Ethics in Medicine

For part 1 and 2 below, please email me your file with the following file name: "2013-02-19-Ethics-yourname". These are due by next Tuesday at midnight.

PART I: Use the recommended links below (and also some other trusted websites) to answer the following questions:

1. Health care institutions are obligated to translate or simplify the patient bill of rights to ensure that their patients are able to understand the document. If you can find another copy of the patient bill of rights, you can use that! As a human relations employee at a hospital located in a low-socioeconomic area, you have been assigned to the task of re-writing #1 - #7 at a sixth grade reading level to accommodate non-native English speaking patients and patients that are poor readers. Adapt each (#1-7) point to a lower reading level but be careful not to lose the overall meaning of the statement.

2. Review further information on OBRA here. What brought about OBRA? How might the components of OBRA improve living conditions for residents of nursing homes?

3. Explain the relationship between confidentiality and HIPAA. Is ALL patient information required to be kept confidential at ALL TIMES? Are there any exceptions?  Explain.

4. You are an oncologist (cancer doctor) dealing with a terminal patient. The patient complains that he is confused and overwhelmed because his family is pressuring him to make end of life decisions. His oldest son has told the patient that he should turn over all decision making to him before he becomes too sick to make his own decisions. Reassure your patient by explaining PSDA and living will options.

 PART II: Read the following scenarios and then answer the questions below: 

A. Mr. Duke v. Dr. Rodriguez and University Hospital

Points of law to consider about informed consent:

· A competent individual has the authority to refuse lifesaving treatment

· A physician who treats a patient despite the patient’s refusal is liable for assault and battery

· A person is considered to be competent unless the evidence shows otherwise

Mrs. Duke died of respiratory failure on July 24, 2007. Her breathing tube became dislodged that day and she and Mr. Duke refused, for more than two hours, to allow the medical personnel to reinsert it. After she finally consented to the re-intubation, an emergency room physician performed the procedure. Several minutes later however, Mrs. Duke coded and she was pronounced dead at 6:30 AM.

The plaintiff argues that Dr. Rodriguez should have gone to the hospital and re-intubated Mrs. Duke despite her wishes. During the trial, Dr. Rodriguez established that he would not have performed the re-intubation without the patient’s consent, even if he had gone to the hospital that morning. Nurse McKay, one of the ICU nurses who cared for Mrs. Duke throughout the morning, testified that patient’s breathing tubes frequently become dislodged. She stated that the emergency room physician would have been called to perform the re-intubation the moment Mrs. Duke signed the consent form.

Dr. Bone was the medical expert for the Dukes. He stated that Dr. Rodriguez’s conduct fell below the standard of care because: 1) Mrs. Duke was not competent to refuse intubation, 2) the situation was an emergency and Mrs. Duke’s consent was therefore implied, 3) Dr. Rodriguez should have gone to Mrs. Duke’s bedside to evaluate her competency, 4) a timely intubation would have saved Mrs. Duke’s life. According to Dr. Bone, “Mrs. Duke was in no position to judge appropriate therapy for herself and make a rational decision.”

Nurse McKay, three other ICU nurses, and Dr. Franks, the emergency room physician who eventually re-intubated Mrs. Duke, testified that the entire period of time Mrs. Duke was without a breathing tube she was awake, alert, oriented, and asking appropriate questions. In Nurse McKay’s chart notes at 4:00AM it was written that Mrs. Duke “was informed of and understood the risk of death if the tube is not timely reinserted.”

ANALYSIS QUESTIONS: Discuss the points of law for informed consent. Why didn't the medical personnel re-intubate Mrs. Duke? Were their actions appropriate? Explain. Are Dr. Bone's arguments valid? Explain. If you were a jury member in this case how would you rule? Explain.

B. Myrtle Otis v. University Hospital

In this case, consider the following legal standard:

·     In a wrongful death lawsuit, the plaintiff must prove more likely than not that the death was caused by the defendant’s negligence.

On October 10, 2009, at 10:00 AM, Harry Otis suffered lower abdominal pain and fainted at home. His wife called the office of his gasteroenterologist, Dr. Land, to inform Dr. Land of these symptoms. Dr. Land told Mrs. Otis to call an ambulance and have Mr. Otis transported to the University Hospital emergency room. Mr. Otis was transported to the emergency room and arrived at 10:25 AM. The emergency room staff was informed by Mrs. Otis that Dr. Land said he would meet them in the emergency room. The emergency room staff did not take a history or examine Mr. Otis in the belief that Dr. Land was coming to the emergency room and would arrive shortly. Dr. Land did not respond to the emergency room’s page at 10:30AM or 10:40AM because he was performing a procedure on another patient in the hospital’s outpatient clinic.

Mr. Otis complained of increasing abdominal pain and asked to use a bedpan at 10:50AM. Soon after straining on the bedpan, Mr. Otis could not catch his breath. Dr. Land arrived in the emergency room at 10:55AM and had just entered Mr. Otis’ room when Mr. Otis went into cardiac arrest. Mr. Otis died 35 minutes after arriving at the hospital. The autopsy revealed that he died from a ruptured abdominal aneurysm which caused massive internal bleeding.

Mrs. Otis brought a wrongful death action against the hospital alleging negligence by the emergency room staff in not taking a history and failing to physically examine Mr. Otis. Mrs. Otis’ expert witness, Dr. John Baily, a cardiologist, testified that the inaction by the emergency room staff violated acceptable medical standards.

The hospital’s expert witness, Dr. Candel, a thoracic surgeon, testified that someone in Mr. Otis had no better chance to survive if there had been an immediate diagnosis of the aneurysm and emergency surgery.

· ANALYSIS QUESTIONS: Do you think Dr. Land is at fault? Explain

· Do you think the hospital is at fault? Explain

· Is there sufficient evidence to prove the wrongful death of Mr. Otis? Explain.