release. Medical Record - Correct answerA collection of data recorded when a patient seeks medical treatment. 5 C's of Charting - Correct answer1)Concise. 2) Complete/Objective 3) Clear/Legibly written 4)Correct 5)Chronologically Ordered. Doctrine of professional discretion - Correct answerA physician can exercise a judgement as to whether to show patients who are being treated for mental or emotional conditions their recors; whether in the physicians judgement, it would do more harm than good. Retention and Storage - Correct answerRecords should be kept until the statute of limitations has elapsed. - usually ranges from two to seven years. - in some cases this involves keeping the records of minors for a specified length of time after they reach legal age. Confidentiality of Alcohol and Drug Abuse, Patient Records - Correct answerA federal statute that protects patients with histories of substance abuse regarding the release of information about treatment. Consent - Correct answerPermission from a person either expressed or implied for something to be done by another Doctrine of informed consent - Correct answerThe legal basis for informed consent, usually outlined in a state's medical practice acts. Informed Consent - Correct answerImplies that the patient understands - proposed modes of treatment, why the treatment is necessary, risks involved in the proposed treatment, available alternative modes of treatment, risks involved if treatment is refused. Important to have patient sign a consent form. EXCEPTiONS who cannot give informed consent include: - Correct answerMinors, Persons who are mentally incompetent, Persons who speak limited or no english. Good Samaritan acts - Correct answerSate laws protecting physicials and sometimes other health care practitionners and laypersons from charges of negligence or abandonment if they stop to help the victim of an accident or other emergency. Consent is Unnecessary in emergency situations. HIT - Health Information Technology - Correct answerThe application of information processing, involving both computer hardware and software, that deals with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decision making. HIPAA - Health Insurance Portability Accountibility Act - Correct answermandates certain procedures and standards for the electronic transmission and storage of health care information. HHS - Health and Human Services - Correct answerresults of HHS projects include: X- Rays over the internet, Lab results can be sent electronically, prescriptions can be sent eletronically. EHR - Electronic Health Record - - Correct answerContains the same information as any medical record, but in electronic form. Affirmative action programs p. 196 - Correct answerto remedy discriminating practices in hiring minority group members. Also covered under Title VII. Courts may mandate that affirmative action programs be implemented if there is evidence that an employer has intentionally discriminated against a particular minority group. Age Discrimination in Employment Act (ADEA) of 1967 p. 197 - Correct answerprotects persons 40 years or older against employment discrimination because of age. • Applies to employers who have 20 or more employees. • Does not apply if the older employee does not have the ability to perform the job • The employer must be able to show in writing why the younger job applicant was hired over the older one. • Mandatory retirement is prohibited under this law except for certain exempt executives. • People over 40 are protected by ADEA and Title VII. Americans with Disabilities Act (ADA) of 1973 p. 198 - Correct answerprohibits employers who have more than 15 employees from discriminating against disabled individuals. • There are 43 million disabled persons in the U.S. • Persons with AIDS are also covered under this act. • Employers must make reasonable accommodations to make the work environment accessible to their disabled employees. • Exceptions occur if making the accommodations would put undue hardship for the employer. • The vagueness of term "undue hardship" has caused problems interpreting this law. • Employers have a 2 years to implement the accommodations. • Patients are also protected under this statute. Autonomy p. 190 - Correct answerindependence. As long as a person is competent, he or she has the right to make their own decisions. • ERISA requires employers to earmark money that can only be used to pay future benefits. • Guarantees vesting of pension plans • Under ERISA, employees who stay with a company for 10 years are entitled to 50 percent of the employer's retirement plan even if they leave the company and take another job. • The employee is entitled to 100% of the employer's pension contribution after fifteen years of employment when he or she becomes fully vested. • ERISA protects employees from being laid off just before they become vested. Employment-at-will p. 195 - Correct answera common-law doctrine of employment that takes place at either the will of the employer or the employee when a contract is not present. Employment may be terminated at will, without notice, at any time,and without a reason. An employee may quit at any time. The only protection is that employees cannot be fired for an illegal reason (race, religion, etc.) This does not apply if there is a contract between the employer and employee that defines the duration of the employment. This concept is beginning to lose favor as wrongful-discharge lawsuits rise. Equal Credit Opportunity Act of 1975 p. 207 - Correct answerprohibits businesses (including hospitals) from granting credit based on race and gender—unfair treatment is referred to as discrimination. Equal Employment Opportunity Act (EEOA) of 1972 p. 193 & 197 - Correct answerauthorizes the EEOC to sue employers in federal court on behalf of people whose rights have been violated under Title VII. Equal Employment Opportunity Commission (EEOC) p. 193 - Correct answermonitors Title VII of the Civil Rights Act. It has strict guidelines on the types of questions that can be asked during a job interview. • EEOC monitors Title VII and the Justice Department enforces the statute. Equal Pay Act of 1963 p. 204 - Correct answerMakes it illegal for an employer to discriminate on the basis of gender in the payment of men and women who are doing the same job. Ethnocentric p. 189 - Correct answera belief that one's cultural background is better than any other Fair Credit Reporting Act of 1971 p. 207 - Correct answerestablishes guidelines for use of an individual's credit information • If a patient is denied credit based on a poor credit rating from a credit agency, the patient must be notified of this fact and given the name and address of the reporting agency. • The agency must disclose the information to the consumer and correct any outdated or erroneous information. Fair Debt Collection Practices Act of 1987 p. 208 - Correct answerprohibits unfair collection practices by creditors. • The FCC issued guidelines for specific times that credit collection phone calls can be made (8 a.m. - 9 p.m.) • It prohibits harassment and threats • Guidelines on page 209 • Billing and collections personnel must have a full understanding of the laws regulating the collection process Fair Labor Standards Act (FLSA) p. 205 - Correct answerestablishes the minimum wage, requires payment for overtime work, and sets the maximum hours employees covered by the act may work. • This is the main statute regulating employee benefits. • Over time must be provided at time and a half if over 40 hours are worked each week • Hospitals are an exception when they make an agreement with their employed to establish a work period of 14 days. Overtime then starts at 80 hours. • This law affects only full-time, hourly employees. • Salaried, management, part-timers, and time-sharers usually do not benefit from this law. Family and Medical Leave Act (FMLA) of 1994 p. 206 - Correct answerallows both the mother and the father to take a leave of absence for up to 12 weeks, in any 12-month period, when a baby is born. • The employees job, or an equivalent position, must be held. • In most cases the leave is without pay. • FMLA also allows an employee to take 12 weeks for a family members medical situation (birth, death, adoption). • The employees heath coverage must be maintained • Accumulated employee benefits cannot be lost Federal Insurance Contribution Act (FICA) of 1935 p. 205 - Correct answerrequires employers to contribute to Social Security for employees. • The oldest act relating to compensation. • Employers are required to contribute to Social Security plans for their employees. • Severe fines ensue if the employer does not pay on time. • Detailed documentation of the employer's payments are necessary Federal Wage Garnishment Law p. 209 - Correct answerrestricts the amount of the paycheck that can be garnished to pay off a debt. Garnishment p. 209 - Correct answercourt order that requires an employer to pay a portion of an employee's paycheck to one of the employee's creditors until the debt is resolved. Just cause p. 195 - Correct answerlegal reason. National Labor Relations Act of 1935 or The Wagner Act p. 199 - Correct answerprohibits employer actions, such as attempting to force employees to stay out of unions, and labels these actions as "unfair labor practices." Occupational Safety and Health Act (OSHA) of 1970 p. 200 - Correct answerrequires an employer to provide a safe and healthy work environment; the employer must protect the worker against hazards. • OSHA regulations preempt all other state and local regulations regarding employee safety and health, meaning that states may not pass any laws concerning the working environment. • Right-to-know laws • It is legal to include a finance charge, however, few physicians and dentists require the charge. Unemployment Compensation p. 205 - Correct answerprovides for temporary weekly payments for the unemployed worker who lose their job through no fault of their own. • In order to receive unemployment insurance, the employee must have worked for an employer who has paid, or was required to pay, unemployment compensation taxes. • Exemptions apply for religious, educational, or charitable organizations. • Employees who are fired for a good cause cannot collect unemployment benefits. Vesting p. 206 - Correct answera point in time, such as after 10 years of employment, when an employee has the right to receive benefits from a retirement plan. Worker's Compensation Act p. 205 - Correct answerprotects workers and their families from financial problems resulting from unemployment related injury, disease, and death. • Employers typically pay into a fund to help cover costs when a worker is hurt during the course of employment. • The goal of worker's compensation is to get the worker pack to work as soon as possible. • COBRA may allow for a retraining opportunity if the injury results in permanent inability to work the same job • If the employee has only worked at the job a few months, the former employer may have to pay worker's compensation. • Some medical practices specialize in worker's compensation cases • Worker's Compensation is completely administered at the state level • The employee must submit written notice of the injury to the employer • Worker's Compensation pays a fraction of the normal salary, such as 2/3. • Available even if the employee is at fault for the injury, except employees who violate hospital policy • An employee who is injured by a nonemployee can collect Workman's Compensation and sue the nonemployee for damages. Wrongful discharge p. 195 - Correct answerlawsuit in which the employee believes the employer does not have a just cause, or legal reason, for the firing. Discuss the regulations concerning equal employment opportunity and employment discrimination. - Correct answerOccupational Safety and Health Act (OSHA) of 1970— Under OSHA, an employer is required by law to provide a safe and healthy work environment. The employer must protect the worker against hazards. Clinical Laboratory and Improvement Act (CLIA) of 1988, 1992—The federal government now requires that all clinical laboratories that test human specimens must be controlled. These standards mandate written policies and procedures for a comprehensive quality assurance program to evaluate the overall quality of the laboratory testing process. Health Maintenance Organization (HMO) Act of 1973—This act requires any company with at least 25 employees to provide an HMO alternative to regular group insurance for their employees if an HMO is available in the area. Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985—Under COBRA, a company with 20 or more employees must provide extended healthcare insurance to terminated employees for as long as 18 months—usually, but not always, at the employee's expense. Drug-Free Workplace Act of 1988—Under this act, employers contracting to provide goods or services to the federal government must certify that they maintain a drug-free workplace. Discuss the regulations affecting employee compensation and benefits. - Correct answerSocial Security Act of 1935—This federal law covers all private and most public sector employees. It laid the groundwork for unemployment compensation in the United States. Social Security is paid by the employer and the employee in equal payroll taxes and Medicare participant premiums. Fair Labor Standards Act (FLSA) of 1938—This is the main statute regulating benefits. It establishes the minimum wage, requires payment for overtime work, and sets the maximum hours employees covered by the act may work. Equal Pay Act of 1963—This act makes it illegal for an employer to discriminate on the basis of gender in the payment to men and women who are performing the same job. Unemployment Compensation—The unemployment compensation laws provide for temporary weekly payments for the unemployed worker. Federal Insurance Contribution Act (FICA) of 1935—Under this law, employers are required to contribute to Social Security plans for their employees. Workers' Compensation Act—This statute protects workers and their families from financial problems resulting from employment-related injury, disease, and even death. Employee Retirement Income Security Act (ERISA) of 1974—ERISA regulates employee benefits and pension plans. Family and Medical Leave Act (FMLA) of 1994—This law allows both parents to take a leave of absence of up to 12 weeks in any 12-month period when a baby is born. The employees' jobs, or equivalent ones, must be available when both return to work. The FMLA also requires employers to provide unpaid leave for up to 12 weeks to employees who request leave for their own or a family member's medical or family-related situation, such as birth, death, or adoption. Give examples of regulations affecting consumer protection and collection practices - Correct answer• Emergency Medical Treatment and Active Labor Act (EMTALA)—A section of the Consolidated Omnibus Budget Reconciliation Act (COBRA) dealing with "patient dumping." • Fair Credit Reporting Act of 1971—This act establishes guidelines for use of an individual's credit information. • Equal Credit Opportunity Act of 1975—This act prohibits businesses, including hospitals and medical offices, from denying credit based on the applicant's race or gender—an unfair treatment referred to as discrimination. • Truth in Lending Act (Regulation Z) of 1969—This act requires a full written disclosure about interest rates or finance charges concerning the payment of any fee that will be collected in more than four installments. • Fair Debt Collection Practices Act of 1978—This act prohibits unfair collection practices by creditors. • Federal Wage Garnishment Law—This law restricts the amount of the employee's paycheck that can be used to pay off a debt (garnishment). Describe accommodations that can be made in the workplace for persons with disabilities. - Correct answer• Parking spaces, marked for the handicapped, near an accessible doorway • Inclined ramps into buildings and over curbs in parking lots • Elevator floor numbers accessible to wheelchair-bound persons • Handicapped accessible bathrooms with handrails • Hallways with 36 inches of clearance for a wheelchair • Desks and counters that accommodate a wheelchair • Telephone adapters for the hearing impaired List several questions that may be legally asked during an employment interview - Correct answerLegal questions a. Age—Only legal to ask if he or she is between 17 and 70; if the person's age falls outside this boundary, then it is legal to ask only the birth date. b. Birthplace—Legal, but inadvisable to ask where the applicants, their parents, spouse, or children were born. It is illegal to ask about their national heritage or nationality or that of their spouse. • Guardianship may have to be established by the courts so the best interested of the patient are observed. • It is never appropriate to judge, either with verbal or nonverbal criticism, another person's religious customs and beliefs. A exception occurs when there is evidence of abuse as a result of a religious practice. • There are some beliefs that do not allow a person to receive a blood transfusion. When the patient is a child, a court order is needed for the transfusion to proceed against the objections of the parents. • Employers has a legal obligation under the Civil rights Act to make accommodations so that employees can practice their religious observations. Effective Hiring Practices p. 191 - Correct answer• Employee handbooks should clearly state that they are not contracts and should be carefully examined for any erroneous or misleading statements. • Employees should be allowed to see, comment on, or copy anything affecting them in written review and personnel file memos. Federal Regulations Affecting the Medical Professional p. 194 - Correct answer• Both state and federal laws regulate the employer and employee relationship. • Healthcare facilities must remain current on regulations affecting employment practices such as health, safety, compensations, worker's compensation, unions, and discrimination laws. • In general federal law usually applies to organizations that employ a declared number of employees and who work a minimum number of weeks in the year. • Usually, federal law preempts state laws. An exceptions occur when: - there is no federal law on the topic - the state law does not conflict with the federal law - Congress prohibits states from regulating a certain law by complete preemption Major categories of federal laws regulating the employer-employee relationship - Correct answer• equal employment opportunity and employment discrimination • employee health and safety • compensation and benefits regulations • consumer protection and collection practices • federal labor acts Equal Employment Opportunity and Employment Discrimination p. 194 - Correct answerThe government regulates the employment relationship, including laws affecting: • recruitment • placement • pay plans • benefits • penalties • termination The basis of the law is that people must be judged primarily by their job performance. Employment-at-Will Concept Equal Employment Opportunity and Employment Discrimination Laws p. 195 - Correct answerTable 8.3 Quid pro quo p. 196 - Correct answera Latin term meaning "something for something". Who is an Employee Under Title VII? p. 196 - Correct answerIf an employer witholds employment taxes from a person's income, than that person is considered an employee. Who Is an Employer Under Title VII? p. 196 - Correct answerA person who employs the services of another and provides payment for those services is considered an employer. The employer has the right to control the physical conduct of the employee in performing the service. The statute does not apply to independent contractors. Parent companies are not liable under Title VII. Basic accommodations that can be made for persons with disabilities include: p. 199 - Correct answer... National Labor Relations Board (NLRB) - Correct answerEnforces the National Labor Relations Act National Employee Health and Safety Laws p. 200 - Correct answerTable 8.4 Employee Health and Safety p. 200 - Correct answerBoth state and federal laws regulate issues affecting an employee's health and safety. State law can be stricter than the federal law, it cannot be more lenient. Right-to-know laws p. 200 - Correct answerlaws that give employees access to workplace safety information. OSHA Occupational Exposure to Bloodborne Pathogens Standards P. 200 - Correct answer• Fines up to $7,000 per violation • All healthcare workers have occupational exposure • OSHA standards mandate that each employee with occupational exposure must be offered the hepatitis B vaccination at the expense of the employer. An employee may decline, in writing, to receive the vaccine. • The OSHA standard refer to urine, stool, sputum, nasal secretions, vomitus, adn sweat only if there is visible evidence of blood. • OSHA compliance checklist for medical facilities includes: - eyewash stations - fire extingishers - first-aid kits - written training programs - labels for chemical and hazardous waste - sharps containers - exit signs - spill kits - accident report forms - chemical inventory lists • OSHA guidelines are available from the U.S. Department of Labor, Washington, D.C. Occupational Exposure p. 200 - Correct answera reasonable anticipation that the employee's duties will result in skin, mucous membrane, eye, or parental contact with bloodborne pathogens or other potentially infectious material. List of Potentially Infectious Materials p. 201 - Correct answerTable 8.5 Hazard Communication Standard (HCS) p. 201 - Correct answer• An OSHA standard meant to reduce injuries and illnesses in the workforce by alerting healthcare employees to potential dangers and risks when using hazardous chemicals and materials. • MSDS must be posted wherever hazardous materials are used. • Employees are instructed to read the sheets and know how to handle the materials. doctrine of professional discretion - Correct answerThat a physician may determine, based on his or her best judgment, if the patient with mental or emotional problems should view the medical record. Privacy Act of 1974 - Correct answerFederal agencies and government contractors may maintain only information relevant to its authorized purpose. Citizens have the right to gain access to records and to copy records if necessary. open-record laws - Correct answerState freedom of information laws that grant public access to records maintained by state agencies. disclosed - Correct answerMade known. Public Health Services Act - Correct answerProtects patients who are receiving treatment for drug and alcohol abuse. electronic media record (EMR) - Correct answerFully computerized method of record- keeping of all patient-related data. encryptions - Correct answerScrambling and encoding information before sending it electronically. firewalls - Correct answerSoftware to prevent unauthorized users. microfiche - Correct answerMiniaturized photographs of records. improper disclosure - Correct answerHealthcare providers and institutions may face civil and criminal liability for releasing medical records without proper patient authorization. Privacy Rule - Correct answerall covered entities must be in compliance WLANs - Correct answerwireless systems to send and receive data HIPAA - Correct answerHealth Insurance Portability and Accountability Act of 1996 EIN - Correct answernumber assigned to to an employer clearinghouse - Correct answera billing service healthcare plan - Correct answerindividual or group that provides or pays for medical care PHI - Correct answerindividually identifiable information telemedicine - Correct answeruse of information technologies to treat people at a distance employer identifier standard - Correct answerbased on employer's tax ID or on their EIN HHS - Correct answerDepartment of Health and Human Services The Privacy Rule is meant to ensure - Correct answera and b only (standardization of health data and standardization fo financial data An example of a clearing house is - Correct answera billing service The government organization that investigaes a violation of a patient's medical privacy is called - Correct answerOCR A network of wireless communication systems used to access patient record is - Correct answerWLANs The privacy law - Correct answerdoes not apply to most police and fire departments A violation of HIPAA - Correct answeris a criminal offense When implementing HIPAA, physicians and physician groups should - Correct answerall of the above (hire a privacy officer, implement a notice of privacy practices, retain signed authorizations for at least six years, and enter into written agreements with nonemployee service providers) Covered entities include all of the following except - Correct answerpolice departments Patients' rights under HIPAA include the ability to - Correct answera, b, and c (examine their medical record, have a full copy of their medical record, and complain to the HHS if they believe their is a violation of privacy When patient information is requested via a subpoena, you must - Correct answerprovide all PHI that is requested in the subpoena Synopsis - Correct answerThe study of healthcare ethics is an applied ethics, which means that it is more than just a study of theory. Students need to understand the role of ethics in the practice of their medical discipline. A critical-thinking approach to ethics requires the student to look for a solution that includes fairness to patients, respect for society, and a concern for the future implications of the decision. This must be a decision in which the dignity of the individual is always respected. This chapter includes a brief history of ethics, codes of ethics, and a discussion of ethics committees. Bioethical issues such as transplant rationing, biomedical research, and conflicts of interest are included. Three models for examining ethical dilemmas are included in Chapter 1. Allege p. 266 - Correct answerto assert or declare without proof. Censure p. 266 - Correct answer—to find fault with, criticize, or condemn. • Physicians accused of unethical behavior can be issued a warning or censure by the AMA. Chromosome p. 279 - Correct answer—threadlike structures within the nucleus (center) of a cell that transmit genetic information. Clone - Correct answer—a group of identical matching cells that come from a single common cell. Control group p. 275 - Correct answer—research subjects who receive no treatment. Double-blind test p. 278 - Correct answer—a research design in which neither the experimenter nor the patient knows who is getting the research treatment. Euthanasia p. 275 - Correct answer—the administration of a lethal agent by another person to a patient for the purpose of relieving intolerable and incurable suffering. Expulsion p. 266 - Correct answer—the act of forcing out. Gene markers p. 279 - Correct answer—list of genes that are responsible for disease. Gene therapy p. 281 - Correct answer—the replacement of a defective or malfunctioning gene. believed that the use of stem cells will eventually allow the body to heal itself from diseases such as Parkinson's, diabetes, stroke, and Alzheimer's. Summarize the ethical issues of organ transplantation. - Correct answerThe ethical concerns for this issue are wide-ranging but include determining who receives a scarce organ, the expense of a transplant, and the sale of organs. Discuss the importance of codes of ethics such as the Nuremberg Code and the Declaration of Helsinki. - Correct answerThese codes were developed as a direct response to atrocities that occurred during wartime, especially in response to the medical experimentation in Nazi concentration camps during World War II. These codes express concern for the human subject in medical experimentation. Introduction p. 265 - Correct answer• Healthcare ethics, bioethics and medical law are intertwined. • Ethics (a branch of philosophy) in healthcare are applied ethics. • Ethics requires critical-thinking approach that examines important considerations such as fairness for all consumers, the impact on society, and future implications of the decision. • The dignity of the individual, whether it is the patient, employee,or physician must always be of paramount concern when discussing ethics and bioethics. • Bioethics concerns ethical issues discussed in the context of advanced medical technology. • An illegal act is almost always unethical. However, an unethical act may not be illegal. Early History p. 265 - Correct answer• The Hippocratic Oath reminds students of the importance of their profession, the need to teach others, and the obligation to never knowingly harm a patient or divulge a confidence. • The same principles are found in the AMA's code of ethics. Ethical Standards and Behaviors p. 266 - Correct answer• According to the AMA, ethical behavior refers to moral principles or practices, the customs of the medical profession, and matters of medical policy. • Physicians accused of unethical behavior can be issued a warning or censure by the AMA. • The AMA Board of Examiners may recommend the expulsion or suspension of a physician from the AMA, but it does not have authority to bring legal action against a physician. • The AMA is required to report to the state licensing board or governmental agency if someone alleges that a physician has committed a criminal act. • Violation and conviction may result in a fine, imprisonment, or revocation of the physician's license. • Serious cases of fraud require the loss of a physician's license. Codes of Ethics p. 267 - Correct answer• People's behavior must match their set of values. • Codes of Ethics or statements of intent are developed by professional organizations to summarize the the principles of behavior they expect of their practitioners. • The Nuremberg Code was developed in response to a wartime medical ethic atrocities; it outlines the basic ethical principles that must be followed when conducting medical research • The first AMA Code of Ethics was developed in 1847. Since then the AMA has taken a leadership role in setting such standards. • Know the code of ethics that relates to your professional practice. Many healthcare professionals keep a framed copy near their place of work to remind them of this responsibility. American Medical Association (AMA) Principles of Medical Ethics p. 267 - Correct answerThe AMA Principles of Medical Ethics discuss • Human dignity • Honesty • Responsibility to society • Confidentiality • The need for continued study • Patient autonomy • Responsibility of the physician to improve the community • Responsibility to the patient • Access to medical care Every healthcare professional who interacts with patients (even medical receptionists) must be familiar with the Principles of the AMA. Judicial Council Opinions of the AMA p. 267 - Correct answer• The Council on Ethical and Judicial Affairs of the AMA is compromised of nine members who interpret the Principles of Medical Ethics. Issues include: • Abuse • Accepting patients • Allocations of health resources • Confidential care of minors • Euthanasia • Fee splitting • Financial incentives for organ donation • Gene therapy • Ghost surgery • HIV testing • Mandatory parental consent to abortion • Physician-assisted suicide • Quality of life • Withholding or withdrawing life-prolonging treatment Codes of Ethics for Other Medical Professionals p. 269 - Correct answerANA - American Nurses Association AAMA - American Association of Medical Assistants ADA - American Dietetic Association AHIMA - American health Information Management Association ASMT - American Society for Medical Technology ASRT - American Society of Radiologic Technologitst Nurses' Code of Ethics p. 269 - Correct answerThe American Nurses Association (ANA) has developed a code for nurses. Code of Ethics for the American Association of Medical Assistants (AAMA) p. 269 - Correct answer... Bioethical Issues p. 269 - Correct answerNew bioethical issues arise almost daily due to advances in medical technology. Organ and Tissue Donation p. 271 - Correct answerIn the United States people may voluntarily donate their organs and tissues to others. They can indicate this desire in their advance directive or on their driver's license (in some states). • The most commonly donated are corneas, heart, kidneys, skin, bone marrow, blood, liver, and lungs. The long bones of the body (tibia, fibula, femur, humerus, radius, and ulna) can also be transplanted. • Some organs and tissues can be donated by a living person, such as, blood, bone marrow, and kidneys. • A U.S. law prohibits the sale of organs. Payment to cover the medical cost for the donor is allowed. • UNOS contains a database relating to every organ donation and transplant in the U.S. since 1986. • Physicians are responsible for explaining the risks involved in a research project, however, other healthcare professionals have a duty to covey information the patient tells them to the doctor. Conflict of Interest p. 277 - Correct answer• A conflict of interest can arise in research if the researcher's interests are put above the patients'. As when a researchers falsifies data so they continue to receive funding. • Physicians should not engage in drug trials for drugs made by companies that they own stock in. • Department of Clinical Bioethics p. 277 - Correct answerat the National Institute of Health Clinical Center Dear Doctor Letter p. 278 - Correct answer... Ethics of Randomized Test Trials p. 278 - Correct answer• Many ethicsists believe that control groups are unethical because that group cannot benefit form the experimental drug • Race based control groups create another ethical dilemma because people of a certain race may not receive treatment • However, race based control groups are necessary when researching a condition that only affects that particular race Problems with the Double-Blind Test p. 278 - Correct answerConsidered to be an objective means of gathering test data because it eliminates bias, an ethical question still arises. Is the process of informed consent adequate when the patient does not know if they are receiving treatment or not. Human Genome Project p. 278 - Correct answerThe goal of the Human Genome Project is to provide a map of where each gene is located on the 23 pairs, or 46 chromosomes. Genetic Engineering p. 279 - Correct answerThe ability to alter the basic structure of life to correct a malfunction is the goal of genetic engineering. Moral and ethical concerns are raised by critics who say that manipulation the human genetic code is akin to playing God. Cloning p. 279 - Correct answer• Researches claim that a major reason for developing cloning in animals is to permit the study of genetic development and genetic diseases. • Arguments against human cloning is the effect it might have on human dignity.If we control the creation of human beings, then we can eliminate the creation of imperfect human beings. • Three more oppositions to cloning are: - health risks from mutated genes - emotional risks - the risk of abusing technology • Also,since therapeutic cloning destroys a 4-d-ay-old embryo, many anti-abortionists are against it. Gene Therapy p. 280 - Correct answerA needed gene is spliced onto the DNA of a body of cells to control the production of a particular substance. • This could cure some diseases but there are unanswered questions such as: - Should gene therapy be used to create healthier fetuses? - Should companies develop tests to predict mental illness? - Could gene therapies, designed to save lives, end up being a way to choose the traits we want our children to have? Human Stem Cell Research p. 281 - Correct answer• Stem cells can be used to treat Parkinson's disease, Alzheimer's, disease, stroke, and diabetes. • The controversy revolves around the moral implications of using human embryos to obtain stem cells. • Embryos are grown in the lab, in-vitro fertilization left overs and from abortions. • Congress has banned all federal funding of stem cell research • The FDA has little jurisdiction over embryonic research • States have widely opposing views • The ban on stem cell research was lifted in 2009 • Research using stem cells from sources other than embryos is less controversial. • Some fear there are dangers of starting a practice that is ethically questionable Induced Pluripotent Stem Cells - Correct answerSomatic cells that are genetically reprogrammed to differentiate differently Whistleblowing p. 282 - Correct answer►Occurs when employees publicly report a potentially dangerous situation in their organization to authorities who can take corrective action. The employee must: • Exhaust all other channels for correcting the situation within the organization • Have documented evidence that would convince an impartial and reasonable observer. • Have a good reason to believe that by "blowing the whistle" and going public the necessary changes will be made to prevent harm and injury. ► Anonymous complaints can be made to reulatory agencies like the EPA or OSHA. ►The Occupational Safety and Health Act of 1970, the Solid Waste Disposal Act and the FDA prohibits retaliation against an employee who files a complaint with them. Federal workers are protected from losing their jobs. ►Whisteblowing is used as a last resort when all other methods for warning about a dangerous situation have failed. Healthcare Reform p. 282 - Correct answer• An estimated 50 million Americans are without healthcare • Illness has been linked to 50 percent of all personal bankruptcies in the U.S. Often the person starts out owning a home and having health insurance, but once they get sick and can no longer work, they lose their health insurance and then their homes. With out a law to protect them, they may be denied new insurance because of their preexisting condition. • Physicians no longer provide as much free care as they used to. • Medical office personnel must treat all patients with the same consideration for the patient's dignity no matter what their ability to pay. • Another cause of rising medical cost is the physicians need to practice defensive medicine to avoid potential lawsuits. • Rationing of medical resources to keep costs down but often makes patients unhappy Patient Protection and Affordable Care Act Health Reform 3590 p. 284 - Correct answerThe House passed H.R. 3590 on March 21, 2010 and was approved by the Senate on December 24, 2009. Major components include: • A provision that allows individuals who already have healthcare coverage to retain their coverage if desired • A provision also applies to employers who currently offer coverage. • Patients who are not eligible under Medicare and Medicaid will be required to maintain minimum coverage beginning after 2013. There will be a fine for failing to retain coverage. • A tax credit and reduced cost sharing, on a sliding scale, for qualified individuals. • An expansion of Medicaid • The act does not require employers to provide healthcare coverage, However, if they do not, they may be liable for an additional tax. • Hospitals would be required to conduct periodic community health needs assessments. slippery slope - Correct answerpredicting (without justification) that one step in a process will lead unavoidably to a second, generally undesirable step