3.3 Medical Ethics, Informed Consent, and Scope of Practice
Key Takeaways
- The four principles of medical ethics are autonomy (patient self-determination), beneficence (doing good), nonmaleficence (do no harm), and justice (fairness)
- Informed consent requires that the patient receive information about the procedure, risks, benefits, alternatives, and the right to refuse before agreeing
- CMAAs may witness signatures on consent forms but cannot explain procedures or obtain informed consent — that is the provider's responsibility
- Scope of practice defines the boundaries of what a CMAA can legally perform — administrative tasks only, never clinical judgment
- Advance directives include living wills, healthcare power of attorney (HCPOA), and do-not-resuscitate (DNR) orders
- CMAAs must understand mandatory reporting requirements for child abuse, elder abuse, communicable diseases, and certain injuries
Last updated: March 2026
Medical Ethics, Informed Consent, and Scope of Practice
Understanding medical ethics, the informed consent process, and your scope of practice as a CMAA is essential for legal compliance and patient safety.
The Four Principles of Medical Ethics
| Principle | Definition | Example |
|---|---|---|
| Autonomy | Respect for the patient's right to make their own healthcare decisions | Honoring a patient's decision to refuse treatment, even if the provider disagrees |
| Beneficence | The obligation to act in the patient's best interest | Recommending preventive screenings based on age and risk factors |
| Nonmaleficence | The obligation to "do no harm" | Ensuring medications are prescribed correctly; avoiding unnecessary procedures |
| Justice | Fair and equitable distribution of healthcare resources | Treating all patients equally regardless of race, gender, income, or insurance status |
Additional Ethical Concepts
| Concept | Definition |
|---|---|
| Veracity | Truthfulness — being honest with patients about their condition and treatment |
| Fidelity | Faithfulness — keeping promises and commitments to patients |
| Confidentiality | Protecting patient information from unauthorized disclosure |
| Role fidelity | Staying within your professional role and scope of practice |
Informed Consent
Informed consent is both a legal requirement and an ethical obligation. It ensures patients make voluntary, knowledgeable decisions about their healthcare.
Elements of Informed Consent
For consent to be valid, the patient must receive:
| Element | Description |
|---|---|
| Diagnosis | The patient's current condition or suspected diagnosis |
| Proposed treatment/procedure | What will be done |
| Risks | Potential complications or side effects |
| Benefits | Expected positive outcomes |
| Alternatives | Other available treatment options, including no treatment |
| Right to refuse | The patient's right to decline treatment without negative consequences to their care |
Who Obtains Informed Consent?
| Role | Responsibility |
|---|---|
| Provider (MD, DO, NP, PA) | Explains the procedure, risks, benefits, and alternatives — obtains informed consent |
| CMAA | May witness the patient's signature on the consent form, but does NOT explain the procedure or obtain consent |
| Patient | Must be competent, informed, and consenting voluntarily |
When Informed Consent Is NOT Required
| Exception | Example |
|---|---|
| Life-threatening emergency | Patient is unconscious and needs immediate surgery — implied consent applies |
| Minor/routine procedures | Taking vital signs, drawing blood (implied consent by presenting for care) |
| Therapeutic privilege | Very rare — when disclosing risks would severely harm the patient |
Who Can Provide Consent?
| Situation | Who Provides Consent |
|---|---|
| Competent adult (18+) | The patient |
| Minor (under 18) | Parent or legal guardian |
| Emancipated minor | The minor themselves (married, in military, court-declared emancipated) |
| Incapacitated adult | Healthcare power of attorney / legal guardian |
| Mature minor | Some states allow minors to consent for certain services (STI treatment, contraception, mental health) |
Advance Directives
Advance directives are legal documents that express a patient's healthcare wishes when they are unable to communicate:
| Document | Purpose | Key Details |
|---|---|---|
| Living Will | Specifies which medical treatments the patient wants or does not want if incapacitated | May address ventilators, feeding tubes, CPR, dialysis |
| Healthcare Power of Attorney (HCPOA) | Designates a person (agent/proxy) to make healthcare decisions for the patient if incapacitated | Also called healthcare proxy or durable power of attorney for healthcare |
| Do-Not-Resuscitate (DNR) | Orders healthcare providers not to perform CPR if the patient's heart stops | Must be signed by the patient and physician |
| POLST/MOLST | Physician/Medical Orders for Life-Sustaining Treatment — more specific than a living will | Signed by the physician; travels with the patient across care settings |
CMAA Responsibilities for Advance Directives
- Ensure advance directive documents are scanned into the patient's medical record
- Flag the chart so providers are aware of existing directives
- Do NOT interpret, advise, or influence the patient's advance directive decisions
- Know the office protocol for handling advance directive inquiries
Scope of Practice for CMAAs
CMAAs CAN:
- Schedule appointments, referrals, and procedures
- Register patients and collect demographics
- Verify insurance eligibility and benefits
- Collect copayments and account balances
- Manage medical records and EHR data entry
- Compose business correspondence and patient letters
- Answer phones and route messages
- Process billing and coding paperwork (under supervision)
- Witness signatures on consent forms
CMAAs CANNOT:
- Diagnose or suggest diagnoses
- Prescribe or recommend medications
- Give medical advice (including over the phone)
- Interpret lab results for patients
- Perform clinical procedures (injections, blood draws)
- Obtain informed consent (only the provider can do this)
- Override a provider's clinical decisions
- Practice outside their training and certification
Mandatory Reporting Requirements
Healthcare workers, including CMAAs, are mandated reporters in most states. Failure to report can result in legal penalties:
| Reportable Condition | Report To | Details |
|---|---|---|
| Child abuse/neglect | State child protective services | Physical abuse, sexual abuse, neglect, emotional abuse |
| Elder abuse/neglect | State adult protective services | Physical abuse, financial exploitation, neglect, abandonment |
| Domestic violence | Per state law — varies | Some states require reporting to law enforcement |
| Communicable diseases | State/local health department | Tuberculosis, HIV, hepatitis, STIs, foodborne illness |
| Gunshot/stab wounds | Law enforcement | Required in most states regardless of circumstances |
| Suspected bioterrorism | State/local health department and law enforcement | Anthrax, smallpox, other potential bioterror agents |
Other Important Healthcare Laws
| Law | Year | Purpose |
|---|---|---|
| EMTALA (Emergency Medical Treatment and Active Labor Act) | 1986 | Requires emergency departments to screen and stabilize all patients regardless of ability to pay |
| ADA (Americans with Disabilities Act) | 1990 | Prohibits discrimination against individuals with disabilities; requires reasonable accommodations |
| Genetic Information Nondiscrimination Act (GINA) | 2008 | Prohibits discrimination based on genetic information in health insurance and employment |
| Patient Self-Determination Act | 1990 | Requires healthcare facilities to inform patients of their right to create advance directives |
| Stark Law | 1989 | Prohibits physician self-referrals for Medicare/Medicaid patients |
| Anti-Kickback Statute | 1972 | Prohibits offering, paying, soliciting, or receiving anything of value to induce referrals for services covered by federal healthcare programs |
| False Claims Act | 1863 | Imposes liability on individuals and companies that defraud government healthcare programs |
Test Your Knowledge
A patient asks the CMAA to explain the risks and benefits of an upcoming surgical procedure. What should the CMAA do?
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B
C
D
Test Your Knowledge
Which advance directive designates a specific person to make healthcare decisions for the patient if the patient becomes incapacitated?
A
B
C
D
Test Your Knowledge
A CMAA notices bruises on a child patient that appear inconsistent with the parent's explanation. What is the CMAA's legal obligation?
A
B
C
D
Test Your Knowledge
Which law requires hospital emergency departments to screen and stabilize all patients regardless of their ability to pay?
A
B
C
D