You know that there are numerous patients in your hospital waiting for organs. The family of the patient is with you. You have an excellent relationship with the family and they trust you. What should you do about the donation? The medical tcant taking care of the patient shoukl not ask for the donation. Even if your relationship witr. Becausea greater number. By legal statute,only those specificallytrained to obtain consentfor orqan donation should approachthe family for this consent.
In addition, there is thc perception of an enormous conflict of intereston the part of the family n'hen a caregiver attempts to obtain consent.
This makes it scer' that the priority of the health-care II team is to obtain organs. It is essentiarfor the hcarth-care teanl to preserve its reration o ship rvith thc family as the advocatesfor prcserving the rife of the patient.
In addition, the S organ donation network has a much greaterchanccof obtaining colscnt, so if the primarv rl health care team tries to obtain consent,it cor.
The economic aspectsof organ clonationmust be ninimizecl so that pcople P believe that the patients who need organs the most w I get them, not that the rvealthv lc will get preferential treatment.
It is, howeveq acceptableto cover the cost to the donor 'l of dona- tior. Family objection can overrule the or gan donor card. Tr tr fc al bi! By hould of the ent, tt rssible Physicians and laboratoriesare mandatedto report a nunber of medicai illnesses. The r-care mai'purposein reportinginncsses is both epicremiologicaswenasto rnterruptthespread ttion- of certaincommunicablediseases. The illnessesthat are alrval. LlTlAIV rubella'and pertussis. Thc list of other reportablediscases is extensiye.
Thesediseases are reportable by sonrebody,not necessarily the physician. Phvsicians are alwayslegallyprotectedfor participatingin partner notification. In addition,the healthdepartmentcanincarcerate patientswith tuberculosis ywill to pre r,entthe spreadof diseasc.
If the sourcepatiert Land still won,t tell his or her partner,you arewithin your legarright to tell the innocentthird party. My right to autonomyends rvhereyour safetybegins. I havean absoluteright to privacy,except when my restaurant ser'es foodinfectedwith sarmonera, andthenthepatient'srightstoautonomybecomeress [am importantthan protectingothersfron harm.
In additronto doing contact tracingofthe contactsin order to do ppD testing,thereis the speciar rssueof incarceration fortuberculosis. Patientswith tubercurosisshouldbe isolatedfor abouttwo weeks, which is approximately the amount of time that is takesfor sputumto becomenegativefor acid-fast bacillilf a patient refusesto take antituberculosistherapy,physicians havethe option of MTDICAL.
Incarcerationfor tuberculosisis not the same thing asbeing arrested. It hasnothing to d0 with the criminal-justicesystem. The incarceration o.. You cannot force-feedtuberculosismedications, but you can preventpeoplefrom walking at their leisurein the community to spreaddisease. Incarcerattonis a last resort and is.
Becauseof the social stigma of HIV there is an additional layer of confidential- ity and consent required. When a patient enters the hospital or other health-care facility thereis general consent given that allows the routine testing of blood for chernistry and hematologyand so on.
She has a historv of sexually transmitted diseasessuch as gonorrhea. You offer HIV test- ing, which the patient refuses,as a routine part of prenatal care. She returns at 14 and l8 weeks of pregnancy but is still refusing becauseof anxiety that she may be positive.
You inform the patient that there are medications that can reduce trans- mission from mother to child to less than 2 percent. She persists in her refusal. Although there are medications to prevent transmission of HIV to the fetus during preg- nancl, you cannot compel mandatory testing of pregnant women. The woman has the right to refuse testing as well as to refuse antiretrovirals.
Therefore, you should offer HIV testing universally to all pregnant women-but there is no mandatory testing of the pregnantwoman without her expressconsent to do so.
Althoueh from T] time to time, there is aberrancyin the Jegalsysten. She has a very low CD4 coult less than 50 and a high viral load more than , The t woman is anxious, but clearly has the capacity to understand the implications of P this decisionon both her health and the health ofher child. Sheis stirrrefusinsthe y C sectionand medications.
What should you do next? However, a rvoman's right to choose her own forms ofhealth care are considered superior to virtually all other treatment concerns. The wrong answer in a question like this would be to give the medications an1. The autonomy of the mother is regarlvsuperior to beneficence for the fetus.
Althoush a lveekfetus is a viable child, the fetus is still inside the woman's body and doesn t become a person until it is delivered. A noman has the right to refuse HIV testing in pregnancl, to refuse antiretroviral medicati.
A crrcumstancesuchas thiswouldbervhenan HIV-positive personhasa sexualor needle-sharing partnerthatis at risk. The method of notificationfollowsthe stepsof first counseringa patient to notiry t his partnersvoluntarily'This wourd be idealand follows the generalthemeof uSMLE, rvhich is to first answer"encouragediscussions,, when listed as one of the choices.
The health department interviewsthe patient and attemptsto constructa list of partnersin order to notify them. T reveared tothepartner andtheconndentiaritv ks ;[:ffi[i[::]ff;l;;. Thereis no incarceration you cannotcompelhim le rrmtnal penaltyfor not disclosing paticntrvill not notiff his partncrs thesenames. If a tf rouhaveresar r--,,'i,,,. When askif her boyfriend knows her you leor HIV staru.. On a subscquentvisit, a ,.
At this point cither you can askthe heaitha. If thepartner wereto seroconvert lr:i Ir I surehe lvasnotified you rvould for HIV and you did not make fic be legallyliable becauseyou aJ ivarn. This is similar to having psychiatric ,. Universalprecautionsare supposedto be maintained. Theseshouldpro- tect the patients. On the other hand, you cannot con. If your to question brings up the subject of rcfusal, the best answcr is to refcr the paticnt to someone H else who will perfnrm the care.
Although reporting requirernents vary somewhat fron-t state ur t0 state,certain diseasesare reportable nationally such as syphilis, gonorrhea, and AIDS. Contacttracing is predominantly used to intcrrupt a cyclc of transmission. Herpes cannot beeradicatedfrom the body; hence there is no utility in treating the partner. Gonorrhea ands,vphilis,however, can be asymptomatically carried try the contacts of our patients and theycanbe transmitted to additional partners even if the sourcepatient is asymptomatic.
In addition,syphilisand gonorrhea can be eradicated cured with treatment. For exomple,'tsob' is a year-old man in your clinic being treated for primary syphilis.
He is very embarrassedabout his diagnosis and he asksyou if his condi- tion rvill be kept confidential. Wliat should you tell him? Justbecause,voumust contact and treat partners of patients rsith STDs such as syphilis doesnot mean you will breach his confidentiality and identit him as the source to lris contacts.
Ifthere is a choice "encourage "ask thatsays him to notif. If that is not a choice,then you should ofler to inform thecontactsfor the patient if he does Dot want to do it.
At all points you should be clear "llob that,vouwiJl not contact his partners and say, gaveyou a disease. What should you tell him? The Department of Health does not dir. The Department of Health contacts the partners and saysthere is an impor- tant health issue concerning them that has come to the department's attention and then asks them to come to the hcalth departrnent.
For example, Bob does not want to tell eithcr you or the Department of Health the names of his partners. He says he is mor. He has not told his wife ofhis condition. What DE should vou do now? If theseare not in the choicesor the patient refusesthen you nust directly notif. Her testingand treatmentis essentialto protectboth her own rele health as well as to preventperinatal transmission. Congenitalsyphilis is a seriousand tive dangerousdiseasebut is entirelypreventable. Ilob becomesfuri- ous and threatensto sueyou if you violate his confidentiality.
You are legallyprotectedif you inform a person at risk of harm. Bob can get asupsetashe wants. You are not legall,v at risk. In other to words,if the plysician alA or did not do some- thingthat wasdiff-erentfrom what is locally ris accep,"ap. Ifa ver is r. If the bestsurgeonin wofldamputates the the wrongfoot,thennaipracticchasoc. Hc rs very rude and arrogantand speaksharshlyto the patient. The patient signsconser. He filessuit againstthe surgeonfor malpractice. Wl;1 will be the most likely outcome ofthc suit?
A pneumothoraxil; nn n.. The patientwasfully of informed of this and still agreedto the proce- durc. Therehasnot automaticaliy becnwrongdolDg in this case. P ueorc,rL I. For example, a patient with diabeteshas osteomyelitis on an X ray ofhis foot. The physician does not perform a bone biopsy and givcs the patient oral cefadro:i:7l for six weeks.
After therapy is over, the osteomyelitis has completely resolved. In addition, he seesthat intravenous therapy is the standard of care. He files suit against the physician. What will be the most likely outcome? The patient is right that the physician deviated from the standard of care on these two points. However, his diseasewas effectively treatecl and thcre was no harm clone to the patient, and in fact there was benefit.
Therefore, malpractice has not occurred. Becausethereis a certainamount of subjectivity in care,it is incumbent upon the physi cranto determinewhat the locallyacceptedstandard of careis. In addition,you must fully inform the patientof all options in carein order to makea truly i'formed choice. His patient with lymphomasrgnsconsent for an exploratorylaparotomyto stagelymphoma.
He doesnot inform the patient that CT scanningis a valid option. The surgeon tellsher,,,I don,t trust thosescans. We alwaysdid laparotomiesin my fellowship. In the suit that follows the surgeonstates,,,l did the most accurateprocedurefor my patrentto excludecancerin the abdomen. That is what all my protessorsdid in their studies. The surgeonerredin two ways. Because he did not fully inform her, he will probably lose the case. Second, the local standardof care outsideof certain!
Becausethe patient developed a complication tient. The same reasoning would be true for a surgeon insisting on an he arillarylymph node dissection for evcry patient with breast cancer instead of a sentinel lymphnode dissection. If the patient develops edema and cellulitis from an unnecessary ryl rd. The sentinel node dissection is most often the local u- standardof care.
In addition, if the patient was not informed of the option of an axillary to dissection,then there has not been full informed consent. The patient cannot choose a IS procedureif she has never hcard of it. In terms of errors,part o the of theliability dependson whetheror not the error resultedin harm to tne parlent.
For example,a patient admits to the hospital for a knee replacement. The staff forgetsto start the patient on deepvenousthrombosis DVT prophylaxis.
The patient does not developa DVT, On transferringcare severalmonths later the patientobtainsa copy of the chart and seesthe omission. He filessuit for a devia- tion of care. What is the most likely outcome? Althoughit is a clearerror to omit DVT prophylaxisin this case,no harm hasoccurredto thepatientand it would be difficult to obtain monetaryreimbursementfor damagesif the patientis unharmed.
Complicationsof therapydo not imply malpractice. The main issuein determiningmal- practiceis whetherthe patient wasfully informed that the Itarm could occur and whether or not he wasinformed of other valid options in therapy. If he wasfully informed and he signedconsentan. For exemplq an actressdevelopsstageIV non-Hodgkin'slymphoma. We hope that you people benefit from our blog!
Includes advice and information about the ethical issues addressed on the USMLE, as well as practice questions on end-of-life issues, euthanasia and physician-assisted suicide, competence, medical malpractice, abortion-related issues, and HIV-related issues. No features, in particular, have been stated by the publisher of this book. Thanks for your cooperation. Download Dr. You can change your ad preferences anytime.
Upcoming SlideShare. Like this document? Why not share! Embed Size px. Start on. Forgot your password? Get help. We use this information to create a better experience for all users. Please review the types of cookies we use below. These cookies allow you to explore OverDrive services and use our core features. Get help. You may send an email to freeusmlebooks gmail.Includes advice and information about the ethical kaplan medical usmle medical ethics pdf free download addressed on the USMLE, as well as practice questions on end-of-life issues, euthanasia and physician-assisted suicide, competence, medical malpractice, abortion-related issues, and HIV-related issues. Free Download Here. Sign in. Log into your account. Forgot your password? Password recovery. Recover your password. Wednesday, July 15, Get help. You may send an email to freeusmlebooks gmail. Recent Posts. April ldf, March 30, April 23, We use kaplan medical usmle medical ethics pdf free download to ensure that we give you the best experience on our website. If you continue to use this site we will assume that you are happy with it. This article contains Kaplan Medical USMLE Medical Ethics: The Cases for free download. This book has been authored by Conrad. Download USMLE Medical Ethics PDF Free - The Cases You Are Most Likely To See On The Exam [Direct Link] - MB PDF. Info: YOUR KAPLAN MEDICAL onoroff.biz all USMLE step1 books of kaplan free Usmle Related Book. onoroff.biz Medical. Kaplan Medical USMLE. USMLE'"'MEDICAL ETHICS: THE IOOCASES YOU ARE MOST LIKELYTO SEEON THE EXAM OTHERBOOKSBY KAPLANMEDICAL onoroff.biz\r Stcp 1 Qbook. kaplan usmle medical ethics free download · usmle step 1 medical kaplan medical usmle medical ethics pdf free download · kaplan medical. Download Books Master the Boards USMLE Medical Ethics: The Cases You on the Test BOOK FREE Download Books, Ebook Download Full PDF, Fischer Pages: pages Publisher: Kaplan Publishing Language. Tags: Download Kaplan Medical USMLE Medical Ethics: The Cases You Are Most Likely to See on the Exam free ebook pdf epub. Kaplan. Includes advice and information about the ethical issues addressed on the USMLE, as well as Download Board and Beyond USMLE STEP 1 Videos & PDFs Free We have uploaded a genuine cases by Conrad Fischer PDF Free to our Download Step-Up to Medicine (Step-Up Series) 5th Edition PDF Free. Features: Coverage of ethics and legalities surrounding the major issues most likely to be covered on the Ethics section of Steps 2 and 3 of USMLE and the. In order to ensure that user-safety is not compromised and you enjoy faster downloads, we have used trusted 3rd-party repository links that are not hosted on our website. Recover your password. Disclaimer About Contact. Search in posts. If you feel that your copyrights have been violated, then please contact us immediately: Contact us: admin usmlebooksdownload. Download Link. Page Count. Zanki Step 1 Deck Download Free. Exact matches only. Necessary Always Enabled. If you continue to use this site we will assume that you are happy with it. Please enter your comment! Accept Read More. Please complete the required fields.