7.2 Medical Ethics and Legal Considerations
Key Takeaways
The four principles of medical ethics are autonomy (patient self-determination), beneficence (doing good), nonmaleficence (do no harm), and justice (fair treatment)
Informed consent requires that the patient understands the procedure, risks, benefits, alternatives, and consequences of refusal before agreeing to treatment
Mandatory reporting includes suspected child abuse/neglect, elder abuse, domestic violence, communicable diseases, gunshot/stab wounds, and certain injuries
Scope of practice defines what a medical assistant can legally do; it varies by state and is determined by state law, employer policy, and the individual's training
Medical malpractice requires four elements (the "4 Ds"): duty, dereliction (breach), direct cause (proximate cause), and damages
Advanced directives include living wills, durable power of attorney for healthcare, and do not resuscitate (DNR) orders — they document a patient's wishes for end-of-life care
Four Principles of Medical Ethics
| Principle | Definition | Clinical Application |
|---|---|---|
| Autonomy | Patient's right to make their own healthcare decisions | Informed consent, right to refuse treatment, advance directives |
| Beneficence | Doing good; acting in the patient's best interest | Providing evidence-based care, patient education, preventive services |
| Nonmaleficence | "Do no harm" — avoiding actions that harm the patient | Following safety protocols, reporting errors, practicing within scope |
| Justice | Fair and equitable treatment of all patients | Equal care regardless of race, gender, income, insurance status |
Informed Consent
Informed consent is the process by which a patient voluntarily agrees to a procedure or treatment after being provided with all relevant information.
Required Elements of Informed Consent:
| Element | Description |
|---|---|
| Nature of the procedure | What will be done, in understandable terms |
| Purpose/benefits | Why it is being recommended |
| Risks and complications | What could go wrong; potential side effects |
| Alternatives | Other treatment options available |
| Consequences of refusal | What may happen if the patient declines |
| Opportunity for questions | Patient must be given time to ask questions and receive answers |
| Voluntariness | Consent must be given freely without coercion |
| Competency | Patient must have the mental capacity to understand and decide |
Who Obtains Informed Consent?
- The provider (physician, PA, NP) must explain the procedure, risks, and alternatives
- The MA may witness the patient's signature on the consent form
- The MA does NOT explain procedures or obtain consent — this is the provider's responsibility
Special Consent Situations:
| Situation | Who Gives Consent |
|---|---|
| Minor (under 18) | Parent or legal guardian |
| Emancipated minor | The minor themselves (married, military, court-declared) |
| Mentally incapacitated | Legal guardian or healthcare proxy |
| Emergency | Implied consent if patient is unconscious and at risk of death |
| Mature minor | Some states allow minors to consent for specific services (STI treatment, pregnancy care, substance abuse) |
Mandatory Reporting
Medical assistants are mandated reporters required by law to report certain conditions:
| Condition | Report To |
|---|---|
| Suspected child abuse/neglect | Child Protective Services (CPS), local law enforcement |
| Suspected elder abuse/neglect | Adult Protective Services (APS), local law enforcement |
| Domestic violence | Per state law — some states mandate, others encourage |
| Communicable diseases | Local/state health department (TB, HIV, hepatitis, STIs, COVID-19) |
| Gunshot wounds | Local law enforcement |
| Stab wounds | Local law enforcement |
| Animal bites | Local animal control/health department |
| Suspicious deaths | Coroner/medical examiner |
| Certain injuries | As required by state law |
Key Points:
- Failure to report as mandated can result in criminal charges and civil liability
- Reporting in good faith is protected from legal liability, even if the report is unfounded
- You do NOT need patient consent to make a mandatory report
- Mandatory reporting supersedes HIPAA patient confidentiality
Negligence and Malpractice
Negligence is the failure to exercise the standard of care that a reasonably prudent person would exercise in a similar situation.
Medical malpractice is professional negligence by a healthcare provider. It requires proving the "4 Ds":
| Element | Definition | Example |
|---|---|---|
| Duty | Provider owed a duty of care to the patient | Patient-provider relationship was established |
| Dereliction | Provider breached the standard of care | Failed to follow proper procedure |
| Direct cause | Breach directly caused the injury | Incorrect medication dosage → adverse reaction |
| Damages | Patient suffered actual harm or injury | Physical injury, financial loss, emotional harm |
All four elements must be proven for a successful malpractice claim.
Advance Directives
Advance directives are legal documents that allow patients to express their wishes regarding end-of-life care:
| Document | Purpose |
|---|---|
| Living will | Written instructions about the patient's wishes for medical treatment if they cannot communicate (e.g., ventilator, feeding tube, CPR) |
| Durable power of attorney for healthcare (healthcare proxy) | Designates a person to make healthcare decisions on the patient's behalf if they become incapacitated |
| Do Not Resuscitate (DNR) order | A physician order directing that CPR should not be performed |
| POLST/MOLST | Physician/Medical Orders for Life-Sustaining Treatment — specific medical orders for seriously ill patients |
Key Points About Advance Directives:
- The Patient Self-Determination Act (PSDA) requires healthcare facilities to inform patients of their right to create advance directives
- Advance directives can be changed or revoked at any time by the competent patient
- The healthcare proxy makes decisions only when the patient cannot communicate
- Advance directives should be reviewed and updated periodically
- Medical assistants should ensure advance directives are in the patient's chart and accessible
Legal Concepts for Medical Assistants
| Concept | Definition |
|---|---|
| Standard of care | Level of care a reasonably prudent medical assistant would provide in similar circumstances |
| Scope of practice | Legal boundaries of what an MA can do, determined by state law, training, and employer policy |
| Respondeat superior | "Let the master answer" — employers are liable for employees' actions performed within their job duties |
| Res ipsa loquitur | "The thing speaks for itself" — negligence is obvious (e.g., sponge left inside patient after surgery) |
| Statute of limitations | Time limit to file a lawsuit (varies by state, typically 2-6 years for medical malpractice) |
| Good Samaritan laws | Protect individuals who provide emergency care in good faith from liability |
| Abandonment | Discontinuing care without proper transfer or notification |
| Battery | Performing a procedure without the patient's consent |
| Assault | Threatening to perform a procedure without consent |
| Defamation | Making false statements that damage a person's reputation (libel = written; slander = spoken) |
| Fraud | Intentional deception for financial gain (upcoding, falsifying records) |
Patient Bill of Rights
All patients are entitled to certain fundamental rights:
| Right | Description |
|---|---|
| Informed consent | Right to understand and approve of all treatment |
| Refuse treatment | Right to decline any procedure or medication |
| Confidentiality | Right to have medical information kept private |
| Access to records | Right to view and obtain copies of medical records |
| Respectful care | Right to be treated with dignity, regardless of background |
| Second opinion | Right to seek another provider's opinion |
| Know providers | Right to know the names and qualifications of care providers |
| Advance directives | Right to make decisions about end-of-life care |
| Complaint | Right to voice grievances without fear of retaliation |
| Safe environment | Right to receive care in a safe setting |
Which of the following correctly describes all four elements needed to prove medical malpractice (the "4 Ds")?
Diagnosis, Dereliction, Direct cause, Damages
Duty, Dereliction, Direct cause, Damages
Duty, Dereliction, Documentation, Damages
Diagnosis, Documentation, Direct cause, Damages
A medical assistant witnesses a patient sign a consent form. The MA's role in informed consent is to:
Explain the procedure, risks, and alternatives to the patient
Determine if the patient is mentally competent to give consent
Witness the patient's signature — the provider explains the procedure
Decide whether the procedure is medically necessary
A medical assistant suspects that a child patient is being physically abused. The MA should:
Wait for the provider to make the report
Document the observations and report to the appropriate authorities
Ask the parent directly if they are abusing the child
Keep the information confidential per HIPAA regulations
The legal term for performing a medical procedure on a patient without their consent is:
Negligence
Assault
Battery
Fraud
Which of the following are mandatory reporting situations for medical assistants? (Select all that apply)
Select all that apply
Suspected child abuse
Patient complaining about wait times
Communicable disease diagnosis
Gunshot wound
Patient requesting a second opinion
Suspected elder abuse
Sections you finish are checked off in the contents.