Instructor Manual for Applied Law and Ethics in Health Care 1st Edition by Wendy Mia Pardew

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 1: The Big Business of Health Care and You

Instructor Manual Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 1: The Big Business of Health Care and You

Table of Contents Purpose and Perspective of the Chapter .................................................................................................... 2 Chapter Objectives ..................................................................................................................................... 2 Key Terms ................................................................................................................................................... 2 What's New in This Chapter ........................................................................................................................ 3 Chapter Outline .......................................................................................................................................... 4 Discussion Questions .................................................................................................................................. 5 Additional Resources .................................................................................................................................. 5 Internet Resources ............................................................................................................................................ 5 Appendix ..................................................................................................................................................... 7 Generic Rubrics .................................................................................................................................................. 7 Standard Writing Rubric .................................................................................................................................... 7 Standard Discussion Rubric ............................................................................................................................... 7

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

1

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 1: The Big Business of Health Care and You

Purpose and Perspective of the Chapter The purpose of this chapter is to give the learner an understanding of their crucial role in the health care system. Chapter 1 advises how understanding legal and ethical responsibility will protect these new health care professionals, their employers, and their patients. The chapter discusses differences among skill sets, scope of practice, and standards of care with information about how to proceed if there is a concern about employer assigned tasks. Patient protections in terms of patient rights and mandatory reporting for public health are addressed. Finally, the chapter reviews types of business entities and health care organizations that a learner may be working in as well as the benefits and challenges of remote health care, telemedicine.

Chapter Objectives The following objectives are addressed in this chapter: 01.01 Recognize the importance of your role on the front lines of the health care industry.

01.02 Differentiate among registration, certification, and licensure for health care providers.

01.03 Identify proper protocol when a health care professional is asked to perform a task outside the scope of practice.

01.04 Summarize what is meant by personal protection and provider protection.

01.05 Compare standard of care for medical assistants and for different health care professionals.

01.06 Summarize laws and standards that protect patients.

01.07 Identify the different types of legal entities.

01.08 List the main types of managed care organizations.

01.09 Explain the risks and rewards of telemedicine.

Key Terms Agent: One who has authority to act on behalf of another.

Bylaws: Regulations adopted by a corporation or association to govern its internal affairs.

Capitation: Payment in a lump sum to providers, HMOs, and health care facilities to deliver health care to a segment of the population.

Certification: Endorsement by an accredited professional organization that the holder has specific expertise as evidenced by passing an examination.

Conglomerate: A corporation diversifying operations by acquiring varied businesses.

Directors: Those elected and terminated by stockholders to manage a corporation.

Dividends: Distributed profits of a corporation.

Fee-for-service: Basis of professional billing, either so much per hour or per identified procedure.

Investment: Expenditure of resources (money, effort, etc.) intended to secure income or profit.

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 1: The Big Business of Health Care and You

Joint venture: A group of persons together performing some specific business undertaking that is limited in duration or scope.

Legal entity: An individual or organization that has legal capacity to contract, incur and pay debts, and sue and be sued.

Negligence: Failure to act with reasonable and prudent care given the circumstances.

Negotiated fee schedules: The amount an insurance company or other third-party payer will reimburse for a specific medical procedure.

Notice: An announcement of pertinent information to those who have a right or obligation to know.

Officers: Persons holding formal positions of trust in an organization, especially those involved in high levels of management.

Per capita payment: Pay equally according to the number of individuals.

Reasonable person: A prudent person whose behavior would be considered appropriate under the circumstances.

Registration: Recordation and maintenance of professionals’ license related administrative information.

Respondeat superior: Legal theory that holds employers responsible for the behavior of an employee working within the scope of employment.

Scope of practice: The tasks and services that a qualified health care professional is considered competent and allowed to perform pursuant to their license, or, if no license, their education, and experience.

Shares: Units of stock giving the possessor part ownership in a corporation.

Standards of care: The amount of care that a reasonable person in similar circumstances would exercise.

Stockholders: Those who hold an interest in a corporation.

Utilization review: A process by which hospitals review patient progress to efficiently allocate scarce medical resources.

Vicariously liable: Legally obligated for the acts of others who are acting as their agent.

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What's New in This Chapter The following elements are improvements in this chapter from the previous edition: ●

New content on certification; scope of practice; vicarious liability; health care delivery systems; surprise billing; HSAs; and technology and medicine, including impact of COVID-19 upon telemedicine and health information on personal electronic devices.

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 1: The Big Business of Health Care and You

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Chapter Outline In the outline below, each element includes references (in parentheses) to related content. "CH.##” refers to the chapter objective.

I.

II.

III.

IV.

V.

Introduction to the Business of Health Care (01.01) a. This section reviews the complexity of the US health care system. It notes the general complexity of the business as well as the new allied health care professional’s potentially dire role as a frontline worker and the heavy responsibility that holds. It mentions the conflicts between care delivery, cost containment and compliance. The competing interests between government, providers, patients, payers, and employers are also raised. Finally, this section discusses competition for cost control, market share and new product innovation with the emergence of Managed Care.

The Front Line Is You (01.01) a. This section discusses that the Allied Health Professional needs to understand that they are on the front line of the health care industry most in contact with patients.

Therefore, these professionals need to be aware of their legal and ethical responsibility and understand how their professional behavior has an impact on the legal and ethical standing of the organization as well as their own careers. b. Study Question #1: 15 minutes: Reviewing what the allied health professional can do to minimize risk of malpractice.

The Importance of Legal Knowledge (01.01, 01.02, 01.03, 01.04, 01.05, 01.06) a. This section introduces concepts of standard of care, licensure, registration, and certification, as well as scope of practice. Personal and provider protection are discussed as well as patient protection and the Patient Bill of Rights. b. Suggested Activity #1: 15 minutes total. Discuss the licenses and certifications that are available in the area and who issues them. c. Cases for Discussion #1: 30 minutes total. Discuss the case of Brackenridge Hospital and Resident Dr. Villafani performed tracheostomy with a breathing tube, which resulted in bleeding and permanent brain damage to the patient. The question is: Who, if anyone, should be held vicariously liable for Dr. Villafani’s treatment of the plaintiff? d. Cases for Discussion #2: 40 minutes total. Discuss the case of Parkview Health System’s OB/GYN case where patient Ms. SoderVick sued under assertion of respondeat superior after an employee violated HIPAA privacy provisions.

The Business Structure: Legal Entities (01.07) a. This section introduces the business structures that can be found in health care, from small structures like a solo practice to the conglomerate and informs about the concept of DBA. b. Suggested Activity #2: 30 minutes total. Find online resources for state corporations and research legal entity registrations with year created and other significant information. c. Study Question #2: 15 minutes: compare and contrast sole proprietorships and partnerships d. Study Question #3: 20 minutes: compare corporations and partnerships.

Health Care Delivery and Compensation System (01.08)

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 1: The Big Business of Health Care and You

a. This section describes fee-for-service as well as managed care entities and features. The description and challenges of fee-for-service are discussed. The Managed Care Organization (MCO) is defined along with associated delivery systems such as HMO, PPO and others. A case study describing Amazon Care is featured illustrating commercial and provider collaboration in managing care. The Affordable Care Act subsection defines the ACA, the purpose, and the features of the law. b. Suggested Activity #3: 45 minutes total. Group discussion about what types of plans individuals may prefer and the variety of health insurance features. c. Study Question #4: 15 minutes total. Identifying the conflicts of MCO bonuses for providers who reduce testing.

Technology and Medicine (01.09) a. This section mentions how the COVID pandemic influenced the increased use of telemedicine and includes an insert that visits this concept in some depth. Here also are mentioned personal electronic devices with health metric monitoring expansion of electronic health records and associated technology. Telemedicine subsection delves into the use of video visits and transmitted monitoring, the development of best practices for remote health care services, and the legal challenges of telemedicine. b. Suggested Activity #4: 30 minutes total. Discussion of group’s experiences with telemedicine and how these services compare to in-person health care. c. Study Question #5: 15 minutes total. Identifying the risks associated with technology in health care.

VI.

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Discussion Questions Refer to the Cases for Discussion at the end of the chapter. You can assign these cases and questions several ways: in a discussion forum in your LMS; as whole-class discussions in person; or as a partner or group activity in class. Answers appear in the Solution and Answer Guide. [return to top]

Additional Resources Internet Resources ●

Legal entities: U.S. Small Business Administration. (n.d.). Choosing your business structure. In Starting & managing. Retrieved from https://www.sba.gov/business-guide/launch-your-business/choosebusiness-structure

●

Managed care organizations: U.S. Centers for Medicare & Medicaid Services. (n.d.). Health insurance plan & network types: HMOs, PPOs, and more. Retrieved from https://www.healthcare.gov/choose-a-plan/plan-types/

●

American Telemedicine Association. Retrieved from https://www.americantelemed.org/

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 1: The Big Business of Health Care and You

[return to top]

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 1: The Big Business of Health Care and You

Appendix Generic Rubrics Providing students with rubrics helps them understand expectations and components of assignments.

Rubrics help students become more aware of their learning process and progress, and they improve students’ work through timely and detailed feedback.

Customize these rubrics as you wish. The writing rubric indicates 40 points and the discussion rubric indicates 30 points.

Standard Writing Rubric Criteria Content

Organization and Clarity

Research

Research

Grammar and Spelling

Meets Requirements Needs Improvement Incomplete The assignment clearly and The assignment partially The assignment does not comprehensively addresses all addresses some or all address the questions in the questions in the assignment. questions in the assignment. assignment.

15 points 8 points 0 points The assignment presents ideas The assignment presents ideas The assignment does not in a clear manner and with in a mostly clear manner and present ideas in a clear manner strong organizational structure. with a mostly strong and with strong organizational The assignment includes an organizational structure. The structure. The assignment appropriate introduction, assignment includes an includes an introduction, content, and conclusion. appropriate introduction, content, and conclusion, but Coverage of facts, arguments, content, and conclusion. coverage of facts, arguments, and conclusions are logically Coverage of facts, arguments, and conclusions are not related and consistent. and conclusions are mostly logically related and 10 points logically related and consistent. consistent.

0 points 7 points The assignment is based upon The assignment is based upon The assignment is not based appropriate and adequate adequate academic literature upon appropriate and academic literature, including but does not include peer adequate academic literature peer reviewed journals and reviewed journals and other and does not include peer other scholarly work. scholarly work. reviewed journals and other 5 points 3 points scholarly work.

0 points The assignment follows the The assignment follows some The assignment does not required citation guidelines. of the required citation follow the required citation 5 points guidelines. guidelines.

3 points 0 points The assignment has two or The assignment has three to The assignment is incomplete fewer grammatical and spelling five grammatical and spelling or unintelligible. errors. errors.

0 points 5 points 3 points

Standard Discussion Rubric Criteria Participation

Meets Requirements Submits or participates in discussion by the posted deadlines. Follows all assignment. instructions for initial post and responses.

5 points

Needs Improvement Incomplete Does not participate or submit Does not participate in discussion by the posted discussion. deadlines. Does not follow 0 points instructions for initial post and responses.

3 points

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 1: The Big Business of Health Care and You

Contribution Quality

Etiquette

Comments stay on task.

Comments may not stay on Does not participate in Comments add value to task. Comments may not add discussion. discussion topic. Comments value to discussion topic.

0 points motivate other students to Comments may not motivate respond. other students to respond.

20 points 10 points Maintains appropriate Does not always maintain Does not participate in language. Offers criticism in a appropriate language. Offers discussion. constructive manner. Provides criticism in an offensive 0 points both positive and negative manner. Provides only negative feedback. feedback.

5 points 3 points

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

8

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 2: Laws and Regulations You Will Encounter

Instructor Manual Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 2: Laws and Regulations You Will Encounter

Table of Contents Purpose and Perspective of the Chapter

2

Chapter Objectives

2

Key Terms

2

What's New in This Chapter

3

Chapter Outline

3

Discussion Questions

5

Additional Resources

5

Internet Resources ............................................................................................................................................ 5 Appendix

6

Generic Rubrics .................................................................................................................................................. 6 Standard Writing Rubric .................................................................................................................................... 6 Standard Discussion Rubric ............................................................................................................................... 6

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

1

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 2: Laws and Regulations You Will Encounter

Purpose and Perspective of the Chapter The purpose of this chapter is to explain the many laws that students will encounter in the workplace.

Discrimination is a prominent issue in the hiring and promotion of employees that your students will want to know about. This chapter also addresses sexual harassment, a serious problem in the workforce. Students will learn how the ADA regulates the hiring and promotion of physically and mentally disabled individuals; the FADA protects the rights of older workers; the Equal Pay Act prevents the practice of paying women less than men for the same job; the FLSA establishes a federal minimum wage, mandates extra pay for overtime work, and regulates the employment of children; the ERISA involves pensions; and, the OSHA affects health care workers, particularly with regulations involving right-to-know laws and blood-borne pathogens. Other issues discussed in this chapter are workers’ compensation and social security, which affect every employer and employee. The chapter covers Occupational Safety and Health Act and regulations for blood-borne pathogens. Finally, this chapter makes clear the importance of working conditions by discussing procedure manuals, job descriptions, and employee handbooks, as well as discusses unions and collective bargaining.

Chapter Objectives The following objectives are addressed in this chapter: 02.01 Describe the government’s influence on the practice and licensing of medicine.

02.02 Identify circumstances that require mandatory reporting.

02.03 Describe controlled substance acts.

02.04 Summarize basic workplace discrimination and harassment laws.

02.05 Summarize basic laws impacting employee wages and benefits.

02.06 Summarize Occupational Safety and Health Act (OSHA) regulations for the health care industry.

02.07 Describe the purpose and components of job descriptions, procedures manuals, and employee handbooks.

02.08 Explain the purpose of unions.

Key Terms Bargaining unit: The labor union, or group of employees with similar interests, authorized to conduct negotiations on behalf of the employees who are members of the union or group.

Censure: A formal statement of disapproval.

Collective bargaining: Procedural attempt to achieve collective agreements between an employer and accredited representative of a group of employees to improve the conditions of employment.

Disparate impact: Disproportionate result that seemingly fair practices or policies have upon a protected group.

Disparate treatment: A marked difference between the way two things are handled.

Facially neutral: On the surface the matter appears to be impartial.

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 2: Laws and Regulations You Will Encounter

Inference: A process of reasoning by which a fact is deduced as a logical consequence of other facts.

Interstate commerce: The movement of goods and services, or services that rely on the movement of goods, which cross state borders within the United States.

Mitigating: Make less severe due to considerations of fairness and mercy.

Negligent per se: Conduct that is not aligned with the applicable standard of care and without more can be deemed negligence.

Probable cause: Having more evidence for than against.

Quality assurance: Procedures and protocols that maintain a stated level of quality of care received by patients.

Risk management: The practice of considering the risk of actions taken and taking steps to minimize the undesired risks of those actions. [return to top]

What's New in This Chapter The following elements are improvements in this chapter from the previous edition: ●

Additional content on licensing; scope of practice; medical license revocation or suspension; mandatory reporting; chain of custody, workplace sexual harassment; the Americans with Disabilities Act; Medicare and Medicaid; and unions and health care workers.

●

Expanded “Controlled Substances Acts” section, including information on the Controlled Substances Schedules, Drug Enforcement Agency, and United States Pharmacopeia (USP).

[return to top]

Chapter Outline In the outline below, each element includes references (in parentheses) to related content. "CH.##” refers to the chapter objective.

I.

II.

Introduction to Health Care Laws, Regulations, and Business Protocols (02.01) a. Health care professionals need to be aware of various medical practice laws and regulations, the nature of your employment, discrimination, sexual harassment, health care laws and regulations, and union membership and collective bargaining. Health care professionals are expected to know the laws and regulations that govern the profession, and ignorance of a law, or a regulation, does not excuse a health care professional’s violation.

Medical Practice Laws (02.01) a. Medical practice laws control the practice of medicine. State legislatures create medical boards that control health care provider licensing. These boards have the authority to grant licenses, as well as renew and revoke licenses. Medical boards must allow due process when pending notice of suspension or revocation of a license. A medical license can be revoked or suspended if a health care practitioner is performing procedures outside of their scope of practice.

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 2: Laws and Regulations You Will Encounter

III.

IV.

V.

VI.

VII.

VIII.

Mandatory Reporting (02.02) a. Health care reporters are required to submit reports to governmental agencies about births, deaths (suspicious or ‘unnatural deaths’), communicable diseases, as well as injuries to children, elderly, and patients due to abuse. Providers, nurses, and other health care professionals are required by most states to report abuse of children, elderly, and patients.

Controlled Substances Acts (02.03) a. A controlled substance is a drug or chemical whose manufacture, storage, distribution, and use are controlled by the government because of its potential for misuse or abuse.

Control substance acts restrict the distribution, classification, sale, handling, storage, prescription, and use of controlled substances. Control substance acts cover criminals to health care providers who hold licenses to write prescriptions as well as drug manufacturers. The Drug Enforcement Agency (DEA) is in charge of enforcing the Controlled Substances Act, including the distribution, classification, sale, handling, storage, prescription, and use of controlled substances.

Employment Law (02.04) a. The federal Employment Law seeks to ensure that employees can work in an environment free from discrimination and harassment. Employment law encompasses laws against discrimination against gender, disabilities, and age. b. Suggested Activity 1: 15 minutes total. Discuss the “#MeToo” movement and what the students learned about harassment that they did not realize was harassment. c. Suggested Activity 3: 10 minutes total. Students are asked if they have ever experienced an inappropriate interview question or faced questions that were discriminatory. d. Study Questions 1: 10 minutes. Students draft interview questions that should be asked and should not be asked during an interview. e. Study Questions 2: 10 minutes. Students need to explain whether it is discriminatory to ask interview questions about COVID-19. f. Cases For Discussion 1: 20 minutes. Students read a case study and discuss the case study to determine if the actions were acceptable or discriminatory practices. g. Cases For Discussion 2: 20 minutes. Students read a case study and determine if the conduct would be considered harassment.

Employee Wages and Benefits (02.05) a. Several federal acts ensure employers provide equal pay for employees regardless of gender, minimum wage, and overtime, as well as leave for employees to care for family members. There are laws pertaining to employee benefits such as worker compensation, social security benefits, Medicare, and Medicaid. b. Study Question 3: 5 minutes total. Students need to reference the act that they would reference for a coworker who asked for time away to care for a child.

Occupational Safety and Health Act (02.06) a. Occupational Safety and Health Act (OSHA) sets rules and regulations intended to prevent injuries and promote job safety. b. Suggested Activity 2: 15 minutes total. Students locate the website for a cleaning product and look for the MSDS information about the product. c. Study Question 4: 10 minutes. Students need to decide what they and the employer should do if they get an accidental needle stick.

Working Conditions (02.07)

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 2: Laws and Regulations You Will Encounter

IX.

a. The working conditions in a health care office should be defined in individual job descriptions, office handbooks, and procedure manuals.

Unions and Health Care Workers (02.08) a. People join unions for many reasons, primarily because of dissatisfaction with wages, benefits, or working conditions. When a union is organized, the employer and the union are obligated to bargain in good faith with one another.

[return to top]

Discussion Questions Refer to the Cases for Discussion at the end of the chapter. You can assign these cases and questions several ways: in a discussion forum in your LMS; as whole-class discussions in person; or as a partner or group activity in class. Answers appear in the Solution and Answer Guide. [return to top]

Additional Resources Internet Resources ●

The DEA website about the Controlled Substances Act https://www.dea.gov/druginformation/csa

●

Sexual harassment: U.S. Equal Opportunity Employment Commission. (n.d.). Sexual harassment.

In Laws, rules, & regulations. Retrieved from https://www.eeoc.gov/sexual-harassment

●

ADA Amendments Act of 2008. Retrieved from https://www.eeoc.gov/statutes/adaamendments-act-2008

●

OSHA. Retrieved from https://www.osha.gov/

●

Social Security. Retrieved from https://www.ssa.gov/

●

Medicare. Retrieved from https://www.medicare.gov/

●

Medicaid. Retrieved from https://www.medicaid.gov/

[return to top]

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

5

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 2: Laws and Regulations You Will Encounter

Appendix Generic Rubrics Providing students with rubrics helps them understand expectations and components of assignments.

Rubrics help students become more aware of their learning process and progress, and they improve students’ work through timely and detailed feedback.

Customize these rubrics as you wish. The writing rubric indicates 40 points and the discussion rubric indicates 30 points.

Standard Writing Rubric Criteria Content

Organization and Clarity

Research

Research

Grammar and Spelling

Meets Requirements Needs Improvement Incomplete The assignment clearly and The assignment partially The assignment does not comprehensively addresses all addresses some or all address the questions in the questions in the assignment. questions in the assignment. assignment.

15 points 8 points 0 points The assignment presents ideas The assignment presents ideas The assignment does not in a clear manner and with in a mostly clear manner and present ideas in a clear manner strong organizational structure. with a mostly strong and with strong organizational The assignment includes an organizational structure. The structure. The assignment appropriate introduction, assignment includes an includes an introduction, content, and conclusion. appropriate introduction, content, and conclusion, but Coverage of facts, arguments, content, and conclusion. coverage of facts, arguments, and conclusions are logically Coverage of facts, arguments, and conclusions are not related and consistent. and conclusions are mostly logically related and 10 points logically related and consistent. consistent.

0 points 7 points The assignment is based upon The assignment is based upon The assignment is not based appropriate and adequate adequate academic literature upon appropriate and academic literature, including but does not include peer adequate academic literature peer reviewed journals and reviewed journals and other and does not include peer other scholarly work. scholarly work. reviewed journals and other 5 points 3 points scholarly work.

0 points The assignment follows the The assignment follows some The assignment does not required citation guidelines. of the required citation follow the required citation 5 points guidelines. guidelines.

3 points 0 points The assignment has two or The assignment has three to The assignment is incomplete fewer grammatical and spelling five grammatical and spelling or unintelligible. errors. errors.

0 points 5 points 3 points

Standard Discussion Rubric Criteria Participation

Meets Requirements Submits or participates in discussion by the posted deadlines. Follows all assignment. instructions for initial post and responses.

5 points

Needs Improvement Incomplete Does not participate or submit Does not participate in discussion by the posted discussion. deadlines. Does not follow 0 points instructions for initial post and responses.

3 points

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 2: Laws and Regulations You Will Encounter

Contribution Quality

Etiquette

Comments stay on task.

Comments may not stay on Does not participate in Comments add value to task. Comments may not add discussion. discussion topic. Comments value to discussion topic.

0 points motivate other students to Comments may not motivate respond. other students to respond.

20 points 10 points Maintains appropriate Does not always maintain Does not participate in language. Offers criticism in a appropriate language. Offers discussion. constructive manner. Provides criticism in an offensive 0 points both positive and negative manner. Provides only negative feedback. feedback.

5 points 3 points

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

7

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 3: From the Constitution to the Courtroom

Instructor Manual Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 3: From the Constitution to the Courtroom

Table of Contents Purpose and Perspective of the Chapter

2

Chapter Objectives

2

Key Terms

2

What's New in This Chapter

4

Chapter Outline

4

Discussion Questions

5

Additional Resources

5

Internet Resources ............................................................................................................................................ 5 Appendix

7

Generic Rubrics .................................................................................................................................................. 7 Standard Writing Rubric .................................................................................................................................... 7 Standard Discussion Rubric ............................................................................................................................... 7

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

1

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 3: From the Constitution to the Courtroom

Purpose and Perspective of the Chapter All laws in the United States flow from the Constitution. This chapter explains the basis for a federalist system of government: the federal government concurrently existing with state governments. The discussion of the Constitution includes the significance of the Supremacy Clause and other enumerated powers. Also explained in this chapter is the federal government’s division into three branches: the executive, the legislative, and the judiciary. The judicial branch of law, both in the federal and state governments, is responsible for settling legal disputes. Each lawsuit that goes to trial follows certain phases of development. From the time the alleged negligence occurs to the time the case goes to trial, both sides are involved in discovery, which is a form of legal investigation. After the verdict has been announced, either side has the right to an appeal. Finally, this chapter discusses that an individual who is a party or a witness in a trial undertakes extensive preparation. Students will learn that time should be spent with the counsel preparing the questions and answers that the attorney will ask, as well as anticipating those of the other side.

Chapter Objectives The following objectives are addressed in this chapter: 03.01 Explain how the Constitution’s Supremacy Clause supports a federalist government.

03.02 Describe the three branches of government.

03.03 Identify the three levels of the judiciary.

03.04 Differentiate between federal and state law.

03.05 Differentiate between origins of statutory, administrative, and common law.

03.06 Differentiate between criminal and civil law.

03.07 Describe the four phases of a lawsuit.

03.08 Explain how a medical record can be used in a lawsuit.

03.09 Describe techniques that aid in being a good witness.

Key Terms Adjudicate: To decide a disputed matter Arbitration: A hearing held between two or more parties who disagree on an issue but agree in advance to abide by the decision of an impartial third party Assault: Any intentional act, attempt, or threat to inflict bodily injury on another person with the apparent ability to do so Battery: Intentional touching of another person without permission Beyond a reasonable doubt: Evidence so strong and credible that it leaves no more than a remote possibility that there is another explanation for what happened Civil: The system of law concerned with disputes between individuals or, where the case does not relate to the violation of a criminal statute, between an individual and the state

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 3: From the Constitution to the Courtroom

Common law: Law created as a result of judicial decisions Concurrent: Two or more events happening at the same time Contingency: Something that may occur but is dependent on a different and uncertain future event to happen first Criminal: The system of law concerned with offenses prosecuted by and deemed prohibited by state or federal law, or a person who has been proven guilty of such an offense Cross-examination: Attorney’s interrogation of a witness by the other party’s attorney Defendant: A person or party against whom a civil plaintiff has initiated a lawsuit to settle a dispute; in a criminal matter, a person or party that has been charged with a crime and who is being prosecuted Deposition: A sworn verbal statement given out of court in response to questions posed by attorneys involved in the case and transcribed by a court reporter Deterrence: Punishment used to discourage crime Direct examination: Attorney’s interrogation of a witness by the party for whom the witness has been called Enumerate: To list a number of things Interrogatory: Written questions about a case addressed to one party or witness by another party Judgment: A court’s decision regarding the rights and obligations of the parties in a lawsuit Mediation: A neutral party meets with parties to a dispute with the intent of persuading them to settle their dispute Motion: The application made to a judge to take a specific action in a case Negligent act: Failure to take reasonable precaution to protect others from the risk of harm Negotiation: Exchange and consideration of offers with the objective of reaching an agreement Perjury: A false statement under oath Plaintiff: A person or party who brings a civil court action against a person or party with whom they have a dispute Preponderance of evidence: The greater weight of the evidence that is more likely than not Pretrial conference: A meeting of the parties and the judge to discuss the readiness for and details of trial process Reformation: The rehabilitation of a criminal Restraint: Restriction of personal liberty Retribution: Something given or demanded as a punishment for criminal wrongdoing Standard of proof: Level of proof required, which is established by considering all evidence and witnesses

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 3: From the Constitution to the Courtroom

Strict liability: Responsibility of a seller or manufacturer for a defective product that causes injury Tort: A wrong or injury, other than breach of contract, for which a court will provide a remedy

[return to top]

What's New in This Chapter The following elements are improvements in this chapter from the previous edition: ●

Additional content on common law and the phases of a lawsuit.

[return to top]

Chapter Outline In the outline below, each element includes references (in parentheses) to related content. "CH.##” refers to the chapter objective.

I.

II.

III.

IV.

It All Starts with the Constitution (03.01) a. The American government and legal systems flow from the Constitution, which determines whether federal or state law is applicable and enforceable. The first three Articles of the Constitution address the separation of powers into three distinct branches: the executive, the legislative, and the judicial. This allows for a system of “checks and balances,” which prevents abuse of power from any one branch. The Constitution also addresses federalism and the enumerated powers of the federal government. b. Study Question#1: 5 minutes total. Students will describe the purpose of the Supremacy Clause and how it is tied to the federalist system of government.

Three Branches of Government (03.02) a. The federal government is divided into three branches: the executive, the legislative, and the judiciary. b. Suggested Activity #1: 10 minutes total. Students will watch “I’m Just a Bill” by Schoolhouse Rock and summarize the law-making process in an unforgettable way. c. Study Question #2: 5 minutes total. Students will list the three branches of government and describe why it is necessary to separate the government in this manner. d. Study Question #3: 5 minutes total. Students will list the three levels of the judiciary and name the highest court in the United States.

Health Care: Federal or State Law? (03.04) a. The Constitution does not contain any express federal powers or rights related to health care. The enumerated powers have played a part in allowing the federal government to legislate health care. The federal and state governments have become increasingly intertwined in health care funding, regulation, and administration.

Administrative and Common Law (03.05) a. Administrative law governs the activities of administrative agencies of government. In carrying out their responsibilities, agencies usually perform one or more of the following: rule making, adjudication, prosecution, advising, supervision, and investigation. Common law is court-made law that arises from judges’ interpretation of

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 3: From the Constitution to the Courtroom

statutory or regulatory law. Judicial decisions from the past with similar underlying facts or issues require that current judicial decisions adhere to the prior conclusion. b. Study Question #4: 5 minutes total. Students will determine if federal agencies are authorized to make their own rules and prosecute those who violate them.

The Distinction Between Criminal and Civil Law (03.06) a. A crime is defined as the performance of an act forbidden by law, or the omission of an act required by law. In a criminal case, the defendant is found guilty or not guilty. In a civil case, the defendant is found liable or not liable. In a criminal case, the standard of proof is beyond a reasonable doubt. In a civil case, the standard of proof is preponderance of the evidence. The most common civil lawsuit in health care is tort and is based on intentional acts, negligent acts, or strict liability. b. Study Question #5: 5 minutes total. Students will differentiate between criminal and civil law.

What Happens During a Lawsuit (03.07) a. Less than 10 percent of medical malpractice lawsuits go to trial. The rest are settled out of court by agreement, arbitration, or mediation. Cases that do go to trial will go through four phases.

You As a Witness (03.09) a. When considering a testimony, witnesses should look at both sides to see how they fit in, anticipate defense remarks, be objective, and follow the instructions of the attorney.

Other suggestions include paying attention, behaving in a professional manner, answering the question asked and only the question asked, cooperating with the attorney, and being honest. b. Suggested Activity #2: 130 minutes total. Students will watch The Verdict. c. Suggested Activity #3: 30 minutes total. Students will discuss the witnesses in The Verdict and rate them as excellent, adequate, or poor based on their attention span, their mannerisms, how they answered questions, and whether they were cooperative or not. d. Suggested Activity #4: 90 minutes total. Students will role-play a recent court case. Roles will include the witness, plaintiff’s attorney, and the defendant’s attorney.

V.

VI.

VII.

[return to top]

Discussion Questions Refer to the Cases for Discussion at the end of the chapter. You can assign these cases and questions several ways: in a discussion forum in your LMS; as whole-class discussions in person; or as a partner or group activity in class. Answers appear in the Solution and Answer Guide. [return to top]

Additional Resources Internet Resources ●

Constitution. Retrieved from https://www.archives.gov/founding-docs/constitution

●

Supreme Court. Retrieved from https://www.supremecourt.gov

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 3: From the Constitution to the Courtroom

[return to top]

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 3: From the Constitution to the Courtroom

Appendix Generic Rubrics Providing students with rubrics helps them understand expectations and components of assignments.

Rubrics help students become more aware of their learning process and progress, and they improve students’ work through timely and detailed feedback.

Customize these rubrics as you wish. The writing rubric indicates 40 points and the discussion rubric indicates 30 points.

Standard Writing Rubric Criteria Content

Organization and Clarity

Research

Research

Grammar and Spelling

Meets Requirements Needs Improvement Incomplete The assignment clearly and The assignment partially The assignment does not comprehensively addresses all addresses some or all address the questions in the questions in the assignment. questions in the assignment. assignment.

15 points 8 points 0 points The assignment presents ideas The assignment presents ideas The assignment does not in a clear manner and with in a mostly clear manner and present ideas in a clear manner strong organizational structure. with a mostly strong and with strong organizational The assignment includes an organizational structure. The structure. The assignment appropriate introduction, assignment includes an includes an introduction, content, and conclusion. appropriate introduction, content, and conclusion, but Coverage of facts, arguments, content, and conclusion. coverage of facts, arguments, and conclusions are logically Coverage of facts, arguments, and conclusions are not related and consistent. and conclusions are mostly logically related and 10 points logically related and consistent. consistent.

0 points 7 points The assignment is based upon The assignment is based upon The assignment is not based appropriate and adequate adequate academic literature upon appropriate and academic literature, including but does not include peer adequate academic literature peer reviewed journals and reviewed journals and other and does not include peer other scholarly work. scholarly work. reviewed journals and other 5 points 3 points scholarly work.

0 points The assignment follows the The assignment follows some The assignment does not required citation guidelines. of the required citation follow the required citation 5 points guidelines. guidelines.

3 points 0 points The assignment has two or The assignment has three to The assignment is incomplete fewer grammatical and spelling five grammatical and spelling or unintelligible. errors. errors.

0 points 5 points 3 points

Standard Discussion Rubric Criteria Participation

Meets Requirements Submits or participates in discussion by the posted deadlines. Follows all assignment. instructions for initial post and responses.

5 points

Needs Improvement Incomplete Does not participate or submit Does not participate in discussion by the posted discussion. deadlines. Does not follow 0 points instructions for initial post and responses.

3 points

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 3: From the Constitution to the Courtroom

Contribution Quality

Etiquette

Comments stay on task.

Comments may not stay on Does not participate in Comments add value to task. Comments may not add discussion. discussion topic. Comments value to discussion topic.

0 points motivate other students to Comments may not motivate respond. other students to respond.

20 points 10 points Maintains appropriate Does not always maintain Does not participate in language. Offers criticism in a appropriate language. Offers discussion. constructive manner. Provides criticism in an offensive 0 points both positive and negative manner. Provides only negative feedback. feedback.

5 points 3 points

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

8

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 4: Criminal Acts and Intentional Torts

Instructor Manual Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 4: Criminal Acts and Intentional Torts

Table of Contents Purpose and Perspective of the Chapter .................................................................................................... 2 Chapter Objectives ..................................................................................................................................... 2 Key Terms ................................................................................................................................................... 2 What's New in This Chapter ........................................................................................................................ 3 Chapter Outline .......................................................................................................................................... 3 Discussion Questions .................................................................................................................................. 4 Additional Resources .................................................................................................................................. 5 Internet Resources ............................................................................................................................................ 5 Appendix ..................................................................................................................................................... 5 Generic Rubrics .................................................................................................................................................. 5 Standard Writing Rubric .................................................................................................................................... 5 Standard Discussion Rubric ............................................................................................................................... 6

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

1

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 4: Criminal Acts and Intentional Torts

Purpose and Perspective of the Chapter The purpose of this chapter is to explain the differences between misdemeanor and felony crimes, and that intent is the factor as to whether the behavior is labeled criminal or civil, intentional or negligent, based on the level of malice or premeditation involved. The statutes made by local, state, and federal legislatures drive the appropriate response to each criminal or misdemeanor activity. Additionally, child, elder, and domestic abuse will be discussed. The student will learn how to identify each, what abuses require mandatory reporting versus other reporting or filing a complaint in regard to their state’s legal responses.

It will also be important for students to understand fraud, the many forms it takes, how it differs from abuse, the legislative response involved, how to report fraudulent activity, and what acts and governmental offices are dedicated to reducing this from occurring. Finally, students will learn about the types of intentional torts and the defenses available to defendants accused of intentionally injuring patients.

Chapter Objectives The following objectives are addressed in this chapter: 04.01 Summarize types of felonies.

04.02 Identify and define types of abuse that mandate reporting.

04.03 Recognize some of the indicators of an abused child or older adult.

04.04 Explain the steps involved in mandatory reporting, following federal and state guidelines.

04.05 Determine proper protocol for reporting an illegal activity in the health care setting.

04.06 Describe types of fraud in the health care industry.

04.07 Distinguish between criminal and civil causes of action.

04.08 Summarize types of intentional torts.

Key Terms Conspiracy: An agreement among two or more people to undertake an illegal act.

Euthanasia: An intentional action or lack of action causing the merciful death of someone suffering from a terminal illness or incurable condition.

Felony: A crime that is generally punishable by imprisonment for a sentence longer than a year.

Larceny: Taking the personal property of another with the intent to permanently deprive that person of their property.

Malice: An unjust intention to commit an illegal act to injure someone.

Manslaughter: The killing of a person without premeditation.

Misdemeanor: A crime that is generally punishable by a fine or imprisonment of less than a year.

Murder: An act done with intent to kill the victim.

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 4: Criminal Acts and Intentional Torts

Qui tam lawsuit: A lawsuit alleging fraud and initiated by a whistleblower who receives a share of any recovery as a reward.

Robbery: The forcible stealing of the personal property of another either from their person or in the immediate presence of the victim.

Theft: Taking property without the property owner’s consent.

Wanton: An act done with reckless disregard of another’s rights or needs. [return to top]

What's New in This Chapter The following elements are improvements in this chapter from the previous edition: ●

Additional content on classifications of murder; fraud, including false billings, and delegation of duties; and defamation of character.

●

New content on federal and state anti-kickback statutes, including the Stark law.

●

Expanded and revised “Abuse” section, including content on child abuse, elder abuse, domestic violence, and sexual assault.

●

Additional content on reporting illegal activities in the health care setting following proper protocol and completing an incident report related to patient care.

[return to top]

Chapter Outline In the outline below, each element includes references (in parentheses) to related content. "CH.##” refers to the chapter objective.

I.

Criminal Acts (04.01, 02, 03, 04, 05) a. This section first differentiates between misdemeanors and felonies, defines, and describes the different types of felonies that one can be charged for, and discusses the legislative responses and penalties involved with each. It discusses child, elder, and domestic abuse, teaches the reader how to identify each, and focuses on how to report these instances, whether the reporting is mandatory or compulsory. b. Suggested activity 1: 15 minutes total. Research and describe mandatory reporting procedures for child and older adult abuse in the student’s state of intended practice, as well as federal acts involved. c. Suggested activity 3: 10 minutes total. The student will describe the steps and chain of command involved in reporting an OSHA violation. d. Suggested activity 4: 10 minutes total. Students are asked to read the AMA Code of Medical Ethics Opinion 8.10 and discuss health care providers' role in this. e. Suggested activity 5: 15 minutes total. The student is asked to research gunshot wound reporting obligations in their state and whether or not they would be considered a mandatory reporter or not. f. Study question 1: 10 minutes. Students explain murder versus euthanasia and the court’s response to both.

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 4: Criminal Acts and Intentional Torts

II.

III.

IV.

g. Study question 2. 10 minutes. Students describe how the health care industry is affected by statutes and regulations on child and elder abuse. h. Study question 3. 5 minutes. Students must explain the difference between robbery and larceny. i. Cases for discussion 1: 20 minutes. Students read the case studies and determine in each if child abuse should be reported.

Fraud (04.06) a. This section describes the different types of fraud that can be witnessed in the health care setting, the legislative responses to each, the penalties involved, and the defenses available to defendants accused. The Health Insurance Portability and Accountability Act of 1996 is also described. b. Suggested activity 2: 15 minutes total. Create a list of situations where fraud could be committed in light of the COVID-19 pandemic and how a witness would report the fraud. c. Study question 5: 10 minutes total. Out of the five examples listed, the student is asked to identify which are insurance fraud and which are insurance abuse. d. Cases for discussion 2: 20 minutes. After reviewing the proposed case of fraud against a surgeon, the student will discuss if the court will rule in favor of the plaintiff or not. e. Cases for discussion 3: 15 minutes: The student will determine if the illegal drug possession case requires a search warrant.

Other Reporting (04.04, 05, 06) a. This section goes into more detail about the steps involved in mandatory and nonmandatory reporting of illegal or unsafe activities and patient care errors. Emphasis is placed on following state, office, or hospital protocols in place for reporting the witnessed act.

Civil Causes of Action - Intentional Torts (04.04, 07, 08) a. This section discusses civil law of torts and their intentionality. Students will learn about the different types of intentional torts, read case studies, and briefly learn about the defenses available to defendants. b. Study question 4: 10 minutes. A case of false imprisonment of a patient is analyzed, and the student determines if the patient can file charges or not. c. Cases for discussion 4: 10 minutes. The case describes a case of a patient versus a surgeon regarding an invasion of privacy. The student determines if the patient should win the case or not. d. Cases for discussion 5: 15 minutes. The student reads the case of potential libel against a health care provider and determines if the provider has a convincible defense.

[return to top]

Discussion Questions Refer to the Cases for Discussion at the end of the chapter. You can assign these cases and questions several ways: in a discussion forum in your LMS; as whole-class discussions in person; or as a partner or group activity in class. Answers appear in the Solution and Answer Guide. [return to top]

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 4: Criminal Acts and Intentional Torts

Additional Resources Internet Resources ●

Child Welfare Information Gateway. (2019) Mandatory Reporters of Child Abuse and Neglect.

Retrieved from www.childwelfare.gov/topics/systemwide/laws-policies/statutes/manda/

●

Child Welfare Information Gateway. (2017). Making and Screening Reports of Child Abuse and Neglect. Child Welfare Information Gateway. Retrieved from www.childwelfare.gov/pubPDFs/repproc.pdf

●

National Council on Aging. (n.d.). (2021, February 23). Get the Facts on Elder Abuse. NCOA. Retrieved from www.ncoa.org/article/get-the-facts-on-elder-abuse

●

The United States Department of Justice. (n.d.). What is domestic violence? Retrieved from www.justice.gov/ovw/domestic-violence

●

National Coalition Against Domestic Violence (2020). Domestic violence. Retrieved from https://assets.speakcdn.com/assets/2497/domestic_violence2020080709350855.pdf?1596811079991

●

Health Insurance Portability and Accountability Act of 1996. Retrieved from https://www.hhs.gov/hipaa/index.html

●

Office of the Attorney General, Eastern District of New York. (2015, November 4). Riverhead physician assistant arrested for conspiracy to illegally prescribe oxycodone. United States Department of Justice. Retrieved from www.justice.gov/usao-edny/pr/riverhead-physicianassistant-arrested-conspiracy-illegally-prescribe-oxycodone

[return to top]

Appendix Generic Rubrics Providing students with rubrics helps them understand expectations and components of assignments.

Rubrics help students become more aware of their learning process and progress, and they improve students’ work through timely and detailed feedback.

Customize these rubrics as you wish. The writing rubric indicates 40 points and the discussion rubric indicates 30 points.

Standard Writing Rubric Criteria Content

Organization and Clarity

Meets Requirements Needs Improvement Incomplete The assignment clearly and The assignment partially The assignment does not comprehensively addresses all addresses some or all address the questions in the questions in the assignment. questions in the assignment. assignment.

15 points 8 points 0 points The assignment presents ideas The assignment presents ideas The assignment does not in a clear manner and with in a mostly clear manner and present ideas in a clear manner strong organizational structure. with a mostly strong and with strong organizational The assignment includes an organizational structure. The structure. The assignment

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 4: Criminal Acts and Intentional Torts

appropriate introduction, content, and conclusion.

Coverage of facts, arguments, and conclusions are logically related and consistent.

10 points

Research

Research

Grammar and Spelling

assignment includes an appropriate introduction, content, and conclusion.

Coverage of facts, arguments, and conclusions are mostly logically related and consistent.

7 points The assignment is based upon The assignment is based upon appropriate and adequate adequate academic literature academic literature, including but does not include peer peer reviewed journals and reviewed journals and other other scholarly work. scholarly work.

5 points 3 points The assignment follows the required citation guidelines.

5 points

The assignment follows some of the required citation guidelines.

3 points The assignment has two or The assignment has three to fewer grammatical and spelling five grammatical and spelling errors. errors.

5 points 3 points

includes an introduction, content, and conclusion, but coverage of facts, arguments, and conclusions are not logically related and consistent.

0 points The assignment is not based upon appropriate and adequate academic literature and does not include peer reviewed journals and other scholarly work.

0 points The assignment does not follow the required citation guidelines.

0 points The assignment is incomplete or unintelligible.

0 points

Standard Discussion Rubric Criteria Participation

Contribution Quality

Etiquette

Meets Requirements Needs Improvement Incomplete Submits or participates in Does not participate or submit Does not participate in discussion by the posted discussion by the posted discussion. deadlines. Follows all deadlines. Does not follow 0 points assignment. instructions for instructions for initial post and initial post and responses. responses.

5 points 3 points Comments stay on task.

Comments may not stay on Does not participate in Comments add value to task. Comments may not add discussion. discussion topic. Comments value to discussion topic.

0 points motivate other students to Comments may not motivate respond. other students to respond.

20 points 10 points Maintains appropriate Does not always maintain Does not participate in language. Offers criticism in a appropriate language. Offers discussion. constructive manner. Provides criticism in an offensive 0 points both positive and negative manner. Provides only negative feedback. feedback.

5 points 3 points

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

6

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 5: What Makes a Contract

Instructor Manual Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 5: What Makes a Contract

Table of Contents Purpose and Perspective of the Chapter .................................................................................................... 2 Chapter Objectives ..................................................................................................................................... 2 Key Terms ................................................................................................................................................... 2 What's New in This Chapter ........................................................................................................................ 4 Chapter Outline .......................................................................................................................................... 4 Discussion Questions .................................................................................................................................. 6 Additional Resources .................................................................................................................................. 6 Internet Resources ............................................................................................................................................ 6 Appendix ..................................................................................................................................................... 7 Generic Rubrics .................................................................................................................................................. 7 Standard Writing Rubric .................................................................................................................................... 7 Standard Discussion Rubric ............................................................................................................................... 7

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

1

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 5: What Makes a Contract

Purpose and Perspective of the Chapter Contracts govern almost everything we do in modern life and in the workplace. This chapter explains that a contract is a voluntary agreement between two or more parties that creates, modifies, or destroys a legal relationship. Students will learn that to have a contract, there must be an offer, acceptance, and consideration. A contract can be verbal or written, and it can be express or implied. The chapter also discusses that employees are the agents of their employers and, under the law of agency, can contract for the principal; contracts made by an authorized agent are valid and enforceable; and the principal is usually held responsible for any damages. In the contract between physician and patient, the patient may desire to change physicians before treatment has been completed, or the physician may desire to refuse further treatment under the informed consent.

This chapter further explains how the discharged physician should memorialize the circumstances and conditions of the discharge in a certified letter sent to the patient. If a physician terminates the relationship, further provisions must be made for the care of the patient, or the physician can be found to have abandoned the patient. Students will learn that contracts not performed according to agreement are termed breached. A party who sustains a breach of contract is entitled to be made whole by the award of damages. Lastly, discussion of an advanced health care directive and how it applies to the care of the patient are explored.

Chapter Objectives The following objectives are addressed in this chapter: 05.01 Explain the elements necessary to make a contract.

05.02 Differentiate between express and implied contracts.

05.03 Describe the law of agency.

05.04 Identify who can and who cannot be a party to a contract.

05.05 Define advance directives.

05.06 Identify the various ways to terminate a contract.

05.07 Identify situations that would be considered a breach of contract in the health care field.

05.08 Identify the individual responsible for payment of medical fees.

05.09 Describe basic collection protocol for past due accounts.

Key Terms Abandon: To give up or cease doing.

Acceptance: An agreement to the terms of an offer.

Advance directives: Written instructions about a person’s future medical care.

Agent: One who has authority to act on behalf of another.

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 5: What Makes a Contract

Age of majority: The age, as determined by state law, at which a person becomes legally able to contract, vote, and join the military.

Breach: To act contrary to a contractual provision or to fail to perform a contractual provision.

Conservator: A court- appointed person given authority to manage the financial affairs of an incompetent person.

Consideration: Something promised that results in making an agreement a lawful, enforceable contract.

Contract: A voluntary agreement, written or unwritten, between two parties that creates an obligation to do or not to do something.

Duress: Being influenced by a threat to do some- thing one would not otherwise do.

Emancipated minors: A person under the age of majority who is deemed to be completely selfsupporting and able to contract.

Express contract: An explicit agreement between two or more parties.

Guardian: A person entrusted to take care of the person, property, and rights of someone too young or otherwise incapable of managing their own affairs.

Implied contract: An agreement not indicated by direct words but evident from the conduct of the parties.

Incompetent persons: Those who lack the necessary qualifications to perform a duty.

Injunctive relief: Remedy preventing or requiring someone to perform or to refrain from performing a particular action.

Legal capacity: A person’s ability to enter into contracts because no legal disabilities exist.

Legal disability: Lack of legal capacity for mutual agreement.

Mature minor: A person under the age of majority who has the mental capacity to make certain medical decisions with- out parental consent.

Mental incompetence: Lack of reasoning faculties needed to enable someone to contract.

Minors: Persons who are under the age of majority as set forth by state law.

Mutual agreement: Common agreement and understanding of all parties to a contract.

Offer: A proposal to perform or refrain from a certain action.

Principal: The employer, or source of authority, of the agent or employee.

Remedies: Ways to make a nonbreaching party whole after a contracting party has breached.

Specific performance: The remedy of requiring a party to a contract to perform the contract as specified.

Undue influence: Any improper persuasion to make someone act differently from his or her own will.

Warranty: A promise that specifically named results will occur.

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 5: What Makes a Contract

[return to top]

What's New in This Chapter The following elements are improvements in this chapter from the previous edition: ●

Additional content about collections, bankruptcy, and termination of delinquent patients.

[return to top]

Chapter Outline In the outline below, each element includes references (in parentheses) to related content. "CH.##” refers to the chapter objective.

I.

II.

Elements of a Contract (05.01) a. Contracts, in general, are reviewed with identification and definitions of the key terms.

Elements needed to make a contract between a patient and health care provider are reviewed and discussed in detail. b. Suggested Activity 3: 10 minutes total. Identify various contracts you encounter in your personal life. What was the last contract you signed? What was the last contract you signed on behalf of someone else (an employer or child, a disabled relative, etc.)? c. Cases for Discussion 2: 15 minutes total. Discussion of whether a patient-provider relationship existed within a medical malpractice case is explored. d. Cases for Discussion 3: 15 minutes total. Discussion of a patient who required x-rays after an automobile accident is explored. The patient did not receive an x-ray of the leg at the first hospital she sought care at; however, the second hospital ordered one and revealed a leg fracture. She sued the first hospital and the radiologist. Does the radiologist, who never saw her, have a contractual relationship with the patient?

Types of Contracts (05.02) a. Differing types of contracts are discussed and explored. Differentiating between express and implied consent is defined and reviewed. Warranty is defined and reviewed with regards to how it relates to a contract. b. Suggested Activity 1: 10 minutes total. What is the age of majority in your state? c. Study Question 1: 10 minutes total. Give examples of implied and express consent to medical treatment in a hospital emergency room situation. d. Study Question 2: 15 minutes total. A patient has just been informed by the health care provider that she must have a hysterectomy and that there is a question of malignancy.

The patient makes a comment that makes the health care professional question whether the patient understands the treatment appropriately. How would you handle this situation? Did the health care provider give the patient a warranty as to the results?

If so, was the warranty express or implied? e. Cases for Discussion 4: 20 minutes total. Exploration of a patient case regarding a piece of gauze being left in them while being operated on is explored. Discussion regarding

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 5: What Makes a Contract

III.

IV.

V.

VI.

VII.

whether the consultant health care provider that did not perform the surgery is liable for the gauze in the patient’s abdomen. f. Cases for Discussion 7: 15 minutes total. A patient sterilization case involving the birth of a child that is developmentally disabled is discussed. Review and discussion regarding whether the plaintiff can allege a breach of warranty. Exploration of whether the court should allow them to recover damages under a breach of warranty action is discussed.

Agency (05.03) a. When a person agrees to work for and under the direction or control of another, a principal-agent relationship is created. Agent and principal are defined in greater detail with regards to how they relate to an established contract.

Capacity of the Parties (05.04) a. Legal disability, minors, incompetent persons, duress, guardian majority, age of majority, emancipated minors, mature minors, undue influence, mental incompetence, and conservator are defined and discussed in detail with relation to who can and cannot be a party to a contract. b. Study Question 4: 15 minutes total. Discussion of a minor and their conservator is reviewed regarding whether the conservator has the capacity to approve medical care for the minor. c. Cases for Discussion 1: 15 minutes total. A case regarding a minor who is pregnant and their parent who is requesting an abortion that the minor does not want, is discussed.

The provider refuses to perform the abortion without a court order. Capacity of parties is discussed and reviewed in detail with regards to the case.

Health Care Advance Directives (05.05) a. The Patient Self-Determination Act, enacted in 1990, requires health care facilities to provide written information to each adult admission regarding patient rights under state law to make advanced directives involving the acceptance or refusal of medical or surgical treatment. b. Suggested Activity 2: 10 minutes total. Exploration and completion of a health care directive in the student’s state are discussed.

Termination of Contracts (05.06) a. The termination of a contract between a health care provider and patient is discussed.

Elements of how to terminate a patient-provider contract appropriately and inappropriately are reviewed. b. Study Question 3: 15 minutes total. Review of a minor patient who is pregnant and miscarried without the knowledge of her parents is explored. Discussion and review regarding what the agent of the health care provider should do in this situation, whether the health care provider can terminate the patient-provider relationship due to failure to pay, and if so, how should the relationship be terminated? c. Case for Discussion 8: 20 minutes total. A mental health patient is discussed that could not pay his bill and was discharged. The patient was prescribed a sedative and ignited himself with a cigarette. The patient suffered nearly fatal third-degree burns. Did the provider have the right to discharge the patient upon realizing he could not pay his bill?

Breach of Contracts (05.07) a. A breach of contract occurs when one of the parties does not keep a promise by not performing, not paying for services, not keeping to schedule, or not doing the procedure as had been agreed. Breach of contract also occurs when one party prevents the other

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

5

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 5: What Makes a Contract

VIII.

IX.

party from performing. Examples are provided on how a patient or provider may breach the contract. b. Cases for Discussion 5: 15 minutes total. Review and discussion regarding a patient who has a failed vasectomy and conceives a child afterward. Discussion regarding whether the surgeon who performed the vasectomy should be liable for breach of contract? c. Cases for Discussion 6. 15 minutes total. A plastic surgery case is discussed when the patient does not obtain the outcome they had anticipated. Breach of contract is discussed in relation to the provider and whether it occurred.

Who Pays? (05.08) a. Information regarding the responsible party for payment to the provider is discussed and reviewed. In general, the patient who receives treatment is responsible for payment even if someone else requests the services. In certain circumstances, such as in the care of minor children and incompetent persons, others are responsible for payment.

Collections (05.09) a. Bankruptcy, bad checks, overdue accounts, collections, and termination of delinquent patients are defined and reviewed with how it relates to the pre-existing patientprovider contract. b. Suggested Activity 4: 15 minutes total. Exploration of the state statute regarding collections in the state the student intends to practice is discussed. c. Study Question 5: 10 minutes. Which federal act governs the collection of past due accounts? What does the act prohibit? d. Cases for Discussion 9: 15 minutes total. A mental illness case is reviewed and discussed with regards to whether the health care provider had the right to discharge the patient from the hospital because he could not pay his bill.

[return to top]

Discussion Questions Refer to the Cases for Discussion at the end of the chapter. You can assign these cases and questions several ways: in a discussion forum in your LMS; as whole-class discussions in person; or as a partner or group activity in class. Answers appear in the Solution and Answer Guide. [return to top]

Additional Resources Internet Resources ●

American Hospital Association. (2022). Fact Sheet Hospital Billing Explained. Retrieved from https://www.aha.org

●

Caring Info. (2021). Advance Directive Forms by State. Retrieved from https://www.caringinfo.org/planning/advance-directives/by-state/

●

TedTalk. (2015). Advanced Care Directive TedTalk. Retrieved from https://www.youtube.com/watch?v=gqp42LiJOQI

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 5: What Makes a Contract

[return to top]

Appendix Generic Rubrics Providing students with rubrics helps them understand expectations and components of assignments.

Rubrics help students become more aware of their learning process and progress, and they improve students’ work through timely and detailed feedback.

Customize these rubrics as you wish. The writing rubric indicates 40 points and the discussion rubric indicates 30 points.

Standard Writing Rubric Criteria Content

Organization and Clarity

Research

Research

Grammar and Spelling

Meets Requirements Needs Improvement Incomplete The assignment clearly and The assignment partially The assignment does not comprehensively addresses all addresses some or all address the questions in the questions in the assignment. questions in the assignment. assignment.

15 points 8 points 0 points The assignment presents ideas The assignment presents ideas The assignment does not in a clear manner and with in a mostly clear manner and present ideas in a clear manner strong organizational structure. with a mostly strong and with strong organizational The assignment includes an organizational structure. The structure. The assignment appropriate introduction, assignment includes an includes an introduction, content, and conclusion. appropriate introduction, content, and conclusion, but Coverage of facts, arguments, content, and conclusion. coverage of facts, arguments, and conclusions are logically Coverage of facts, arguments, and conclusions are not related and consistent. and conclusions are mostly logically related and 10 points logically related and consistent. consistent.

0 points 7 points The assignment is based upon The assignment is based upon The assignment is not based appropriate and adequate adequate academic literature upon appropriate and academic literature, including but does not include peer adequate academic literature peer reviewed journals and reviewed journals and other and does not include peer other scholarly work. scholarly work. reviewed journals and other 5 points 3 points scholarly work.

0 points The assignment follows the The assignment follows some The assignment does not required citation guidelines. of the required citation follow the required citation 5 points guidelines. guidelines.

3 points 0 points The assignment has two or The assignment has three to The assignment is incomplete fewer grammatical and spelling five grammatical and spelling or unintelligible. errors. errors.

0 points 5 points 3 points

Standard Discussion Rubric Criteria Participation

Meets Requirements Submits or participates in discussion by the posted deadlines. Follows all assignment. instructions for initial post and responses.

Needs Improvement Incomplete Does not participate or submit Does not participate in discussion by the posted discussion. deadlines. Does not follow 0 points instructions for initial post and responses.

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

7

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 5: What Makes a Contract

Contribution Quality

Etiquette

5 points 3 points Comments stay on task.

Comments may not stay on Does not participate in Comments add value to task. Comments may not add discussion. discussion topic. Comments value to discussion topic.

0 points motivate other students to Comments may not motivate respond. other students to respond.

20 points 10 points Maintains appropriate Does not always maintain Does not participate in language. Offers criticism in a appropriate language. Offers discussion. constructive manner. Provides criticism in an offensive 0 points both positive and negative manner. Provides only negative feedback. feedback.

5 points 3 points

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

8

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 6: Medical Malpractice and Other Lawsuits

Instructor Manual Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 6: Medical Malpractice and Other Lawsuits

Table of Contents Purpose and Perspective of the Chapter .................................................................................................... 2 Chapter Objectives ..................................................................................................................................... 2 Key Terms ................................................................................................................................................... 3 What's New in This Chapter ........................................................................................................................ 4 Chapter Outline .......................................................................................................................................... 4 Discussion Questions .................................................................................................................................. 7 Additional Resources .................................................................................................................................. 7 Internet Resources ............................................................................................................................................ 7 Appendix ..................................................................................................................................................... 8 Generic Rubrics .................................................................................................................................................. 8 Standard Writing Rubric .................................................................................................................................... 8 Standard Discussion Rubric ............................................................................................................................... 8

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

1

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 6: Medical Malpractice and Other Lawsuits

Purpose and Perspective of the Chapter The purpose of this chapter is to review negligence. Negligence is when one person hurts another without intent. The legal cause of action of negligence by a professional is known as malpractice. The difference between negligence and malpractice is the standard of care required of the injuring party.

Students will learn that if the defendant is a layperson who is held to the reasonable person standard, the act (or failure to act) is considered ‘negligence’ and, if the inflicting party is a professional who is held to the standard of a professional with prescribed education, training, and experience, the act (or failure to act) is considered ‘malpractice.’ This chapter enumerates five defenses available to a defendant in a medical malpractice cause of action: tolling of the statute of limitations, contributory negligence, comparative negligence, assumption of risk, and emergency. Medical malpractice insurance is discussed and available to cover monetary awards against a defendant. Medical assistants may or may not be covered under a physician’s insurance. Your students will want to know that insurance is available for the protection of a medical assistant.

Medical assistants are hybrid health care professionals. Delegated responsibilities extend the effectiveness of a physician and are delegated by the employer. Students will learn that many malpractice lawsuits can be avoided simply with better communication. The patient has a right to refuse treatment; therefore, the physician must provide enough information to allow the patient to make an informed decision. Informed consent is reviewed and requires that a physician communicate information to a patient regarding the treatment he or she is about to receive. Only a physician can accept consent from a patient. It is important for students to note that beyond preparing and filing consent forms, they should be listening and observing whether the patient understood and accepted the proposed treatment; alerting the physician when any discrepancies arise is key. Finally, students will learn that different standards of responsibility are required for trespassers, licensees, and invitees. The standard of property maintenance for a trespasser is reasonable care. The standard of maintenance increases for licensees. The highest standard of maintenance is due to invitees and requires affirmative behavior on the part of the landlord or occupier to warn the invitee about dangerous conditions or activities that are known or could be discovered with reasonable effort.

Chapter Objectives The following objectives are addressed in this chapter: 06.01 Distinguish between a cause of action for negligence and one for malpractice.

06.02 List the elements of a medical malpractice lawsuit.

06.03 Identify when there has been a breach of duty to a patient based on an inappropriate standard of care.

06.04 Analyze the legal cause of a patient’s injury and assess accountability of the employee.

06.05 Identify the legal, moral, and ethical aspects of informed consent.

06.06 Describe negative consequences of medical malpractice lawsuits.

06.07 Identify common subjective contributing factors to the patient’s choice to litigate.

06.08 Summarize risk management measures the health care professional can take to avoid lawsuits.

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 6: Medical Malpractice and Other Lawsuits

06.09 Describe defenses available to the defendant in a medical malpractice lawsuit.

06.10 Analyze emergency situations to determine whether the situation is covered by a Good Samaritan statute.

06.11 Identify a product liability case of action.

06.12 Define strict liability in tort.

06.13 Distinguish between the duty of care owed to invitees, licensees, and trespassers for maintenance of equipment and premises.

Key Terms Adversary: An opponent in a dispute or contest.

Affirmative duty: An obligation to do or to not do something.

Assumption of risk: Voluntary acceptance of a known danger.

Burnout: Exhaustion from overwork.

Comparative negligence: Negligence measured by percentage, with the determined damages lessened according to the extent of injury or damage committed by the party proven guilty.

Consumer: A person who uses products or services.

Contributory negligence: Conduct by a plaintiff that is below the standard to which he or she is legally required to conform for his or her own protection.

Defensive medicine: The practice of medicine where the main focus is preventing a lawsuit rather than improving the health of the patient.

Ethical: Conforming to professionally proper conduct.

Expert witness: A person whose education, profession, or specialized experience qualifies them to testify about their area of expertise as it relates to the lawsuit.

Good Samaritan: A person who helps another person in distress even though there is no duty to do so.

Grossly negligent: Deliberately failing to perform a necessary duty in extraordinary disregard of the consequences to the person neglected.

Insurance: A contract binding one party to compensate another for specific losses, damages, or injury in exchange for the payment of premiums.

Invitee: A person who enters another’s property as a result of express or implied invitation.

Licensee: A person who has express or implied permission to enter another’s property.

Nonverbal communication: Body language used to communicate something.

Peer review: Assessment of academic, professional, or scientific work by others who are experts in the same field.

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 6: Medical Malpractice and Other Lawsuits

Product liability: A tort making a manufacturer liable for compensation to anyone using its product if damages or injuries occur from defects in that product.

Proximate cause: Results as a direct consequence and without which the result would not have happened.

Reasonable care: The amount of care a rational person would use in similar circumstances.

Res ipsa loquitur: Translated from Latin to “the thing speaks for itself.” Evidence showing that negligence by the defendant may be reasonably inferred from the nature of the injury occurring to the plaintiff.

Sanctioned: Penalized for violating a law or accepted procedure.

Sociological: Pertaining to human social behavior.

Statute of limitations: The law setting a time limit within which one person can sue another.

Statutory guidelines: Legislative laws defining legal rights and responsibilities.

Suit-prone: Likely to sue someone or be sued.

Trespasser: Someone who enters another’s property without express or implied invitation or permission. [return to top]

What's New in This Chapter The following elements are improvements in this chapter from the previous edition: ●

New content on expert witnesses and health care providers’ duty to their patients.

●

Additional content on statute of limitations; causation; informed consent; the impact of medical malpractice suits; and defensive medicine.

[return to top]

Chapter Outline In the outline below, each element includes references (in parentheses) to related content. "CH.##” refers to the chapter objective.

I.

Negligence or Malpractice? (06.01) a. Health care professionals are introduced into the practice of medicine and the statutory guidelines in place. Precise limitations exist based on each health care professional’s license and are different within each state. It is the responsibility of each health care provider to understand these laws and ensure they are practicing within them at all times when rendering patient care. Health care professionals are taught the difference between negligence and malpractice. b. Study Questions 1: 10 minutes. Describe a situation that might place a health care professional in the area you intend to practice in the position of being negligent.

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 6: Medical Malpractice and Other Lawsuits

II.

III.

IV.

V.

c. Study Questions 3: 10 minutes. List the possible qualifications for an expert witness in a medical malpractice case involving a nurse who works in a pediatrician’s office. d. Study Questions 4: 10 minutes. What relationship is necessary between a health care provider and patient to establish duty of care for the health care provider?

Elements of a Medical Malpractice Lawsuit (06.02) a. The six elements of a medical malpractice lawsuit are defined and explained in detail.

Each of the six elements are defined and reviewed with regards to how it contributes to a medical malpractice suit. b. Study Questions 2: 10 minutes. Describe a situation that might cause a health care professional to be named as a defendant in a medical malpractice claim. c. Cases for Discussion 1: 20 minutes. Exploration of a negligence action brought by a mother on behalf of a minor, and whether a patient relationship existed with the hospital providing treatment. d. Cases for Discussion 4: 10 minutes. Exploration of a health care provider’s lack of thorough examination on a 16-year-old male patient after an automobile accident. The patient expires thus leading to further discussion regarding appropriate standard of care of a minor and whether the health care provider’s actions, or lack thereof, contributed to the patient expiring. e. Cases for Discussion 3: 10 minutes. A woman delivered before the obstetrician arrived while the nurse ignored requests by the patient and her spouse to call the obstetrician.

The patient is injured during delivery. The discussion of whether the hospital is liable to the patient is discussed.

Informed Consent (06.03) a. The ethical, moral, and legal implications of informed consent are reviewed. Legal responsibility and scope of practice on who collects and reviews an informed consent with the patient are explored. b. Suggested Activity 1: 15 minutes. Play the childhood game of rumors. This will give each player an opportunity to learn about some of the confusion a patient experiences in the informed consent process. c. Cases for Discussion 6: 15 minutes. Informed consent is discussed in relation to care for a minor and who may legally provide the informed consent for the minor patient. d. Cases for Discussion 7: 15 minutes. Discussion of whether a health care provider can extend an operation without consent if they find a secondary issue that wasn’t covered with the patient in the original informed consent. e. Cases for Discussion 2: 20 minutes. A patient suffers disabling brain damage following admission for a procedure. Conflicting evidence regarding whether a provider left the operating room to attend another patient before or after an equally qualified health care provider arrived to provide care. Aspects of informed consent are discussed in depth.

Impact of Medical Malpractice Suits (06.04, 06) a. The impact of medical malpractice suits on a health care provider are explored in depth.

Defensive medicine and the economics of medical malpractice are discussed with regards to the impact of medical malpractice suits. There are many negative consequences of medical malpractice lawsuits including providers becoming bitter and emotional, the practice of defensive medicine, higher health and malpractice insurance, lack of specialists in high verdict areas, and higher health care costs.

Analysis of the Problem (06.05, 07)

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5

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 6: Medical Malpractice and Other Lawsuits

VIII.

VIIII.

X.

XI.

a. Objective and subjective factors of a medical malpractice suit are reviewed. Lack of empathy, the suit prone health care provider, and pharmacy are discussed. Subjective and objective factors contributing to a patient’s choice to litigate are defined and reviewed. Understanding the subjective and objective factors a health care professional can implement demonstrates how the usage of these when caring for a patient can greatly reduce a patient’s choice to litigate. b. Suggested Activity 2: 15 minutes. Role play. Show empathy to a patient who has just learned that he has cancer of the larynx. c. Study Questions 6: 15 minutes. A newly diagnosed cancer patient approaches you after being informed of two alternatives for treatment of cancer. This discussion outlines who the appropriate health care professional is to provide medical advice and informed consent. d. Cases for Discussion 5: 15 minutes. A medical case involving a patient that injures their finger and requires surgical care and the outcome is not what the patient had anticipated. Informed consent is discussed with relation to the surgical care provided to the patient by the health care provider.

Risk Management Issues in the Medical Office (06.08) a. Risk management measures to avoid a medical malpractice lawsuit are reviewed in detail. Each measure is defined in detail regarding how each health care professional may utilize this to avoid a medical malpractice lawsuit. b. Suggested Activity 3: 20 minutes. Watch the TedTalk “Doctor Make Mistakes. Can we Talk About That?”

Defenses to a Medical Malpractice Suit (06.09) a. Common defenses available to a defendant in a medical malpractice lawsuit are reviewed. Definitions and examples of each defense contribute to the overall understanding of the defense and how it can be utilized to defend against a malpractice lawsuit. The Good Samaritan Law is explained in detail with regards to how it protects health care professionals when they respond to an emergency situation. b. Study Questions 8: 15 minutes. This case discusses the obligation of a health care professional owed to a patient with regards to the Good Samaritan Law. c. Study Questions 5: 10 minutes. List the elements of a medical malpractice cause of action. d. Study Questions 7: 15 minutes. List, define, and give examples of the five defenses available to a defendant in a medical malpractice suit. e. Study Questions 11: 15 minutes. Explores the possible defenses of a patient that incurs an injury from medical facility property and incurs a secondary injury from failure to comply with medical directions.

Malpractice Insurance (06.10) a. Malpractice insurance is covered in detail with regards to what the insurance covers, why it is important, and the importance of understanding if the health care professional is covered by their place of work with their malpractice insurance. b. Study Questions 9: 10 minutes. Prepare a question for your future employer to determine whether their malpractice insurance covers a health care professional working in their office.

Product Liability (06.11) a. Product liability is reviewed and how it pertains to a medical lawsuit. Common products are reviewed that have been utilized in a product liability lawsuit.

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 6: Medical Malpractice and Other Lawsuits

b. Study Questions 12: 10 minutes. List equipment you might find in a medical office or hospital that could injure a patient and give rise to a product liability claim.

Strict Liability (06.12) a. Strict liability in tort is a theory used in product liability cases in which the seller is liable for any and all defective or hazardous products that unduly threaten a consumer’s personal safety. Strict liability in health care often arises with regard to drug manufacturing. b. Cases for Discussion 8: 15 minutes. The discussion regarding a defective instrument utilized within a surgical case that causes physical injury to the patient is explored.

Discussion on who can be named as a defendant within the case and whether there is a claim for strict liability.

Premises Liability (06.13) a. The responsibility of hospitals, clinics, and individual practitioners are responsible to the public for their offices, laboratories, buildings, and equipment are reviewed.

Classification of people entering onto another’s property are defined and reviewed with regards to the duty of care owed to each. The duty to warn and reasonable care are defined and reviewed. b. Study Questions 10: 15 minutes. Discusses the responsibility of the medical office when an inebriated trespasser comes onto the medical facility property and is injured from a known hazard within the facility.

XII.

XIII.

[return to top]

Discussion Questions Refer to the Cases for Discussion at the end of the chapter. You can assign these cases and questions several ways: in a discussion forum in your LMS; as whole-class discussions in person; or as a partner or group activity in class. Answers appear in the Solution and Answer Guide. [return to top]

Additional Resources Internet Resources ●

Health Workforce Technical Assistance. (2022). Health Professions Regulation in the U.S. Retrieved from https://www.healthworkforceta.org

●

Goldman, Brian. (2010). Doctors Make Mistakes Can We Talk About That? Retrieved from https://www.ted.com/talks/brian_goldman_doctors_make_mistakes_can_we_talk_about_that? language=en

●

National Conference of State Legislatures. (2022). Medical Liability/Malpractice Laws. Retrieved from https://www.ncsl.org

[return to top]

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 6: Medical Malpractice and Other Lawsuits

Appendix Generic Rubrics Providing students with rubrics helps them understand expectations and components of assignments.

Rubrics help students become more aware of their learning process and progress, and they improve students’ work through timely and detailed feedback.

Customize these rubrics as you wish. The writing rubric indicates 40 points and the discussion rubric indicates 30 points.

Standard Writing Rubric Criteria Content

Organization and Clarity

Research

Research

Grammar and Spelling

Meets Requirements Needs Improvement Incomplete The assignment clearly and The assignment partially The assignment does not comprehensively addresses all addresses some or all address the questions in the questions in the assignment. questions in the assignment. assignment.

15 points 8 points 0 points The assignment presents ideas The assignment presents ideas The assignment does not in a clear manner and with in a mostly clear manner and present ideas in a clear manner strong organizational structure. with a mostly strong and with strong organizational The assignment includes an organizational structure. The structure. The assignment appropriate introduction, assignment includes an includes an introduction, content, and conclusion. appropriate introduction, content, and conclusion, but Coverage of facts, arguments, content, and conclusion. coverage of facts, arguments, and conclusions are logically Coverage of facts, arguments, and conclusions are not related and consistent. and conclusions are mostly logically related and 10 points logically related and consistent. consistent.

0 points 7 points The assignment is based upon The assignment is based upon The assignment is not based appropriate and adequate adequate academic literature upon appropriate and academic literature, including but does not include peer adequate academic literature peer reviewed journals and reviewed journals and other and does not include peer other scholarly work. scholarly work. reviewed journals and other 5 points 3 points scholarly work.

0 points The assignment follows the The assignment follows some The assignment does not required citation guidelines. of the required citation follow the required citation 5 points guidelines. guidelines.

3 points 0 points The assignment has two or The assignment has three to The assignment is incomplete fewer grammatical and spelling five grammatical and spelling or unintelligible. errors. errors.

0 points 5 points 3 points

Standard Discussion Rubric Criteria Participation

Meets Requirements Submits or participates in discussion by the posted deadlines. Follows all assignment. instructions for initial post and responses.

5 points

Needs Improvement Incomplete Does not participate or submit Does not participate in discussion by the posted discussion. deadlines. Does not follow 0 points instructions for initial post and responses.

3 points

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

8

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 6: Medical Malpractice and Other Lawsuits

Contribution Quality

Etiquette

Comments stay on task.

Comments may not stay on Does not participate in Comments add value to task. Comments may not add discussion. discussion topic. Comments value to discussion topic.

0 points motivate other students to Comments may not motivate respond. other students to respond.

20 points 10 points Maintains appropriate Does not always maintain Does not participate in language. Offers criticism in a appropriate language. Offers discussion. constructive manner. Provides criticism in an offensive 0 points both positive and negative manner. Provides only negative feedback. feedback.

5 points 3 points

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

9

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 7: The Health Record

Instructor Manual Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 7: The Health Record

Table of Contents Purpose and Perspective of the Chapter .................................................................................................... 2 Chapter Objectives ..................................................................................................................................... 2 Key Terms ................................................................................................................................................... 2 What's New in This Chapter ........................................................................................................................ 2 Chapter Outline .......................................................................................................................................... 3 Discussion Questions .................................................................................................................................. 5 Additional Resources .................................................................................................................................. 5 Internet Resources ............................................................................................................................................ 5 Appendix ..................................................................................................................................................... 5 Generic Rubrics .................................................................................................................................................. 5 Standard Writing Rubric .................................................................................................................................... 5 Standard Discussion Rubric ............................................................................................................................... 6

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

1

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 7: The Health Record

Purpose and Perspective of the Chapter Health records and information regarding patients are subject to privacy laws. State law determines who owns a patient’s health record. Ownership usually carries with it the exclusive right and power to exercise authority and control over the use of property. In the case of the health record, the owner cannot control the record exclusively. The Health Insurance Portability and Accountability Act (HIPAA) allows patients to see their records and make corrections to them. Physicians are required to transfer medical information to other physicians engaged by their patients and to allow attorneys access to their clients’ records. It is crucial for students to understand that the contents of a health record should not be transferred or disclosed without the patient’s authorization. Records are often required in court and can be ordered by the issuance of a subpoena duces tecum. Finally, health records must be credible.

This means that there can be no alterations, fabrications, or concealments in a record. Corrections to a health record should be made with great care.

Chapter Objectives The following objectives are addressed in this chapter: 07.01 Define the Health Information Technology for Economic and Clinical Health (HITECH) Act and Promoting Interoperability.

07.02 List different types of health records.

07.03 Identify the owner of a health record.

07.04 Determine who is allowed access to the health record.

07.05 Identify the procedures necessary for release of information from the health record.

07.06 Define the importance of health record credibility.

07.07 Follow an acceptable method for making corrections to a health record.

Key Terms Data: Pieces of information.

Premises: Physical location, such as an office or building.

Property right: A right of ownership to a certain thing.

Subpoena: A written order to appear at a specified time and place to give sworn testimony.

Subpoena duces tecum: A written order to produce documents or things. [return to top]

What's New in This Chapter The following elements are improvements in this chapter from the previous edition: ●

Additional content on electronic health records.

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

2

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 7: The Health Record

●

New content on HITECH; goals and benefits of data interoperability; source of privacy rights and the Tarasoff case; patient and family access to health records; release of patient information; and chain of custody.

[return to top]

Chapter Outline In the outline below, each element includes references (in parentheses) to related content. "CH.##” refers to the chapter objective.

I.

II.

III.

IV.

V.

Introduction (07.01) a. Despite changes in the way a health record is kept, the elements of privacy, accuracy, timeliness, and reliance should be upheld. A health record is a recorded collection of data on a patient. The transition from paper charts to electronic health records (EHR) is one of the most significant changes in health care. The Health Information Technology for Economic and Clinical Health (HITECH) Act was intended to encourage the use of health information technology, provide incentives for the use of the EHR, and penalize health providers who do not use the EHR. b. Study Question #1: 10 minutes total. Students will list information contained in a health record.

Electronic Health Records (07.01) a. The HITECH Act has provided incentives for the promotion of data interoperability. EHR technology includes both computer hardware and software systems that store patient information. Challenges related to EHR include funding and not all EHR forms being able to “talk” to each other.

Types of Health Records (07.02) a. The typical form of a health record has transitioned from a collection of handwritten notes to an electronic file stored on a network. Integrated health records are common in large outpatient settings. Integrated health records represent the patient in a single record that includes all outpatient and inpatient activity. Management of the health record requires the same attention to detail and confidentiality regardless of whether it is in a hospital setting or a private office, it is a paper chart, or an EHR. Ownership of the Health Record (07.03) a. State law determines who owns a patient’s health record. Ownership usually carries with it the exclusive right and power to exercise authority and control over the use of property. In the case of the health record, the owner cannot control the record exclusively. Individuals, professionals, corporations, and courts are authorized to see copies of information within the health record regardless of who owns it. b. Study Question #2: 10 minutes total. Students will describe the difference between ownership of a health record and ownership of other property.

Access to the Health Record (07.04) a. Hospitals and health care providers should have a written policy detailing the procedures for releasing patient information. The policy must reflect federal law and state law, if applicable. There is general authorization for providers to release information to insurance companies when a patient is submitting third-party payment claims. Office and hospital records are subject to inspection by an attorney when

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

3

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 7: The Health Record

VI.

VII.

VIII.

authorized by the patient. In other instances, patients implicitly consent to the sending of a health record to a third party. b. Study Question #3: 20 minutes total. Students will role-play a scenario in which they will respond to a patient requesting access to x-rays to show family members. c. Study Question #4: 20 minutes total. Students will discuss how to handle a situation in which a patient requests access to their health record that contains information about telephone calls from the patient’s relatives that will interfere with the family relationship.

Release of Information (07.05) a. Unless otherwise instructed by the law or your employer, you should not disclose information about a patient. Information should not be released unless the request is specific, to include time limits, the purpose and use of the information, and what particular information is needed. b. Suggested Activity #1: 20 minutes total. Students will find a HIPAA-compliant release form on the internet and fill it out. c. Suggested Activity #2: 30 minutes total. Students will draft a letter for a fictitious patient who has requested a copy of their records and include a copy of the release form. d. Case for Discussion #1: 30 minutes total. A plaintiff authorized the release of information to an insurance company following an application for major medical insurance. The health care provider released information regarding the plaintiff’s physical health, mental health, and family life, and indicated that he is a poor insurance risk. Students will discuss if the provider had a right to release the information he provided. e. Case for Discussion #2: 30 minutes total. In a medical malpractice lawsuit, the court ordered a hospital to produce copies of all consultations, operative notes, interpretations of preoperative x-rays, and brain tissue analyses obtained on 140 patients. The hospital refused because consent had not been obtained from any of the patients. Students will discuss if the court should agree with the hospital’s opposition.

Credibility of the Health Record (07.06) a. Credibility of a health record refers to whether the information is believable. If a health record has corrections, amendments, modifications, changes, or misspelled words, it will raise suspicions. The credibility of the health record is crucial during a medical malpractice lawsuit. Credibility is questionable when an investigation reveals delays in filing laboratory test results, incomplete files, illegible records, altered or fabricated records, or the loss or concealment of information. b. Study Question #5: 20 minutes total. Students will discuss how to testify in court as a record keeper when the health provider has removed information from the record. c. Case for Discussion #3: 30 minutes total. A patient visited the emergency room due to chest pains. The nurse refused to call a health care provider and the patient died of myocardial infarction after leaving the hospital. In an attempt to review the records, the widow’s attorney found they were destroyed. Students will discuss if the hospital had a right to destroy the records.

Acceptable Method of Making Changes in Health Records (07.07) a. The goal should always be to maintain a record perfectly. Most EHR systems track entries by user, date, and time. When an error occurs and corrections are made, the original error will remain, and an addendum will be added. When an error occurs with a paper chart, cross out the mistake, initial and date it, and write in the correct

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

4

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 7: The Health Record

information. If changes are made while a patient is under treatment, they may be accepted as rewritten or amended. If changes are made beyond a reasonable period after discharge, they may raise red flags. Record keepers have the responsibility to ensure records are accurate and should bring up any errors to the health provider for corrections. b. Study Question #6: 20 minutes total. Students will discuss how to change a good-faith error in a record that has been subpoenaed when the health care provider requests the record to be deleted and recreated. [return to top]

Discussion Questions Refer to the Cases for Discussion at the end of the chapter. You can assign these cases and questions several ways: in a discussion forum in your LMS; as whole-class discussions in person; or as a partner or group activity in class. Answers appear in the Solution and Answer Guide. [return to top]

Additional Resources Internet Resources ●

HITECH Act. (2017, Jun 16). U.S. Department of Health and Human Resources. Retrieved from https://www.hhs.gov/hipaa/for-professionals/special-topics/hitech-act-enforcement-interimfinal-rule/index.html

●

Public Health Data Interoperability. (2022, Jan 19). Centers for Disease Control and Prevention.

Retrieved from https://www.cdc.gov/datainteroperability/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.c dc.gov%2Fehrmeaningfuluse%2Fintroduction.html

●

HIPAA for Professionals. (2021, May 17). U.S. Department of Health and Human Resources.

Retrieved from https://www.hhs.gov/hipaa/for-professionals/index.html

[return to top]

Appendix Generic Rubrics Providing students with rubrics helps them understand expectations and components of assignments.

Rubrics help students become more aware of their learning process and progress, and they improve students’ work through timely and detailed feedback.

Customize these rubrics as you wish. The writing rubric indicates 40 points and the discussion rubric indicates 30 points.

Standard Writing Rubric Criteria

Meets Requirements

Needs Improvement

Incomplete

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

5

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 7: The Health Record

Content

Organization and Clarity

Research

Research

Grammar and Spelling

The assignment clearly and The assignment partially The assignment does not comprehensively addresses all addresses some or all address the questions in the questions in the assignment. questions in the assignment. assignment.

15 points 8 points 0 points The assignment presents ideas The assignment presents ideas The assignment does not in a clear manner and with in a mostly clear manner and present ideas in a clear manner strong organizational structure. with a mostly strong and with strong organizational The assignment includes an organizational structure. The structure. The assignment appropriate introduction, assignment includes an includes an introduction, content, and conclusion. appropriate introduction, content, and conclusion, but Coverage of facts, arguments, content, and conclusion. coverage of facts, arguments, and conclusions are logically Coverage of facts, arguments, and conclusions are not related and consistent. and conclusions are mostly logically related and 10 points logically related and consistent. consistent.

0 points 7 points The assignment is based upon The assignment is based upon The assignment is not based appropriate and adequate adequate academic literature upon appropriate and academic literature, including but does not include peer adequate academic literature peer reviewed journals and reviewed journals and other and does not include peer other scholarly work. scholarly work. reviewed journals and other 5 points 3 points scholarly work.

0 points The assignment follows the The assignment follows some The assignment does not required citation guidelines. of the required citation follow the required citation 5 points guidelines. guidelines.

3 points 0 points The assignment has two or The assignment has three to The assignment is incomplete fewer grammatical and spelling five grammatical and spelling or unintelligible. errors. errors.

0 points 5 points 3 points

Standard Discussion Rubric Criteria Participation

Contribution Quality

Etiquette

Meets Requirements Needs Improvement Incomplete Submits or participates in Does not participate or submit Does not participate in discussion by the posted discussion by the posted discussion. deadlines. Follows all deadlines. Does not follow 0 points assignment. instructions for instructions for initial post and initial post and responses. responses.

5 points 3 points Comments stay on task.

Comments may not stay on Does not participate in Comments add value to task. Comments may not add discussion. discussion topic. Comments value to discussion topic.

0 points motivate other students to Comments may not motivate respond. other students to respond.

20 points 10 points Maintains appropriate Does not always maintain Does not participate in language. Offers criticism in a appropriate language. Offers discussion. constructive manner. Provides criticism in an offensive 0 points both positive and negative manner. Provides only negative feedback. feedback.

5 points 3 points

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

6

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 8: Introduction to Ethics

Instructor Manual Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 8: Introduction to Ethics

Table of Contents Purpose and Perspective of the Chapter .................................................................................................... 2 Chapter Objectives ..................................................................................................................................... 2 Key Terms ................................................................................................................................................... 2 What's New in This Chapter ........................................................................................................................ 2 Chapter Outline .......................................................................................................................................... 3 Discussion Questions .................................................................................................................................. 4 Additional Resources .................................................................................................................................. 4 Internet Resources ............................................................................................................................................ 4 Appendix ..................................................................................................................................................... 5 Generic Rubrics .................................................................................................................................................. 5 Standard Writing Rubric .................................................................................................................................... 5 Standard Discussion Rubric ............................................................................................................................... 6

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

1

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 8: Introduction to Ethics

Purpose and Perspective of the Chapter This chapter introduces the matter of ethics. Students will learn about the distinctions between ethics, morals, and etiquette. In this chapter, definitions are established, and deontological and teleological ethical theories are explored. Students are offered reasoning into the development of ethical principles and the concept of potential for conflicting personal and professional ethics. The process of ethical decision making is outlined. Reasoning tools are discussed for processing ethical dilemmas, and finally, the chapter discusses the concept of the ultimate decision maker.

Chapter Objectives The following objectives are addressed in this chapter: 08.01 Distinguish between ethics, law, morals, and etiquette.

08.02 Describe the importance of ethics codes in professional organizations.

08.03 Describe how individual values and morals are developed.

08.04 Summarize the main concepts of duty-based, utilitarian, and virtue-based ethical theories.

08.05 Develop a thought process for making ethical decisions.

08.06 Demonstrate acceptable responses to ethical issues.

08.07 Distinguish between personal ethics and professional ethics.

08.08 Describe the relationship between personal ethics and professionalism on the job.

08.09 Develop a plan for separating personal and professional ethics in the workplace.

Key Terms Amoral: Without consideration of morals.

Bioethics: Ethical issues and the implications of the application of biological research.

Dilemma: Situation where a challenging decision must be made between two or more options.

Ethics: Moral principles that guide a person or a society’s choices and conduct.

Etiquette: Prescribed code of courteous social behavior.

Immoral: Not moral.

Philosophy: A basic viewpoint of an individual’s or a community’s value system.

Values: Principles of thought and conduct that are considered desirable. [return to top]

What's New in This Chapter The following elements are improvements in this chapter from the previous edition: ●

New content on definition of ethics; morals; development of values; and professional etiquette.

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

2

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 8: Introduction to Ethics

●

New section entitled “Ethical Theories”, including information about deontology, teleology, utilitarianism, and virtue-based ethics.

●

New section entitled “Ethical Decision Making”, explaining common steps in ethical decision making.

●

New section entitled “Personal Ethics in the Workplace”, differentiating personal and professional ethics.

[return to top]

Chapter Outline In the outline below, each element includes references (in parentheses) to related content. "CH.##” refers to the chapter objective.

I.

II.

III.

The Difference Between Ethics, Law, Morals, and Etiquette (08.01, 02, 03) a. This section defines dilemmas, ethics, morals, and etiquette and compares these concepts to law. The AMA Code of Conduct is reviewed. Morals are more thoroughly discussed, and the definitions of immoral and amoral are mentioned. This section discusses the development of values and mentions Piaget and Kohlberg’s psychological theories of moral development. Finally, the concept of etiquette is discussed in reference to professional etiquette and its impact on the individual and employer. b. Suggested Activity 4: 45 minutes total. Research news media for examples of ethics, law, morals, and etiquette. Use those stories to help distinguish between the concepts. c. Suggested Activity 2: 60 minutes total. Learners should research a code of ethics for their role or profession and identify the purpose for each tenet. d. Study Question 5: 30 minutes total. Compare morals and values and how they are developed. e. Study Question 2: 20 minutes total. Discuss why ethical codes are important in practicing medicine. f. Case for Discussion 2: 30 minutes total. An orthopedist in Maine disciplined for overutilization, malpractice, and unethical practice who proved that his actions were not illegal, yet was accused of violating ethics codes of the state society. Should the provider lose his license or not?

Ethical Theories (08.04) a. This section defines deontological and teleological philosophical theories of duty, utilitarianism, and value-based concepts of ethical theory. It mentions Kant’s categorical imperative, Jeremy Bentham’s view of utilitarianism, and the early philosophers’ concepts of virtue. Each theory is presented with advantageous aspects as well as weaknesses. b. Study Question 4: 30 minutes total. Compare and contrast the duty-based, utilitarianism, and virtue-based ethical theories. c. Case for Discussion 4: 45 minutes total. Review the details of the case study and apply utilitarian, duty-based and virtue-based theories in an ethical decision-making analysis.

Ethical Decision Making (08.05, 06) a. This section calls the learner to take inventory of their own personal ethics. It offers case studies to discuss and situations to consider aiding that personal inventory.

Acknowledging that there are many ethical theories and guides, this section offers a

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

3

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 8: Introduction to Ethics

composite eight step method of identifying the decision-making process of an ethical dilemma. Within the section, the case studies are tabled based on these eight steps and the use of the eight-step process. b. Study Question 3: 20 minutes total. Why is it important to study ethics as a health care professional? c. Suggested Activities 3: 45 minutes total. Independent consideration to inventory personal and professional ethics by creating 10 priorities, tying them to ethics. Then, the learner will review life events and consider how ethical decisions were made using the eight steps in the chapter. d. Case for Discussion 1: 30 minutes. Present the case discussing the rights of the patient and an acceptable response to the ethical issue.

Personal Ethics in the Workplace (08.07, 08, 09) a. This section compounds the ethical inventory of the previous section and discusses the difference between personal and professional ethics. After defining professional ethics, consideration is made toward potential personal versus professional ethical conflicts.

Ultimately, the section presents the concept of determining the ultimate decision maker in an ethical dilemma and the fact that that person or entity must make ethical decisions. The section inspires learners to explore the remaining chapters that offer ethical and legal consideration for special situations found in the health care setting. b. Suggested Activities 1: 30 minutes total. Independent consideration of categories of ethics, potential conflicts with professional ethics, and how one would separate personal and professional ethics if needed. c. Study Question 1: 30 minutes total. Identify three professional ethics and personal ethics that may conflict or align. The learner will describe how they would be separated if needed. d. Case for Discussion 3: 45 minutes total. Discuss the case with these questions in mind: How would you have handled the situation differently? Is there a way in this situation to maintain personal ethics while complying with professional ethics?

IV.

[return to top]

Discussion Questions Refer to the Cases for Discussion at the end of the chapter. You can assign these cases and questions several ways: in a discussion forum in your LMS; as whole-class discussions in person; or as a partner or group activity in class. Answers appear in the Solution and Answer Guide. [return to top]

Additional Resources Internet Resources ●

Vermont Ethics Network. (n.d.). Health care ethics: Overview of the basics. In Health Care Ethics.

Retrieved from https://vtethicsnetwork.org/medical-ethics

●

Cleveland Clinic. (n.d.). Dealing with ethical questions in health care. Retrieved from https://my.clevelandclinic.org/health/articles/dealing-with-ethical-questions-in-health-care

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

4

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 8: Introduction to Ethics

●

Limentani, A. E. (1999). The role of ethical principles in health care and the implications for ethical codes. Journal of Medical Ethics, 25, 394–398. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC479265/pdf/jmedeth00006-0032.pdf

[return to top]

Appendix Generic Rubrics Providing students with rubrics helps them understand expectations and components of assignments.

Rubrics help students become more aware of their learning process and progress, and they improve students’ work through timely and detailed feedback.

Customize these rubrics as you wish. The writing rubric indicates 40 points and the discussion rubric indicates 30 points.

Standard Writing Rubric Criteria Content

Organization and Clarity

Research

Research

Grammar and Spelling

Meets Requirements Needs Improvement Incomplete The assignment clearly and The assignment partially The assignment does not comprehensively addresses all addresses some or all address the questions in the questions in the assignment. questions in the assignment. assignment.

15 points 8 points 0 points The assignment presents ideas The assignment presents ideas The assignment does not in a clear manner and with in a mostly clear manner and present ideas in a clear manner strong organizational structure. with a mostly strong and with strong organizational The assignment includes an organizational structure. The structure. The assignment appropriate introduction, assignment includes an includes an introduction, content, and conclusion. appropriate introduction, content, and conclusion, but Coverage of facts, arguments, content, and conclusion. coverage of facts, arguments, and conclusions are logically Coverage of facts, arguments, and conclusions are not related and consistent. and conclusions are mostly logically related and 10 points logically related and consistent. consistent.

0 points 7 points The assignment is based upon The assignment is based upon The assignment is not based appropriate and adequate adequate academic literature upon appropriate and academic literature, including but does not include peer adequate academic literature peer reviewed journals and reviewed journals and other and does not include peer other scholarly work. scholarly work. reviewed journals and other 5 points 3 points scholarly work.

0 points The assignment follows the The assignment follows some The assignment does not required citation guidelines. of the required citation follow the required citation 5 points guidelines. guidelines.

3 points 0 points The assignment has two or The assignment has three to The assignment is incomplete fewer grammatical and spelling five grammatical and spelling or unintelligible. errors. errors.

0 points 5 points 3 points

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

5

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 8: Introduction to Ethics

Standard Discussion Rubric Criteria Participation

Contribution Quality

Etiquette

Meets Requirements Needs Improvement Incomplete Submits or participates in Does not participate or submit Does not participate in discussion by the posted discussion by the posted discussion. deadlines. Follows all deadlines. Does not follow 0 points assignment. instructions for instructions for initial post and initial post and responses. responses.

5 points 3 points Comments stay on task.

Comments may not stay on Does not participate in Comments add value to task. Comments may not add discussion. discussion topic. Comments value to discussion topic.

0 points motivate other students to Comments may not motivate respond. other students to respond.

20 points 10 points Maintains appropriate Does not always maintain Does not participate in language. Offers criticism in a appropriate language. Offers discussion. constructive manner. Provides criticism in an offensive 0 points both positive and negative manner. Provides only negative feedback. feedback.

5 points 3 points

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

6

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 9: Laws and Ethics of Patient Confidentiality

Instructor Manual Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 9: Laws and Ethics of Patient Confidentiality

Table of Contents Purpose and Perspective of the Chapter .................................................................................................... 2 Chapter Objectives ..................................................................................................................................... 2 Key Terms ................................................................................................................................................... 2 What's New in This Chapter ........................................................................................................................ 2 Chapter Outline .......................................................................................................................................... 3 Discussion Questions .................................................................................................................................. 4 Additional Resources .................................................................................................................................. 4 Internet Resources ............................................................................................................................................ 4 Appendix ..................................................................................................................................................... 5 Generic Rubrics .................................................................................................................................................. 5 Standard Writing Rubric .................................................................................................................................... 5 Standard Discussion Rubric ............................................................................................................................... 6

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

1

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 9: Laws and Ethics of Patient Confidentiality

Purpose and Perspective of the Chapter The purpose of this chapter is to review privacy, confidentiality, and privileged communication, terms used to define the relationship between medical professionals and their patients and between legal professionals and their clients. HIPAA provides rules about the confidentiality requirements of health care facilities and personnel. This chapter makes clear that all factors must be reviewed when making decisions about breaking patient confidentiality. Students will learn that regardless of the format of the information (electronic, written, verbal), HIPAA governs it. This chapter explains that there are limits to a patient’s right to confidentiality when there is a greater interest in disclosing the information, which creates ethical dilemmas. Students will learn that maintaining confidence often involves ethical conflicts.

Chapter Objectives The following objectives are addressed in this chapter: 09.01 Distinguish between privacy, confidentiality, and privileged communication.

09.02 Summarize the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

09.03 Evaluate health care interactions to determine if they violate HIPAA. 09.04 Summarize consequences for violating HIPAA. 09.05 Perform HIPAA compliance reporting.

09.06 Identify challenges to maintaining patient confidentiality.

09.07 Identify methods of maintaining confidentiality in medical facilities.

09.08 Identify situations in which disclosure of health information is legal and necessary.

Key Terms Confidentiality: Not disclosing information to those who are not authorized to receive it.

Patient-provider privilege: Legal doctrine that protects communications between a patient and a provider from disclosure in court.

Privacy: Being protected from public scrutiny or having your personal information shared without your permission.

Protected health information: Information held by a covered entity related to a patient’s health status, their health care, or payment for health care.

Privileged communication: A communication (written or verbal) that occurs between two or more people that is protected by law from disclosure in court (see also patient–provider privilege).

Waives: The act of giving up a claim, privilege, or right. [return to top]

What's New in This Chapter The following elements are improvements in this chapter from the previous edition:

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

2

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 9: Laws and Ethics of Patient Confidentiality

●

Additional content differentiating patient confidentiality, privacy, and privileged communication.

●

New content on HIPAA, including the Privacy Rule, the Security.

●

Rule, HIPAA compliance, the Enforcement Rule, the Breach Notification Rule, violations and penalties, and filing a HIPAA complaint.

●

New sections entitled “HIPAA-Authorized PHI Uses and Disclosures” and “Patient-Authorized PHI Uses and Disclosures”.

[return to top]

Chapter Outline In the outline below, each element includes references (in parentheses) to related content. "CH.##” refers to the chapter objective.

I.

II.

III.

IV.

Patient Confidentiality, Privacy, and Privileged Communication (09.01) a. Discussion and review of patient confidentiality, privacy, privileged communication, and protected health information. b. Study Question 1: 10 minutes total. Privacy means many different things in a medical setting. Distinguish between the patient’s right to privacy and privacy of privileged communication. c. Suggested Activity 1: 10 minutes total. Research methods of maintaining the confidentiality of medical records at a local emergency room or hospital.

Health Insurance Portability and Accountability Act of 1996 (HIPAA) (09.02, 04, 05) a. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is reviewed.

Enforcement, violations, and maintenance of HIPAA are explained in depth. b. Suggested Activity 2: 15 minutes total. Find out and document the procedure and charges to obtain a copy of your own medical record from a health care provider. c. Suggested Activity 3: 20 minutes total. Find three HIPAA compliant Notice of Privacy Practices online. How are they the same? How do they differ? d. Study Question 2: 10 minutes total. Explain HIPAA’s three main objectives. e. Study Question 3: 10 minutes total. Explain how a HIPPA covered entity might identify violations that occurred on its electronic health records system. f. Study Question 4: 10 minutes total. Identify those who are eligible to file a HIPAA complaint.

Challenges to Maintaining Confidentiality (09.03) a. Technologic, high-profile patients, and additional factors that are challenging with regards to maintaining confidentiality are explored. b. Cases for Discussion 5: 15 minutes total. A hospital employee calls a patient’s home and leaves a voicemail that detailed her medical condition and treatment plan that her daughter heard. The patient specified to only utilize her cell phone for voicemails. What are the implications of this? c. Cases for Discussion 6: 15 minutes total. A patient was injured in an unusual sporting accident, and the hospital released their skull x-ray to the local media. The local newspaper then featured it on the front page. Was this a permissible disclosure?

HIPAA-Authorized PHI Uses and Disclosures (09.07)

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

3

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 9: Laws and Ethics of Patient Confidentiality

a. The Tarasoff case is reviewed with regards to the implementation of HIPAA. In some circumstances, there are interests that outweigh a patient’s right to confidentiality, and HIPAA recognizes and identifies those circumstances. b. Case for Discussion 2: 20 minutes total. A patient, who was also an employee of the hospital, alleged that their PHI was impermissibly disclosed to their supervisor. Was this a HIPAA violation? Why or why not?

Patient-Authorized PHI Uses and Disclosures (09.06, 08) a. Mandatory elements of PHI and HIPAA that must be included in the disclosures are reviewed. b. Cases for Discussion 1: 15 minutes total. A private practice provider denied a patient access to her medical records because she had an outstanding balance for services. Is this permissible under HIPAA? Why or why not? c. Cases for Discussion 3: 20 minutes total. An HMO sent a patient’s entire medical record to a disability insurance company without proper authorization. The authorization form used by the HMO did not comply with HIPAA’s requirements. Is an authorization needed in this instance? What should the investigating compliance officer recommend? d. Cases for Discussion 4: 20 minutes total. As part of a negotiation settlement a patient sustained from a car accident, the defendant’s insurance company requested the plaintiff undergo an independent medical exam (IME). The patient is denied a copy of the medical record related to the IME. Is the plaintiff entitled to a copy of their record of the exam?

Confidentiality as an Ethical Dilemma a. In addition to the consequences of violating HIPAA, intentionally disclosing confidential PHI raises issues as to what is ethically right or wrong given the circumstances. There are many situations in which protecting or releasing protected health information can cause ethical questions or dilemmas, but compliance with the law and profession’s code of ethics is essential.

V.

IV.

[return to top]

Discussion Questions Refer to the Cases for Discussion at the end of the chapter. You can assign these cases and questions several ways: in a discussion forum in your LMS; as whole-class discussions in person; or as a partner or group activity in class. Answers appear in the Solution and Answer Guide. [return to top]

Additional Resources Internet Resources ●

Center for Disease Control and Prevention. (2022). Health Insurance Portability and Accountability Act of 1996. Retrieved from https://www.cdc.gov/phlp/publications/topic/hipaa.html

●

TedTalk. (2019). Privacy and Consent. Retrieved from https://www.ted.com/talks/fred_cate_privacy_and_consent

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

4

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 9: Laws and Ethics of Patient Confidentiality

●

U.S. Department of Health and Human Services. (2022). Summary of the HIPAA Security Role.

Retrieved from https://www.hhs.gov/hipaa/for-professionals/security/lawsregulations/index.html

[return to top]

Appendix Generic Rubrics Providing students with rubrics helps them understand expectations and components of assignments.

Rubrics help students become more aware of their learning process and progress, and they improve students’ work through timely and detailed feedback.

Customize these rubrics as you wish. The writing rubric indicates 40 points and the discussion rubric indicates 30 points.

Standard Writing Rubric Criteria Content

Organization and Clarity

Research

Research

Grammar and Spelling

Meets Requirements Needs Improvement Incomplete The assignment clearly and The assignment partially The assignment does not comprehensively addresses all addresses some or all address the questions in the questions in the assignment. questions in the assignment. assignment.

15 points 8 points 0 points The assignment presents ideas The assignment presents ideas The assignment does not in a clear manner and with in a mostly clear manner and present ideas in a clear manner strong organizational structure. with a mostly strong and with strong organizational The assignment includes an organizational structure. The structure. The assignment appropriate introduction, assignment includes an includes an introduction, content, and conclusion. appropriate introduction, content, and conclusion, but Coverage of facts, arguments, content, and conclusion. coverage of facts, arguments, and conclusions are logically Coverage of facts, arguments, and conclusions are not related and consistent. and conclusions are mostly logically related and 10 points logically related and consistent. consistent.

0 points 7 points The assignment is based upon The assignment is based upon The assignment is not based appropriate and adequate adequate academic literature upon appropriate and academic literature, including but does not include peer adequate academic literature peer reviewed journals and reviewed journals and other and does not include peer other scholarly work. scholarly work. reviewed journals and other 5 points 3 points scholarly work.

0 points The assignment follows the The assignment follows some The assignment does not required citation guidelines. of the required citation follow the required citation 5 points guidelines. guidelines.

3 points 0 points The assignment has two or The assignment has three to The assignment is incomplete fewer grammatical and spelling five grammatical and spelling or unintelligible. errors. errors.

0 points 5 points 3 points

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

5

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 9: Laws and Ethics of Patient Confidentiality

Standard Discussion Rubric Criteria Participation

Contribution Quality

Etiquette

Meets Requirements Needs Improvement Incomplete Submits or participates in Does not participate or submit Does not participate in discussion by the posted discussion by the posted discussion. deadlines. Follows all deadlines. Does not follow 0 points assignment. instructions for instructions for initial post and initial post and responses. responses.

5 points 3 points Comments stay on task.

Comments may not stay on Does not participate in Comments add value to task. Comments may not add discussion. discussion topic. Comments value to discussion topic.

0 points motivate other students to Comments may not motivate respond. other students to respond.

20 points 10 points Maintains appropriate Does not always maintain Does not participate in language. Offers criticism in a appropriate language. Offers discussion. constructive manner. Provides criticism in an offensive 0 points both positive and negative manner. Provides only negative feedback. feedback.

5 points 3 points

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

6

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 10: Professional Ethics and the Living

Instructor Manual Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 10: Professional Ethics and the Living

Table of Contents Purpose and Perspective of the Chapter .................................................................................................... 2 Chapter Objectives ..................................................................................................................................... 2 Key Terms ................................................................................................................................................... 2 What's New in This Chapter ........................................................................................................................ 3 Chapter Outline .......................................................................................................................................... 3 Discussion Questions .................................................................................................................................. 4 Additional Resources .................................................................................................................................. 5 Internet Resources ............................................................................................................................................ 5 Appendix ..................................................................................................................................................... 6 Generic Rubrics .................................................................................................................................................. 6 Standard Writing Rubric .................................................................................................................................... 6 Standard Discussion Rubric ............................................................................................................................... 6

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

1

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 10: Professional Ethics and the Living

Purpose and Perspective of the Chapter The purpose of this chapter is to prepare the student to face ethical issues related to the allocation of resources as a future health care provider. Resources such as time, the scarcity of organs for transplant, the limitation of funds for health care delivery systems, ICU beds, and even COVID-19 vaccines all fall into the allocation of resources. Managed care organizations also are discussed and raise issues of the conflict between cost savings and providing the best patient care.

Additionally, this chapter contains a discussion of the ethics of human and medical experimentation, including the Tuskegee Study and the Nuremberg Code. Medical transplants, their types, the growth in popularity of medical tourism, and the ethical dilemmas that arise from these topics are important for the student to understand. Finally, this chapter explains that a professional’s desire to save a life sometimes conflicts with an individual’s desire to be autonomous and make informed decisions.

Chapter Objectives The following objectives are addressed in this chapter: 10.01 Identify ethical issues faced by medical professionals in allocating scarce resources.

10.02 Explain ethical questions associated with medical research and experimentation.

10.03 Summarize the Tuskegee Study.

10.04 Summarize the terms of the Nuremberg Code.

10.05 Summarize the pros and cons of community-based research.

10.06 Describe what the first transplant operations were and when they occurred.

10.07 Identify the three categories of transplants.

10.08 Define the Uniform Anatomical Gift Act. 10.09 Identify ethical issues related to organ transplants.

10.10 Explain the importance of balancing autonomy and paternalism in patient care.

10.11 Explain the reasons for and consequences of medical tourism.

10.12 Explain ethical dilemmas associated with patient confidentiality.

Key Terms Allocation: The act of distributing something.

Autonomy: Allowing individuals control over themselves.

Herd immunity: The eradication or slowing of the spread of a disease that occurs when a high enough percentage of the population is immune to the disease and it can no longer spread.

Paternalism: Providing for people’s needs but giving them no responsibility or control over their destiny. [return to top]

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

2

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 10: Professional Ethics and the Living

What's New in This Chapter The following elements are improvements in this chapter from the previous edition: ●

New content on the allocation of scare resources; the ethics of transplants; and medical tourism.

●

Additional content on clinical trials and autonomy versus paternalism in health care.

[return to top]

Chapter Outline In the outline below, each element includes references (in parentheses) to related content. "CH.##” refers to the chapter objective.

I.

II.

III.

IV.

Introduction (10.01) a. This introductory section introduces the student to the ethical issues they will face as future health care providers relating to the allocation of scarce resources, medical research, transplants, autonomy, paternalism, and influences upon the patient-provider relationship.

Allocation of Scarce Resources (10.01) a. In this section, students will be introduced to the ethical dilemma of allocating resources in health care. Resources such as scarcity of organs for transplant, limitation of funds for health care delivery systems, ICU beds, and COVID-19 vaccines. Ethical conflicts in the ICU and conflicts created by managed care are also discussed in more detail. b. Suggested Activity 4: 30 minutes total. The student is asked to research a news article on an area of resource allocation related to the pandemic and think about the fairness, helpfulness, and areas of improvement that are applicable. c. Study Question 2: 10 minutes total. The student is asked to think about the similarities and differences between required COVID-19 vaccinations and required child vaccinations for school attendance. d. Cases for Discussion 3: 15 minutes total. In this ethical dilemma, the student is asked to decide and provide rationale for choosing which COVID-19 patient gets an ICU bed, when all three need one.

Ethics in Medical Research (10.02, 03, 04, 05) a. This section discusses the mandates of the Tuskegee Study and the Nuremberg code, created as a result of past unethical behavior in medical research. The ethics, benefits, and conflicts involved in clinical drug trials and private office medical research are also discussed. b. Suggested Activity 1: 120 minutes total. Watch the movie Miss Evers’ Boys, based upon the true story of the Tuskegee Study. c. Suggested Activity 3: 60 minutes total. Watch one of the many documentaries available on the Nuremberg Trials.

Transplants (10.06, 07, 08, 09) a. This section defines the three categories of transplants, reflects on the history of transplant surgery, and explains the creation and provisions involved in The Uniform Anatomical Gift Act. This section also speaks to the scarcity, demand, funding, ethical issues, and illegal sale of organs.

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

3

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 10: Professional Ethics and the Living

V.

VI.

VII.

b. Suggested Activity 5: 15 minutes total. Research the Uniform Anatomical Gift Act as it applies to the state in which the student lives or works. c. Suggested Activity 6: 15 minutes total. The student is asked to find a recent example in the news for each of the three categories of transplants. d. Study Question 1: 10 minutes total. After reviewing a patient's situation regarding fear and questioning of a kidney transplant surgery, the student is asked to think about how they would respond. e. Study Question 3: 10 minutes total. The student is asked to think about how they would respond to a patient case regarding the publicity of a liver transplant. f. Study Question 5: 10 minutes total. An ethical dilemma involving the selling of a kidney for financial and patient benefit is discussed, and the student is asked how they would respond to the situation. g. Cases for Discussion 1: 15 minutes total. The student is asked to ponder upon and discuss a situation involving a prisoner sentenced to die and a child needing a kidney.

Autonomy Versus Paternalism (10.10) a. This section discusses the terms autonomy and paternalism and how these issues are in constant conflict with each other in health care. The different perspectives and roles in health-related situations create tension between the two terms. b. Suggested Activity 2: 120 minutes total. Visit a local nursing home (with permission) to listen to what the residents and staff think about autonomy in decision making, and paternalism with older adults. c. Cases for Discussion 2: 15 minutes total. The student reviews a situation involving the forcible removal of a patient from her home to a hospital and is asked to discuss whether she should be released or not.

Medical Tourism (10.11) a. Medical tourism has grown in response to concerns over the cost and availability of health care services. This section discusses the ethical dilemmas that arise between patients, providers, and employers in response to medical tourism. b. Study Question 4: 10 minutes total. The student is asked to respond to a case in which the patient is seeking follow-up care on a knee surgery done abroad, and the provider is refusing to see them.

Influences on the Patient-Provider Relationship (10.01, 12) a. Many resources, such as time and one’s relative power, influence the patient-provider relationship. This section discusses the ethical concerns and considerations that influence this relationship.

[return to top]

Discussion Questions Refer to the Cases for Discussion at the end of the chapter. You can assign these cases and questions several ways: in a discussion forum in your LMS; as whole-class discussions in person; or as a partner or group activity in class. Answers appear in the Solution and Answer Guide. [return to top]

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

4

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 10: Professional Ethics and the Living

Additional Resources Internet Resources ●

Fressin, F., Wen, A., Shukla, S., Mok, K., Chaguturu, S. (2021, July 23). How We Achieved More Equitable Vaccine Distribution: Social Vulnerability Analytics Are Necessary, But Not Sufficient.

Health Affairs. Retrieved from www.healthaffairs.org/do/10.1377/hblog20210721.568098/full/.

●

Tuskegee Study: Centers for Disease Control and Prevention. (2016, December 8). The Tuskegee timeline. Retrieved from https://www.cdc.gov/tuskegee/timeline.htm

●

Nuremberg Code: United States Holocaust Memorial Museum. (n.d.). Nuremberg code.

Retrieved from https://www.ushmm.org/information/exhibitions/online-exhibitions/specialfocus/doctors-trial/nuremberg-code

●

AMA. (n.d.). Medical Tourism: Code of Medical Ethics Opinion 1.2.13. AMA. Retrieved from www.ama-assn.org/delivering-care/ethics/medical-tourism.

[return to top]

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

5

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 10: Professional Ethics and the Living

Appendix Generic Rubrics Providing students with rubrics helps them understand expectations and components of assignments.

Rubrics help students become more aware of their learning process and progress, and they improve students’ work through timely and detailed feedback.

Customize these rubrics as you wish. The writing rubric indicates 40 points and the discussion rubric indicates 30 points.

Standard Writing Rubric Criteria Content

Organization and Clarity

Research

Research

Grammar and Spelling

Meets Requirements Needs Improvement Incomplete The assignment clearly and The assignment partially The assignment does not comprehensively addresses all addresses some or all address the questions in the questions in the assignment. questions in the assignment. assignment.

15 points 8 points 0 points The assignment presents ideas The assignment presents ideas The assignment does not in a clear manner and with in a mostly clear manner and present ideas in a clear manner strong organizational structure. with a mostly strong and with strong organizational The assignment includes an organizational structure. The structure. The assignment appropriate introduction, assignment includes an includes an introduction, content, and conclusion. appropriate introduction, content, and conclusion, but Coverage of facts, arguments, content, and conclusion. coverage of facts, arguments, and conclusions are logically Coverage of facts, arguments, and conclusions are not related and consistent. and conclusions are mostly logically related and 10 points logically related and consistent. consistent.

0 points 7 points The assignment is based upon The assignment is based upon The assignment is not based appropriate and adequate adequate academic literature upon appropriate and academic literature, including but does not include peer adequate academic literature peer reviewed journals and reviewed journals and other and does not include peer other scholarly work. scholarly work. reviewed journals and other 5 points 3 points scholarly work.

0 points The assignment follows the The assignment follows some The assignment does not required citation guidelines. of the required citation follow the required citation 5 points guidelines. guidelines.

3 points 0 points The assignment has two or The assignment has three to The assignment is incomplete fewer grammatical and spelling five grammatical and spelling or unintelligible. errors. errors.

0 points 5 points 3 points

Standard Discussion Rubric Criteria Participation

Meets Requirements Submits or participates in discussion by the posted deadlines. Follows all assignment. instructions for initial post and responses.

5 points

Needs Improvement Incomplete Does not participate or submit Does not participate in discussion by the posted discussion. deadlines. Does not follow 0 points instructions for initial post and responses.

3 points

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

6

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 10: Professional Ethics and the Living

Contribution Quality

Etiquette

Comments stay on task.

Comments may not stay on Does not participate in Comments add value to task. Comments may not add discussion. discussion topic. Comments value to discussion topic.

0 points motivate other students to Comments may not motivate respond. other students to respond.

20 points 10 points Maintains appropriate Does not always maintain Does not participate in language. Offers criticism in a appropriate language. Offers discussion. constructive manner. Provides criticism in an offensive 0 points both positive and negative manner. Provides only negative feedback. feedback.

5 points 3 points

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

7

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 11: Reproductive Issues and Early Life

Instructor Manual Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 11: Reproductive Issues and Early Life

Table of Contents Purpose and Perspective of the Chapter .................................................................................................... 2 Chapter Objectives ..................................................................................................................................... 2 Key Terms ................................................................................................................................................... 2 What's New in This Chapter ........................................................................................................................ 3 Chapter Outline .......................................................................................................................................... 3 Discussion Questions .................................................................................................................................. 5 Additional Resources .................................................................................................................................. 6 Internet Resources ............................................................................................................................................ 6 Appendix ..................................................................................................................................................... 6 Generic Rubrics .................................................................................................................................................. 6 Standard Writing Rubric .................................................................................................................................... 6 Standard Discussion Rubric ............................................................................................................................... 7

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

1

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 11: Reproductive Issues and Early Life

Purpose and Perspective of the Chapter This chapter explores ethical issues involving the rights of embryos, fetuses, birth issues, the neonatal period, and the growing child, which are gaining prominence. Technology makes it possible to exercise more control over birth and the beginning of life by detecting genetic and chromosomal abnormalities.

New techniques for artificial insemination raise questions of surrogate motherhood and paternal responsibility. Questions about fetal rights and maternal legal obligations during pregnancy take on new importance as technology’s ability to intervene during pregnancy advances. And, because of the value of fetal tissue in transplants, society has taken a new look at the need to protect the fetus. Students will learn that society takes steps to control procedures used to care for handicapped newborn infants because of conflicting ethical positions on sanctity versus quality of life.

Chapter Objectives The following objectives are addressed in this chapter: 11.01Analyze ethical questions associated with artificial insemination and assisted reproductive technology.

11.02 Summarize the decision of Roman v. Roman.

11.03 Identify examples of genetic disorders.

11.04 Explain how genetic testing is performed.

11.05 Analyze ethical questions surrounding genetic research.

11.06 Identify regulations on cloning.

11.07 Explain the dilemma of sanctity versus quality of life.

11.08 Summarize key legal decisions related to abortion.

11.09 Explain the medicolegal rights of a fetus.

11.10 Explain the medicolegal rights of a newborn.

Key Terms Amniocentesis: Test used during pregnancy to diagnose a fetus’ genetic disorders and other health issues.

Chemotherapy: Drug treatment, most often used in the treatment of cancer, that uses potent chemicals to kills fast-growing cells.

Cloning: Identically duplicating an organism.

DNA: Molecule within cells that holds genetic information responsible for the development and performance of an organism.

Embryonic stem cell: Cells that are derived from human embryos or human fetal tissues that are selfreplicating.

Embryos: Fertilized eggs in the early stages of development.

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

2

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 11: Reproductive Issues and Early Life

Fetus: Unborn, developing offspring from the period beginning 8 weeks (when the major structures have formed) after fertilization of an egg by a sperm until the time of birth.

Genetic: Resulting from genes are attributable to them.

Heterologous artificial insemination: An artificial insemination procedure wherein a sperm sample is taken from a donor who is not the partner of the woman seeking to become pregnant.

Homologous artificial insemination: An artificial insemination procedure wherein a sperm sample is taken from a donor who is the partner of the woman seeking to become pregnant.

Pluralistic: Political philosophy wherein people of different beliefs, political parties, and lifestyles coexist and take part equally in the political process.

Preimplantation genetic diagnosis: Genetic testing used to identify whether a parent’s known genetic defect is present in an embryo produced by in vitro fertilization.

Sanctity: The quality of being sacred.

Survival action: A lawsuit related to a death and brought by the decedent’s survivors.

Wrongful death: Death caused by negligence. [return to top]

What's New in This Chapter The following elements are improvements in this chapter from the previous edition: ●

Updated content on artificial insemination and assisted reproductive technology; genetic testing before birth; embryonic stem cells for research; cloning and gene editing; and medicolegal rights of the fetus and the newborn.

[return to top]

Chapter Outline In the outline below, each element includes references (in parentheses) to related content. "CH.##” refers to the chapter objective.

I.

II.

Introduction (11.01) a. Due to the United States’ pluralistic society, there is a growing debate surrounding ethical issues associated with reproduction. Medicine, law, and ethics are intertwined when considering the complex ethical issues concerning life’s early stages. Each advance in medicine, technology, and knowledge adds more challenges.

Artificial Insemination and Assisted Reproductive Technology (11.01, 02) a. Prospective parents that have trouble conceiving naturally have other options to have children. One option is artificial insemination. Artificial insemination can be homologous - meaning the sperm donor is the partner of the woman seeking to become pregnant or heterologous - meaning the sperm donor is not the partner of the woman seeking to become pregnant. Another option is in vitro fertilization (IVF), during which a woman’s

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

3

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 11: Reproductive Issues and Early Life

III.

IV.

V.

eggs are fertilized in a petri dish. Both options require thought and consideration.

Students will learn that in the case of Randy and Augusta Roman, frozen embryos were ultimately discarded after their divorce due to written terms in the IVF consent agreement. Embryos are typically considered property rather than human life. b. Suggested activity 1: 60 minutes total. Students will research three different religions and compare/contrast their positions on artificial insemination. c. Case for discussion 2: 30 minutes total. Discuss the arguments for both a husband and wife who are discussing how to handle frozen embryos during a separation. d. Case for discussion 3: 60 minutes total. Discuss the factors involved when petitioning to adopt a child conceived through artificial insemination after the woman divorces the father and remarries. e. Case for discussion 4: 60 minutes total. Discuss the arguments both for and against visitation rights of a baby conceived through homologous artificial insemination when the couple is not married.

Genetics (11.03, 04, 07) a. There are more than 6,000 known genetic disorders, and at least 500 are linked to a defect in a single gene. They include cystic fibrosis, sickle cell anemia, hemophilia, and Tay-Sachs disease. Investigating genetic makeup is controversial and can have both positive and negative outcomes. On one side, genetic information can be cause for discrimination and can expose family information. However, genetic information can also be used to develop new treatments for disorders and diseases. Testing only requires a DNA sample from tissues, blood, saliva, or nucleated cells. Students will discuss amniocentesis and preimplantation genetic diagnosis and corresponding ethical issues. The sanctity of life versus the quality of life will also be considered. b. Study question 1: 20 minutes total. Discuss the benefits and detriments of genetic testing c. Study question 2: 30 minutes total. Discuss whether you would have an amniocentesis test done if you knew that you or your partner had a family history of a genetic disease.

Discuss what factors you would consider when determining whether to terminate the pregnancy. d. Study question 3: 20 minutes total. Define the sanctity of life and give an example of an ethical decision based on its philosophy. e. Study question 4: 20 minutes total. Define quality of life and give an example of an ethical decision based on its philosophy. f. Study question 8: 10 minutes total. Determine what kind of sample is used for genetic testing and where it can be obtained.

Embryonic Stem Cells for Research (11.05) a. Embryonic stem cell research may aid in the development of new and more efficient treatments for diseases, potentially helping numerous patients. Opponents of embryonic stem cell research argue that potential benefits do not outweigh the harm done to the natural progression of fetal development. Because the beginning of life is defined differently among religions, religious beliefs are often at the core of the debate of what is morally acceptable.

Cloning and Gene Editing (11.06) a. Today’s technology makes it possible for a fertilized egg to be cloned and implanted for human incubation until birth. There are no federal regulations related to human reproductive cloning, but several states have enacted laws that prohibit it. Gene editing

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

4

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 11: Reproductive Issues and Early Life

VI.

VII.

VIII.

can remove certain DNA mutations that lead to disease. This technology can be used to create a baby with or without desired characteristics.

Abortion and the Right to Be Left Alone (11.08) a. Privacy is the right to be left alone to make personal choices. The human right to privacy is grounded in the moral tenet that each individual has incalculable worth, as reflected in the Fourth Amendment. Some argue that incalculable worth extends to the fetus, while others argue that the woman and what she chooses to do with her body is a high priority. The decision of the U.S. Supreme Court case, Roe v. Wade, protects a woman’s right to privacy during a first-trimester abortion. b. Suggested activity 2: 30 minutes total. Students will research a judicial decision that was made after the Roe v. Wade decision and discuss how it modifies the Roe v. Wade ruling.

Medicolegal Rights of the Fetus (11.09) a. Fetuses are protected from harm under the Unborn Victims of Violence Act. The act made it a crime to harm a fetus while assaulting a pregnant woman during the commission of a federal crime. A stillborn child’s estate can be recovered through a wrongful death and survival action for injuries sustained while in the womb. Students will also discuss the growing interest in transplants using fetal tissue and the ethical questions that may be associated with it. b. Study question 6: 30 minutes total. Discuss what restrictions you might give a pregnant mother in regards to the well-being of the fetus. Discuss whether a pregnant woman’s nutrition should be monitored by the government.

Medicolegal Rights of a Newborn (11.10) a. Newborns are protected from medical negligence under the Baby Doe law. The Baby Doe law is an amendment to the Child Abuse Prevention and Treatment Act and prevents withholding of medical care from an infant with noncongential anomalies.

Ethical considerations that are discussed in this section include the harvesting, freezing, and storing of a baby’s umbilical cord and the use of “savior babies.” b. Study question 5: 15 minutes total. List the three exceptions to the Baby Doe law. c. Study question 7: 60 minutes total. Develop philosophies that advocate for opposing views regarding the life of a baby born with congenital conditions. d. Case for discussion 1: 60 minutes total. Discuss the ethical issues involved in the court case regarding a couple who gave birth to a baby with Tay-Sachs disease.

[return to top]

Discussion Questions Refer to the Cases for Discussion at the end of the chapter. You can assign these cases and questions several ways: in a discussion forum in your LMS; as whole-class discussions in person; or as a partner or group activity in class. Answers appear in the Solution and Answer Guide. [return to top]

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

5

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 11: Reproductive Issues and Early Life

Additional Resources Internet Resources ●

Goldenring, J.M. (1985, December). The brain-life theory: Towards a consistent biological definition of humanness. Journal of Medical Ethics, 11(4), 198-204. Retrieved from https://pubmed.ncbi.nlm.nih.gov/4078859/

●

BBC. (n.d.). When is the foetus “alive”? BBC. Retrieved from https://www.bbc.co.uk/ethics/abortion/child/alive_1.shtml

[return to top]

Appendix Generic Rubrics Providing students with rubrics helps them understand expectations and components of assignments.

Rubrics help students become more aware of their learning process and progress, and they improve students’ work through timely and detailed feedback.

Customize these rubrics as you wish. The writing rubric indicates 40 points and the discussion rubric indicates 30 points.

Standard Writing Rubric Criteria Content

Organization and Clarity

Research

Research

Grammar and Spelling

Meets Requirements Needs Improvement Incomplete The assignment clearly and The assignment partially The assignment does not comprehensively addresses all addresses some or all address the questions in the questions in the assignment. questions in the assignment. assignment.

15 points 8 points 0 points The assignment presents ideas The assignment presents ideas The assignment does not in a clear manner and with in a mostly clear manner and present ideas in a clear manner strong organizational structure. with a mostly strong and with strong organizational The assignment includes an organizational structure. The structure. The assignment appropriate introduction, assignment includes an includes an introduction, content, and conclusion. appropriate introduction, content, and conclusion, but Coverage of facts, arguments, content, and conclusion. coverage of facts, arguments, and conclusions are logically Coverage of facts, arguments, and conclusions are not related and consistent. and conclusions are mostly logically related and 10 points logically related and consistent. consistent.

0 points 7 points The assignment is based upon The assignment is based upon The assignment is not based appropriate and adequate adequate academic literature upon appropriate and academic literature, including but does not include peer adequate academic literature peer reviewed journals and reviewed journals and other and does not include peer other scholarly work. scholarly work. reviewed journals and other 5 points 3 points scholarly work.

0 points The assignment follows the The assignment follows some The assignment does not required citation guidelines. of the required citation follow the required citation 5 points guidelines. guidelines.

3 points 0 points The assignment has two or The assignment has three to The assignment is incomplete fewer grammatical and spelling five grammatical and spelling or unintelligible. errors. errors.

0 points

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

6

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 11: Reproductive Issues and Early Life

5 points

3 points

Standard Discussion Rubric Criteria Participation

Contribution Quality

Etiquette

Meets Requirements Needs Improvement Incomplete Submits or participates in Does not participate or submit Does not participate in discussion by the posted discussion by the posted discussion. deadlines. Follows all deadlines. Does not follow 0 points assignment. instructions for instructions for initial post and initial post and responses. responses.

5 points 3 points Comments stay on task.

Comments may not stay on Does not participate in Comments add value to task. Comments may not add discussion. discussion topic. Comments value to discussion topic.

0 points motivate other students to Comments may not motivate respond. other students to respond.

20 points 10 points Maintains appropriate Does not always maintain Does not participate in language. Offers criticism in a appropriate language. Offers discussion. constructive manner. Provides criticism in an offensive 0 points both positive and negative manner. Provides only negative feedback. feedback.

5 points 3 points

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

7

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 12: Death and Dying

Instructor Manual Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 12: Death and Dying

Table of Contents Purpose and Perspective of the Chapter .................................................................................................... 2 Chapter Objectives ..................................................................................................................................... 2 Key Terms ................................................................................................................................................... 2 What's New in This Chapter ........................................................................................................................ 3 Chapter Outline .......................................................................................................................................... 3 Discussion Questions .................................................................................................................................. 5 Additional Resources .................................................................................................................................. 5 Internet Resources ...................................................................................................................................... 5 Appendix ..................................................................................................................................................... 5 Generic Rubrics .................................................................................................................................................. 5 Standard Writing Rubric .................................................................................................................................... 5 Standard Discussion Rubric ............................................................................................................................... 6

© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

1

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 12: Death and Dying

Purpose and Perspective of the Chapter This chapter aims to identify the ethical dilemmas and legal guidelines in relation to death and dying.

This chapter starts by discussing commonalities in perspectives on death and dying. At that point, the learner will review laws such as the UDDA and PSDA to understand some of the legal tools for working in an industry that faces death and dying. Advance Directives, including living wills, durable power of attorney, health care proxy, and do not resuscitate orders, are discussed. Palliative care and death with dignity concepts are explored. Cases including Schiavo, Nayim Carter, and the work of Dr. Kevorkian are reviewed in addition to information from current and ancient resources. Finally, ethical dilemmas surrounding suicide, the right to die, assisted suicide, and euthanasia are identified.

Chapter Objectives The following objectives are addressed in this chapter: 12.01 Identify common influences on an individual’s perspectives on death and dying.

12.02 Summarize the Uniform Determination of Death Act (UDDA).

12.03 Differentiate among advance directives, living wills, durable power of attorney, and health care proxies.

12.04 Summarize the basics of the Patient Self-Determination Act (PSDA) of 1990.

12.05 Define palliative care.

12.06 Identify the states with death with dignity acts.

12.07 Explain the need for a do-not-resuscitate (DNR) order from the patient’s perspective.

12.08 Summarize legal and ethical dilemmas related to the decision to keep or remove life support.

12.09 Summarize legal and ethical arguments for and against euthanasia.

Key Terms Advance directive: A document signed and witnessed according to state statute authorizing one person to make decisions for another, including the authorization or refusal of medical treatment.

Assisted suicide: One person making it possible for another person to commit suicide.

Cardiopulmonary arrest: Cessation of normal functioning of the heart and lungs.

Clear and convincing: Legal standard of proof that requires proof that the allegation or contention is far more likely than not to be true.

Durable power of attorney: A document allowing the principal (the person writing the durable power of attorney) to delegate to another person (the agent) the legal authority to act on the principal’s behalf.

Euthanasia: Ending someone’s life to prevent pain or suffering.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 12: Death and Dying

Health care proxy: Document appointing a specific person to act as a surrogate to make health care decisions for another person under certain circumstances.

Hospice: A medical facility or a home where a terminally ill patient receives palliative care.

Life-sustaining: Helping someone to stay alive with medical intervention.

Living will: A will made by a person in which he or she requests to be allowed to die naturally rather than being kept alive by artificial means in the event there is no probable recovery from mental or physical disability.

Palliative care: Care intended to keep a patient with a serious or terminal illness as comfortable as possible.

Purist: One who believes in and follows all traditional rules.

Sanctity: The quality of being sacred.

Substitute judgment: One person’s decision used to make a decision for another.

Terminally ill: Fatally ill with a condition for which there is no cure. [return to top]

What's New in This Chapter The following elements are improvements in this chapter from the previous edition: ●

Updated content on attitudes toward death; dying and the Uniform Determination of Death Act (UDDA); and the right to die.

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Chapter Outline In the outline below, each element includes references (in parentheses) to related content. "CH.##” refers to the chapter objective.

I.

II.

Attitudes Toward Death and Dying (12.01, 02) a. Recognizing that health care professionals will likely encounter death and dying, this section asks the student to consider different attitudes towards death and dying. The ethical issues of health care question the sanctity and quality of life. Laws that help to define when a person is medically dead and a review of situations where this definition is particularly important to clarify are discussed. Consideration is given to ethical dilemmas over whether current criteria and definitions of death are sufficient. b. Suggested Activity 2: 45 minutes total. Research criteria for the pronouncement of death in the student’s state. c. Case for Discussion 1: 30 minutes total. Violent crime results in the victim becoming brain dead and the defendant found guilty of murder. The defendant appealed stating, that “death” never occurred. How should the court rule?

Advance Directives (12.03, 04) a. This section discusses what advance directives are as well as the ethical dilemma case of Terry Schiavo. The section then reviews the Patient Self Determination Act (PSDA) and

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 12: Death and Dying

III.

IV.

the requirements under this ruling. Lastly, the details regarding the advance directives, living wills, durable powers of attorney, and health care proxy are reviewed. b. Suggested Activity 3: 20 minutes total. Research online for an example of living will in the student’s state. c. Suggested Activity 5: 20 minutes total. Research online for durable power of attorney or living will statute in the student’s state. What types of legal protection does the state provide?

The Terminally Ill Patient (12.05) a. This section defines terminally ill and palliative care and uses a case study to highlight the ways that death and dying impact the patient and their family. Hospice care is reviewed as well as its benefits to patients and families at the end of life. b. Suggested Activity 4: 60 minutes total. Listen to the This American Life episode “Death and Taxes” Act One - Death which is Episode 523 (36 minutes). Identify different types of palliative care.

The Right to Die (12.06, 07, 08, 09) a. This section discusses death with dignity statutes, physician-assisted suicide, and the ethical dilemma of promoting life versus reducing suffering. The ethical dilemmas of euthanasia and suicide are highlighted. DNR orders and removal of life support are discussed. Euthanasia is defined and differentiated from suicide and assisted suicide.

The ethical dilemmas surrounding euthanasia are discussed. The ancient philosophy of Hippocrates is cited as well as more current historical cases such as Brittany Maynard.

Finally, this section reviews the trauma of suicide. b. Suggested Activity 1: 60 minutes total. Interview a clergy person or physician and document the standards on life support and its use on the terminally ill. Note the philosophies that lead to their perspectives and ask what could influence their present position. c. Study Question 1: 30 minutes total. Explain your philosophy regarding euthanasia. d. Study Question 2: 15 minutes total. Why would a patient want a DNR order? e. Study Question 3: 30 minutes total. What are the factors you consider when identifying your position on the right to die? f. Case for Discussion 2: 30 minutes total. The patient falls into a long-term coma and is determined to be in a vegetative state. She was put on life support but continued to deteriorate. The father asked for removal of life support; the physician declined because she did not meet the traditional standard for death. If the life support systems are removed, should the physician be subject to civil or criminal liability? g. Case for Discussion 3: 30 minutes total. 83-year-old monk enters hospital for routine surgery and suffers cardiopulmonary arrest. After resuscitation, he was in a chronic vegetative condition. The patient, following his religious beliefs, had clearly stated he did not want any extraordinary measures to prolong his life. His guardian requested removal of the respirator, but the surgeon refused. The guardian went to court. What should the court decide? h. Case for Discussion 4: 30 minutes total. The patient suffered an aneurysm and underwent a craniotomy but never regained consciousness. Life support was initiated as well as feeding by artificial means, and the patient was diagnosed to be in a vegetative state. The patient was not considered terminally ill. The family requested the removal of the feeding tube apparatus, and the hospital declined. The case went to court. What should the court conclude?

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 12: Death and Dying

i.

Case for Discussion 5: 30 minutes total. 84-year-old patient with irreversible physical and mental impairments in continuing decline, but the patient was not brain dead, comatose, or vegetative. The family wanted the feeding tube removed. Should the court allow the removal of the feeding tube?

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Discussion Questions Refer to the Cases for Discussion at the end of the chapter. You can assign these cases and questions several ways: in a discussion forum in your LMS; as whole-class discussions in person; or as a partner or group activity in class. Answers appear in the Solution and Answer Guide. [return to top]

Additional Resources Internet Resources ●

Death and dying: Updike, N. (2014, April 25). Death and taxes. This American Life Podcast.

Podcast retrieved from https://m.thisamericanlife.org/radio-archives/episode/523/death-andtaxes?act=1#act-1

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MedlinePlus. (n.d.). End of life issues. Retrieved from https://medlineplus.gov/endoflifeissues.html

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Physician-assisted suicide: CNN Library. (2016, June 7). Physician-assisted suicide fast facts. CNN. Retrieved from http://www.cnn.com/2014/11/26/us/physician-assisted-suicide-fast-facts/

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Theresa Schiavo case: Didion, J. (2005, June 9). The case of Theresa Schiavo. The New York Review of Books. Retrieved from http://www.nybooks.com/articles/2005/06/09/the-case-oftheresa-schiavo/

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Appendix Generic Rubrics Providing students with rubrics helps them understand expectations and components of assignments.

Rubrics help students become more aware of their learning process and progress, and they improve students’ work through timely and detailed feedback.

Customize these rubrics as you wish. The writing rubric indicates 40 points and the discussion rubric indicates 30 points.

Standard Writing Rubric Criteria

Meets Requirements

Needs Improvement

Incomplete

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 12: Death and Dying

Content

Organization and Clarity

Research

Research

Grammar and Spelling

The assignment clearly and The assignment partially The assignment does not comprehensively addresses all addresses some or all address the questions in the questions in the assignment. questions in the assignment. assignment.

15 points 8 points 0 points The assignment presents ideas The assignment presents ideas The assignment does not in a clear manner and with in a mostly clear manner and present ideas in a clear manner strong organizational structure. with a mostly strong and with strong organizational The assignment includes an organizational structure. The structure. The assignment appropriate introduction, assignment includes an includes an introduction, content, and conclusion. appropriate introduction, content, and conclusion, but Coverage of facts, arguments, content, and conclusion. coverage of facts, arguments, and conclusions are logically Coverage of facts, arguments, and conclusions are not related and consistent. and conclusions are mostly logically related and 10 points logically related and consistent. consistent.

0 points 7 points The assignment is based upon The assignment is based upon The assignment is not based appropriate and adequate adequate academic literature upon appropriate and academic literature, including but does not include peer adequate academic literature peer reviewed journals and reviewed journals and other and does not include peer other scholarly work. scholarly work. reviewed journals and other 5 points 3 points scholarly work.

0 points The assignment follows the The assignment follows some The assignment does not required citation guidelines. of the required citation follow the required citation 5 points guidelines. guidelines.

3 points 0 points The assignment has two or The assignment has three to The assignment is incomplete fewer grammatical and spelling five grammatical and spelling or unintelligible. errors. errors.

0 points 5 points 3 points

Standard Discussion Rubric Criteria Participation

Contribution Quality

Etiquette

Meets Requirements Needs Improvement Incomplete Submits or participates in Does not participate or submit Does not participate in discussion by the posted discussion by the posted discussion. deadlines. Follows all deadlines. Does not follow 0 points assignment. instructions for instructions for initial post and initial post and responses. responses.

5 points 3 points Comments stay on task.

Comments may not stay on Does not participate in Comments add value to task. Comments may not add discussion. discussion topic. Comments value to discussion topic.

0 points motivate other students to Comments may not motivate respond. other students to respond.

20 points 10 points Maintains appropriate Does not always maintain Does not participate in language. Offers criticism in a appropriate language. Offers discussion. constructive manner. Provides criticism in an offensive 0 points both positive and negative manner. Provides only negative feedback. feedback.

5 points 3 points

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