This document provides an overview of end-of-life issues and ethics. It discusses key concepts around patient autonomy, advance directives, withdrawal and withholding of treatment, medical futility, and do-not-resuscitate orders. It also covers ethics committees and their role in consulting on patient care issues. Organ donation, research, and genetics are discussed in relation to end-of-life decisions. The document concludes with review questions on various topics covered.

1. Chapter 15
End-of-Life Issues
LEARNING OBJECTIVES
• Discuss the human struggle to survive and the
right to autonomous decision-making.
• Describe how patient autonomy has been
impacted by case law and legislative enactments.
• Discuss the following concepts: preservation of
life with limits, euthanasia, advance directives,
futility of treatment, withholding and withdrawal
of treatment, and do-not-resuscitate orders.
LEARNING OBJECTIVES – II
• Discuss the purpose of an ethics committee
and its consultative role in the delivery of
patient care.
• Explain end-of-life issues as they relate to
autopsy, organ donations, research
experimentation, and clinical trials.

2. • Describe how human genetics and stem cell
research can have an impact on end-of-life
issues.
Dreams of Immortality
• Human struggle to survive
• Desire to prevent & cure illness
• Advances in medicine & power to prolong life
• Process of dying can be prolonged
• Ethical & legal issues have increased
– involving entire life span, from right to be
born to right to die
Scope of Ethical Issues
• Entire Life Span
• The Right to be Born
• The Right to Die, &
• Everything in between, e.g.,
– to choose treatment

3. – to refuse treatment for oneself
– to refuse treatment for another
– to limit the suffering one would endure
Ethical Dilemmas Arise
When values,
rights,
duties
& loyalties conflict.
Autonomy
• Right of a person to make one’s own decisions.
• Patient has right to accept or refuse care even
if it is beneficial to saving his or her life.
• Autonomy may be inapplicable in certain
cases
– affected by one’s disabilities, mental status,
maturity, or capacity to make decisions.
Quinlan court

4. Relying on: Roe v. Wade
• Announced the constitutional right to privacy
protects a patient’s right to self-
determination.
• State’s interest did not justify interference
with her right to refuse treatment.
• Quinlan’s father was appointed her legal
guardian
Cruzan Case
• Supreme Court held that right-to-die should be
decided pursuant to state law, subject to a due-
process liberty interest, and in keeping with state
constitutional law.
• Cruzans returned to Missouri probate court:
– Judge Charles Teel authorized physicians to
remove the feeding tubes from Nancy.
– testimony presented demonstrated clear &
convincing evidence Nancy would not have
wanted to live in a persistent vegetative state.
Legislative Response: Patient Self-
Determination Act of 1990
• Requires healthcare organizations to explain

5. to patients their legal right to direct their own
care
• Right to refuse medical treatment
• Right to formulate advance directives
• Right to appoint surrogate decision-maker
• Federal reimbursement requires compliance
with Act
Preservation of Life
• Medical ethics does not require patient’s life
be preserved at all cost under all
circumstances.
• Ethical integrity
– of a profession is not compromised by a
patient’s decision to forego medical care.
• Right to body integrity.
Euthanasia
• Mercy killing of hopelessly ill, injured or
incapacitated
• Active

6. – intentional commission of an act, such as
giving patient lethal drug
• Passive
– occurs when life-saving treatment (such as
a respirator) is withdrawn or withheld
Physician-Assisted Suicide
• Oregon’s Death with Dignity Act of 1994
– physician-assisted suicide became a legal medical
option for the terminally ill residents
• U.S. Supreme Court, in two unanimous & separate
decisions, ruled
– laws in Washington & New York prohibiting
assisted suicide are constitutional
– yet U.S. Supreme Court also ruled that states can
allow doctors to assist in suicide of their
terminally ill patients.
Advance Directives – I
• Making Preferences Known
– Obligation to make medical preferences
known to treating physician.

7. – Any glimmer of uncertainty as to a patient's
desires in an emergency situation should be
resolved in favor of preserving life.
Advance Directives – II
• Living Will
• Health Care Proxy
• Determining Incapacity
• Agent’s Rights
• Durable Power of Attorney
• Guardianship
• Substituted Judgment
Futility of Treatment
• Physician recognizes effect of treatment will
be of no benefit to the patient.
• Morally, a physician has a duty to inform
patient when there is little likelihood of
success.
• Determination as to futility of medical care is a
scientific decision.

8. Withholding & Withdrawing
Treatment – I
• Withholding of treatment
– decision not to initiate treatment or medical
intervention for the patient.
• Withdrawal of treatment
– decision to discontinue treatment or medical
interventions for the patient.
Withholding & Withdrawing
Treatment - II
• When
– Patient in a terminal condition & there is
reasonable expectation of imminent death.
– Patient a non-cognitive state with no reasonable
possibility of regaining cognitive function.
– Restoration of cardiac function will last but for a
brief period.
DNR Orders
• DNR orders written by a physician, indicate

9. that in event of cardiac or respiratory arrest,
no resuscitative measures should be used to
revive patient.
Ethics Committee
• Committee offering objective counsel when
facing difficult health care issues & decisions
resource to patients, families, & staff.
• Includes wide range of community leaders.
• Analyzes ethical dilemmas, advise & educate
health care providers, patients, & families.
• Assists patients & family in coming to
consensus with options that best meet
patient's care needs.
Ethics Committee Function
• Policy & procedure development
• Educational role
• Consultative role
• Political Advocacy
Autopsy

10. • Postmortem examinations to determine cause
of death.
• Add to medical knowledge.
• Necessary for criminal activity or suspicious
deaths.
• Deaths during surgery are reportable.
• Consent required.
Organ Donations – I
• Federal regulations
– hospitals to have, & implement, written
protocols regarding organ procurement.
– notification duties concerning informing
families of potential donors.
• Discretion & sensitivity in dealing with
families.
Organ Donations – II
• Education
– facilitate timely donation & transplantation

11. • Uniform Anatomical Gift Act
– allows a person to make a decision to
donate organs at the time of death and
allows potential donors.
Organ Donations – III
• Millions of people suffer from kidney disease,
but in 2007 there were just 64,606 kidney-
transplant operations in the entire world. In
the U.S. alone, 83,000 people wait on the
official kidney-transplant list. But just 16,500
people received a kidney transplant in 2008,
while almost 5,000 died waiting for one.
—Alex Tabarrok, The Wall Street Journal,
January 8, 2010
Research, Experimentation
& Clinical Trials
• Combination of federal & state regulations
– Office of Research Integrity
• Institutional Review Board
• Informed Consent
• Duty to Warn

12. – Risks, benefits, alternatives
• Food & Drug Administration
Organ Human Genetics – I
• Study of inheritance as it occurs in human
beings, includes stem cell research, clinical
genetics (e.g., genetic disease markers) &
molecular genetics.
• Genetic markers are genes or DNA sequences
with a known location on a chromosome that
can be used to
– identify specific cells & diseases
– individuals & species
Organ Human Genetics – II
• Genetic Information Nondiscrimination Act of
2008 prohibits
– discrimination on the basis of genetic
information with respect to the availability
of health insurance & employment
– employers from using an individual’s
genetic information when making hiring,
firing, job placement, or promotion
decisions

13. STEM CELL RESEARCH
• Use of embryonic stem cells to create organs
and various body tissues.
– highly controversial, involving religious
beliefs and fears as to how far scientists
might go in their attempt to create, e.g.,
another human being.
When We Finally Know
… When we finally know we are dying,
All sentient beings are dying with us,
We start to have a burning, almost heart-
breaking sense of the fragility and
preciousness of each moment and each being,
and from this can grow a deep, clear, limitless
compassion for all beings.
−Sogyal Rinpoche
REVIEW QUESTIONS – I
1. Discuss how one caregiver’s beliefs can be in
conflict with another when making end-of-life
decisions. Consider topics discussed on morality,

14. virtues, situational ethics, autonomy, and medical
paternalism when framing your answer.
2. Discuss the ever-expanding role of ethics
committees, including internal operational issues &
external influences that affect internal operations.
3. What are the differences between allowing a
patient to die and physician-assisted suicide?
REVIEW QUESTIONS – II
4. Examine the statement: "The inherent risk is
that society's faith in doctors as healers
would become subverted if doctors
participate in physician-assisted suicide.“
5. Constitutionally, what gives patients the right
to self-determination?
6. Explain why you think the Schiavo case is an
example of legislating morality.
Chapter 14
Procreation and Ethical
Dilemmas

15. LEARNING OBJECTIVES
• Discuss the 1973 Supreme Court ruling in Roe v.
Wade and the continuing controversy over abortion.
• Describe the flow of abortion cases beginning with
Roe v. Wade, concentrating on counseling, spousal
consent, parental consent, and funding.
• Explain the legal issues of sterilization artificial
insemination, and surrogacy.
• Describe the legal and moral issues of wrongful birth,
wrongful life, and wrongful conception.
Abortion
• Premature termination of pregnancy.
• It can be classified as spontaneous or induced.
• It may occur as an incidental result of a
medical procedure or it may be an elective
decision on the part of the patient.
U.S. SUPREME COURT DECISIONS
Section

16. Right to Abortion
Roe v. Wade – 1973
• First Trimester
– abortion decision between woman & physician.
• Second Trimester
– state may reasonably regulate abortion
procedure.
• Third Trimester
– state may prohibit all abortions except those
deemed necessary to protect maternal life or
health.
Abortion Committee Requirement
Doe v. Bolton – 1973
• To Restrictive
• Requirements struck down
– residency
– performance of abortion by Joint Commission
approved hospital
– approval of abortion by a medical staff committee
– consultations

17. Abortion Funding
• Not Required for Elective Abortions
– In Beal v. Doe, 1977
– Court ruled that it is not inconsistent with the
Medicaid portion of the Social Security Act to
refuse to fund unnecessary medical services.
– Maher v. Roe
– Supreme Court voted 6 to 3 states may refuse to
spend public funds to provide non-therapeutic
abortions.
• Not Required for Therapeutic Abortions
Funding Bans
Unconstitutional in California
• If the state cannot directly prohibit a woman's
right to obtain an abortion, may the state by
discriminatory financing indirectly nullify that
constitutional right?
• Can the state tell an indigent person that the
state will provide him with welfare benefits
only upon the condition that he join a
designated political party or subscribe to a
particular newspaper that is favored by the
government?

18. Funding Bans
Unconstitutional in California
• Can the state tell a poor woman that it will
pay for her needed medical care but only if
she gives up her constitutional right to choose
whether or not to have a child?
Discrimination in Funding Prohibited
Simat Corp. v. Arizona Health Care Cost Containment Sys.
• The Arizona Supreme Court in Simat Corp. v.
Arizona Health Care Cost Containment Sys., found
that the state's constitution does not permit the
state & the Arizona Health Care Cost
Containment System to refuse to fund medically
necessary abortion procedures for pregnant
women suffering from serious illness while, at the
same time, funding such procedures for victims
of rape or incest or when the abortion was
necessary to save the woman's life.
States May Protect Viable Fetus
Colauti v. Franklin 1979
• The Supreme Court in Colautti v. Franklin
voted 6 to 3 that states may seek to protect a
fetus that a physician has determined could
survive outside the womb. Determination of
whether a particular fetus is viable must be a

19. matter for judgment of the physician.
Consent – I
• Missouri: Parental Consent Statute Ruled
Unconstitutional
• Massachusetts: Parental Consent Statute
Ruled Unconstitutional
• Utah: Notifying Parent for Immature Minor
Constitutional
• Consent Not Required for Emancipated Minor
Consent – II
• Parental Notification Not Required
• Minor’s Decision to Abort Found Sufficient
• Abortion Case Returned to Lower Court
• Minor’s Decision to Abort Not Sufficient
• State Interest Not Compelling
Consent – III
• Spousal Consent Requirement

20. Unconstitutional
• Father of Unborn Fetus Could Not Stop
Abortion
• Spousal Consent Undue Burden
Parental Consent
Bellotti v. Baird – 1979
• Parental consent requirement struck down.
• MA statute too restrictive.
– statute as written & construed, no minor, no
matter how mature & capable of informed
decision making, could receive an abortion
without the consent of either both parents or a
superior court judge, making minor's abortion
subject in every instance to an absolute third-
party veto.
Parental Notification Not Req’d
Planned Parenthood v. Owens – 2000
• Colorado Parental Notification Act, Colo. Rev.
Stat. § § 12-37.5-101, et seq. (1998), which
required physician to notify parents of a minor
prior to performing an abortion upon her,
violates minor's rights protected by the U.S.
Constitution.

21. • The act generally prohibited physicians from
performing abortions on an unemancipated
minor until at least 48 hours after written
notice has been delivered to minor's parent,
guardian, or foster parent.
Immature Minors
H.L. Matheson 1981
• Statute requiring physician to notify parents of
minor, when possible, upheld.
• Parental notice does not violate constitutional
rights of immature, dependent minor.
• State may not, however, legislate a blanket un-
reviewable power of parents to veto their
daughter’s abortion.
Emancipated Minors
In re Anonymous – 1987
• Consent Not Required for Emancipated Minor.
Spousal Consent Not Required
Doe v. Zimmerman – 1975
• Provisions Pennsylvania Abortion Control Act
requiring written consent of the husband
unconstitutional.

22. • Provisions impermissibly permitted husband to
withhold his consent either because of his
interest in potential life of the fetus or for
capricious reasons.
• Although father's interest in the fetus was
legitimate, it did not outweigh the mother's
constitutionally protected right to an abortion.
Abortion Rights Reaffirmed
Planned Parenthood v. Casey – 1992
• Restricting Right to Abortion Affirmed
– right of women to have an abortion.
– State’s power to restrict abortions after
fetal viability.
– principle that state has legitimate interests
in protecting woman & life of fetus.
Abortion Rights Reaffirmed
Casey, con’t - 1992
• Undue burden to require spousal notification
• Not undue burden to require:
– informed consent of nature of abortion procedure
& risks involved.

23. – informed consent be provided before abortion
– information be provided on the fetus &
alternatives to abortion
– parental consent be given a minor seeking
abortion, providing for judicial bypass option
– 24-hour waiting period before any abortion can be
performed.
Abortion Counseling
City of Akron v. Akron Center – 1983
• Physician Counseling of Patient Upheld
– States cannot mandate what information
physicians provide abortion patients.
• Hospital deliveries
– States cannot mandate that abortions for
women over 3 months pregnant be
performed in hospital.
Prohibition Abortion Counseling
Rust Sullivan – 1991
• Regulations prohibiting abortion counseling &
referral by family planning clinics that receive
funds under Title X were held to be
constitutional.

24. 24-Hour Waiting Period
Not Burdensome
• State may place some restrictions on
previability abortions.
• Restrictions must not impose an “undue
burden” on woman.
Incompetent Persons
• An abortion was found to have been proper
by a family court in In re Doe
– for retarded woman
– court properly chose welfare agencies as
guardian
– mother apparently had little contact with
her daughter
Viability Test Required
Webster v. Reproductive – 1989
• Statute upheld providing that no public
facilities or employees should be used to
perform abortions.

25. • Physicians should conduct viability tests
before performing abortion.
Partial Birth Abortion – I
• D&E Ban Constitutionally Vague
– Women’s Medical Professional Corp. v.
Voinovich
• Partial-Birth Abortion Ban Act
Unconstitutional
– Little Rock Family Planning Services v. Jegley
• Partial-Birth Abortion Statute Vague
– Planned Parenthood of Cent. N.J. v. Farmer
Partial Birth Abortion II
• Partial-Birth Abortion: Ban Unconstitutional
• 2002 Stenberg v. Carhart
– ban lacked an exception to protect the
health of the mother
• 2003: President Bush signs federal restrictions
banning late term abortions.

26. Partial Birth Abortion – III
• 2005 Partial-Birth Abortion Act
– 2005: Bush administration asked the Supreme
Court to review an appellate court's decision
holding the Partial Birth Abortion Act of 2003
unconstitutional.
• 2006: U.S. Supreme Court Justices heard oral
arguments on November 8 in what may be two of
the most significant abortion rights cases in decades.
The dispute involves Congress’s ban on partial birth
abortion.
Partial Birth Abortion – IV
• Partial-Birth Abortion Act: First Federal
Restrictions
– 2006 National Abortion Federation v.
Gonzages
» ban lacked an exception to preserve
health of mother
Continuing Controversy
• Physician Concern
– Antiabortion Demonstrations

27. – Obstructing Access to Abortion Clinics
Abortion & Conflicting Beliefs
• Two or more ethical principles in conflict with one
another considered “ethical dilemmas.
• Morality of Abortion
– not a legal or constitutional issue
– matter of philosophy, ethics, & theology
– subject where reasonable people can, and do,
adhere to vastly divergent convictions and
principles
– Obligation to define liberty of all
– not to dictate our own moral code.
Sterilization
• Termination of the ability to produce offspring
– Elective Sterilization
– Regulation of Sterilization for Convenience
– Therapeutic Sterilization
– Involuntary/Eugenic Sterilization

28. Artificial Insemination
• Injection of seminal fluid into a woman to
induce pregnancy, takes place outside of the
woman’s
– Homologous artificial insemination
– Heterologous artificial insemination
– Consent Required
– Confidentiality must be maintained
Surrogacy
• Method of reproduction whereby a woman
agrees to give birth to a child she will not raise
but hand over to a contracted party
• Surrogate may be the child’s
– genetic mother
– gestational carrier
Wrongful Birth,
Life & Conception
• Wrongful Birth

29. • Wrongful Life
• Wrongful Conception
• Prevention of Lawsuits
REVIEW QUESTIONS – I
1. Discuss the legal and ethical issues involved in
Roe v. Wade.
2. Do you agree that individual states should be
able to place reasonable restrictions or
waiting periods? Discuss your answer.
3. Should a married woman be allowed to abort
without her husband's consent?
4. Discuss arguments for & against partial-birth
abortions.
REVIEW QUESTIONS – II
5. Explain why you think Roe v. Wade is an
example of legislating morality.
6. Do you agree that eugenic sterilization should
be allowed? Why or why not?
7. Describe the distinctions among wrongful
birth, wrongful life, and wrongful conception.

30. Chapter 13
Patient Consent
© 2014 Jones and Bartlett Publishers
LEARNING OBJECTIVES – I
• Explain the concept of informed consent.
• Discuss the difference between verbal,
written, and implied consent.
• Describe the role of the patient, physician,
nurse, and hospital in informed consent.
© 2014 Jones and Bartlett Publishers
LEARNING OBJECTIVES – II
• Explain how consent differs between
competent patients, minors, guardians, and
incompetent patients.
• Discuss under what circumstances a patient
might refuse treatment.

31. • Explain the available defenses for defendants
as it relates to informed consent.
© 2014 Jones and Bartlett Publishers
Consent
• Voluntary agreement by a person who possesses
sufficient mental capacity to make an intelligent
choice to allow something proposed by another to
be performed on himself or herself.
© 2014 Jones and Bartlett Publishers
Forms of Consent
– Express consent
• Verbal
• Written
– Implied consent
• Act or silence raising presumption consent has been
authorized
– e.g., treatment of accident victim
© 2014 Jones and Bartlett Publishers
Informed Consent

32. • Legal doctrine where a patient has right to know
potential risks, benefits, & alternatives of a proposed
procedure.
• Patient has absolute right to know about & select
from available treatment options.
© 2014 Jones and Bartlett Publishers
Physicians
Informed Consent
• Informed consent is predicated on the duty of
the physician to disclose sufficient info to
enable the patient to evaluate proposed
medical or surgical procedures before
submitting to them.
• Physicians expected disclose risks, benefits, &
alternatives of recommended procedures.
– Disclosure: what a reasonable person would
consider material to a decision of whether to or not
to undergo treatment.
© 2014 Jones and Bartlett Publishers
Nurses
Informed Consent
• Nurses most cases have no duty to

33. – advise a patient as to a surgical procedure to be employed
– may confirm physician has explained the procedure
– witness patient’s signature on consent form
© 2014 Jones and Bartlett Publishers
Hospitals
Informed Consent
• Not generally responsible for informing
patients as to the risks, benefits and
alternatives.
• Some cases in which hospitals have a duty
– CT Scans
– MRI Imaging
© 2014 Jones and Bartlett Publishers
Patients
Informed Consent
• Patient's ability to:
– understand risks, benefits, & alternatives
– evaluate info provided by the physician

34. – express his or her treatment preferences
– voluntarily make decisions regarding his or her treatment
plan
© 2014 Jones and Bartlett Publishers
Course of Treatment
Patient’s Decision – I
Elderly woman living alone fell & fractured her hip.
An orthopedic surgeon reviewed the patient's
condition & decided that rather than utilizing a
pinning procedure for her hip, it would be better to
adopt a conservative course of treatment, bed rest.
© 2014 Jones and Bartlett Publishers
Course of Treatment
Patient’s Decision – II
• Prior to her injury, plaintiff maintained an
independent style of living.
• Expert testimony at trial indicated that bed rest was
an inappropriate treatment.
– Was the patient successful for not being informed
as to alternatives courses of treatment?
© 2014 Jones and Bartlett Publishers

35. Yes!
Court’s Decision
• Court held that it is necessary to advise a
patient when considering alternative courses
of treatment. The physician should have
explained medically reasonable invasive &
noninvasive alternatives, including risks &
likely outcomes of those alternatives, even
when the chosen course is noninvasive.
−Matthies v. Mastromonaco
© 2014 Jones and Bartlett Publishers
Lack of Consent – I
Patient had multiple medical diagnoses. Her
physician, Dr. Sottiurai, ordered bilateral
arteriograms to determine cause of the patient's
impaired circulation. De La Ronde Hospital could not
accommodate Sottiurai's request & patient was
transferred to Dr. Lang, a radiologist at St. Jude
Hospital.
© 2014 Jones and Bartlett Publishers
Lack of Consent – II
Lang performed a femoral arteriogram, not the

36. bilateral brachial arteriogram ordered by Sottiurai.
The patient was prepared for transfer back to De La
Ronde Hospital. Shortly after the ambulance
departed, patient suffered a seizure in the
ambulance & was returned to St. Jude. Riser's
condition deteriorated & died 11 days later.
– What did the trial court determine?
© 2014 Jones and Bartlett Publishers
Trial Court Decision
– The district court ruled for the plaintiffs, awarding
damages in the amount of $50,000 for Riser's pain
and suffering and $100,000 to each child. Lang
appealed.
– On appeal, what did the appeals court determine?
© 2014 Jones and Bartlett Publishers
Appeals Court’s Decision
• The Court of Appeal held that Lang breached
the standard of care by subjecting the patient
to a procedure that would have no practical
benefit to the patient, that Lang failed to
obtain informed consent from the patient.
−Riser v. American Medican Intern, Inc.

37. © 2014 Jones and Bartlett Publishers
Information to be Disclosed – I
• Physician should provide as much information about
treatment options as necessary based on a patient's
personal understanding of physician's explanation of
risks of treatment & probable consequences of
treatment.
• Needs of each patient can vary depending on age,
maturity, & mental status.
© 2014 Jones and Bartlett Publishers
Information to be Disclosed – II
• Individual responsible for obtaining consent must
weigh importance of giving full disclosure to the
patient against likelihood such disclosure will
adversely affect the patient’s decision.
© 2014 Jones and Bartlett Publishers
Information to be Disclosed – III
• Courts generally utilize an "objective" or
"subjective" test
– to determine if a patient would have refused

38. treatment if the physician had provided adequate
information
• as to the risks, benefits, & alternatives of the
procedure.
© 2014 Jones and Bartlett Publishers
Objective Test
• Take into account characteristics of the plaintiff
– idiosyncrasies, fears, age, medical condition, and
religious belief
• Must show that a “reasonable person” would not
have undergone a procedure if properly informed.
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Subjective test
• Relies on credibility of the patient’s testimony
• Patients must testify & prove they would not have
consented to the procedure(s) had they been
advised of the risks.
© 2014 Jones and Bartlett Publishers

39. Adequacy of Consent
• Patient understand risks, benefits, &
alternatives
• Evaluate the information provided
• Express treatment preferences
• voluntarily make decisions regarding
treatment plan
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Written Consent Describes – I
• Nature of the patient’s illness
• Procedure consented to
• Risks & probable consequences of the
procedure
• Probability that the proposed procedure will
be successful
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Written Consent Describes – II
• Alternative methods of treatment
• Associated risks & benefits of each

40. • Indication the patient understands nature of
proposed treatment
• Signatures dated & signed
– patient
– physician
– witnesses
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Special Forms of Consent
• Consent for Routine Procedures
• Consent for Specific Procedures
• Implied Consent
• Statutory Consent
• Judicial Consent
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Statutory Consent
• Consent generally assumed

41. – Ambulance Care
• Good Samaritan Statutes
– Emergency Departments
• When patient clinically unable to give consent
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Judicial Consent
• May be periodically necessary
• When alternatives exhausted
• 2nd opinions by consulting physicians helpful
• On-call legal advice should be sought
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Who May Consent
• Competent patients
• Guardianship
• Consent for minors
• Incompetent patients

42. • Limited Power of Attorney
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Right to Refuse Treatment
• For any or no reason
– Mere whim
– Religious Beliefs
–Blood or blood products
– Impatience
• Text Case: Good People Bad Decisions
© 2014 Jones and Bartlett Publishers
Release Form
• Completed release provides documented
evidence of a patient's refusal to consent to a
recommended treatment.
• Patient's refusal to consent to treatment, for
any reason, religious or otherwise, should be
noted in the medical record.
• A release form should be executed.

43. © 2014 Jones and Bartlett Publishers
Informed Consent Defenses
• Risk not disclosed is commonly known.
• Patient assured practitioner he would undergo
treatment regardless of the risk.
• Consent not reasonably possible.
• Patent did not want to know about the risks.
• Physician disclosed what he considerable reasonable
© 2014 Jones and Bartlett Publishers
Ethics
Informed Consent
• Individual Autonomy
– Informed consent protects the basic right of the
patient to make the ultimate informed decision
regarding the course of treatment to which he or
she knowledgeably consents.
© 2014 Jones and Bartlett Publishers
REVIEW QUESTIONS – I

44. 1. Who should be responsible for reviewing with the
patient the risks, benefits, and alternatives of a
proposed diagnostic test or treatment?
2. Describe what information a patient should be
provided prior to undergoing a risky procedure in
order for consent to be informed.
3. Why is it important to obtain consent from a
patient prior to proceeding with a risky procedure?
© 2014 Jones and Bartlett Publishers
REVIEW QUESTIONS – II
4. Can a patient consent to a procedure and then
withdraw it?
5. Can a parent refuse to consent to a lifesaving
procedure for his or her child? Discuss your answer.
6. Discuss how much information is sufficient in order
for informed consent to be effective (e.g., consider
your answer here from both the objective and
subjective forms of consent).
© 2014 Jones and Bartlett Publishers
REVIEW QUESTIONS – III
7. Discuss the implications of the following
statement: "Patients are generally persons unlearned
in the medical sciences and, therefore, except in rare

45. instances, the knowledge of patient and physician is
not in parity."
© 2014 Jones and Bartlett Publishers
Chapter 12
Patient Rights &
Responsibilities
LEARNING OBJECTIVES
• Discuss the importance of understanding
patient rights.
• Discuss the importance of understanding
patient responsibilities.
• Describe the Advisory Commission on
Consumer Protection and Quality in the
Health Care Industry’s listing of patient
responsibilities.
Patient Rights – I
• Right to Examination & Treatment

46. • Right to Ask Questions
– clarification of caregiver’s instructions
– interpretation of caregivers’ handwriting
– instructions for medication usage
• frequency
• dosing
• side effects, drug-drug & food-drug interactions
Patient Rights – II
• Right to Know Your Rights
• Right to Explanation of Your Rights
• Right to Admission
• Right to Have Special Needs Addressed
• Right to Know Caregivers
• Right to Appoint Decision Makers
• Right to Execute Advance Directives
• Right to Compassionate Care
• Right to Quality Care
• Right to Dignity and Respect
Patient Rights – III
• Right to Refuse Treatment
• Right to Discharge
• Right to Stabilization and Transfer

47. • Right to Access Records
• Right to Know Third-Party Care Relationships
• Right to Pain Management
• Right to Know Restrictions on Rights
• Right to Transparency
– Hospital Charges
Patient Responsibilities – I
• Practice a Healthy Lifestyle
• Maintain Medication Records
• Keep Appointments
• Provide Full Disclosure of Medical History
• Inpatient Care Responsibilities
• Stay Informed
• Comply with Rules and Regulations
Patient Responsibilities – II
Provide Caregivers
• Accurate, timely, & complete information
• Medical complaints
• Symptoms

48. • Past illnesses
• Treatments
• Surgical procedures
• Hospitalizations
• Medications
Patient Responsibilities – III
• Report Unexpected Changes in Condition
• Understand
– plan of care
– course of treatment
– care instructions
• Ask Questions
– This is not only a right, it is a responsibility
Patient Responsibilities – IV
• Report Pain to Caregivers
• Follow Recommended Treatment Plan

49. • Follow organization’s rules & regulations
• Refrain from self-administration of drugs
• Accept Consequences of
– refusing treatment
– not following instructions
Patient Responsibilities – V
• Be Considerate of the Rights of Others
– caregivers
– control of noise
– avoid smoking
– limit number of visitors
• Be Respectful of the Property of Others
• Recognize Effect of Lifestyle on One’s Health
Patient Responsibilities – VI
• Keep Appointments
• Request 2nd Opinion

50. • Confirm Surgery & Surgical Site
• Inform Caregivers of Care preferences
– who the surrogate decision-maker is
PATIENT ADVOCACY
• Caregivers are patient advocates because of
their position to help patients who are often
helpless & unable to speak for themselves.
• Many states have established ombudsperson
programs responsible for the investigation of
reports of abuse.
REVIEW QUESTIONS – I
1. When considering a person's religious beliefs,
should the state have a right to interfere with
a mother's decision to refuse a blood
transfusion? Why?
2. Should a hospital be able to raise whatever
interest the state itself may have in seeking
to compel an unwilling patient to undergo a
routine, lifesaving medical procedure?
Explain.

51. REVIEW QUESTIONS – II
3. Describe why a patient's responsibilities are
as important as his or her rights.
4. Discuss the ramifications of the following
statement: It is the patient's responsibility to
communicate to the staff any symptoms that
he or she is experiencing.