Athe patient fills out a living will to avoid aggressive care; Despite this, this patient is resuscitated and put on a ventilator. In addition to the obvious ethical concerns of such cases, hospitals also face potential legal ramifications for failing to comply with advance directives.
"The growing threat of liability for substandard care demonstrates how advances in clinical ethics advice not only improve patient care, but also advance risk management and compliance goals," he saysThaddeus Masonic Pope, JD, PhD, HEC-C, Rechtsprofessor an der Mitchell Hamline School of Law in St. Paul, MN.
There is a growing number of successful lawsuits for unlawful prolongation of life.1,2“The point of the litigation is that providing too much treatment is a medical error, just as it is to provide too little treatment. If it's clear they didn't want it, then don't provide it," says Pope.
Claims of unlawful life extension are increasing, in part because more people have made living wills, and also because of public relations to promote Physician Orders for Life Support (POLST) forms. More and more people are aware that they can control their care at the end of life. "It really got into the public consciousness," notes Pope. "It will be perceived in 2021 as a real violation of rights that might not have been perceived 10 years ago."
Recent successful lawsuits have also received significant media attention.3All of this means that more families are consulting lawyers in this situation – and more lawyers are agreeing to make claims. "Plaintiffs' attorneys now have more confidence that there will actually be a judgment, settlement or judgment large enough to be worth their time and effort," Pope notes.
When an advance directive is violated, "relatives are now vigorously pursuing these cases," she saysSamuel D. Hodge,Jr., JD, Professor of Law at Temple University.4When cases of wrongful prolongation of life first arose, the courts ruled in favor of the medical providers on the grounds that there was no cause of action.5-10That has changed in recent years as the courts have allowed the procedures and appeals.11-15"Ethically, a patient has the right to make decisions about their treatment at the end of life, and that choice must be respected," says Hodge.
Physicians, whose primary focus is saving lives, do not always consider the legal ramifications of their actions, which may go against the patient's will. To avoid conflicts that can end up in court, ethicists can act as a liaison between the doctor and the patient's family. "If the doctor does not understand the legal implications of his or her actions to prolong life, an ethical or philosophical approach might be more successful," suggests Hodge.
At some point down the line, healthcare providers could fail to honor patients' expressed requests. Here are some reasons why it happens:
•Most people do not have a living will.The patient may have at some point made verbal end-of-life wishes to a surrogate mother or clinician, but never actually followed and completed the living will in writing. "They're probably getting treatment that they don't want," says Pope.
•Even if the patient has filled out a living will, it can be lost.Patients can give the living will to a healthcare provider, but somehow it never gets entered into the system. "It's a system communication problem," notes Pope.
•Some doctors mistakenly assume that an advance directive means the patient is DNR."It's a training problem," says Pope.
•Even if advance directives are included in the table, the document may be too vague to provide specific guidance."If we get through all of this, there may still be issues at this point," Pope regrets.
When the situation seems clear, some deputies disagree with the policy and give conflicting instructions. In this situation, Pope says, “clinicians will generally follow the surrogate. The surrogate is human and they scream while the living will is just a document.”
No doctor or representative can object to the living will. "Unfortunately, the mere threat of a lawsuit is enough to scare doctors because they're afraid not only of liability but of the litigation itself," Pope explains.
In other cases, a doctor contradicts the patient's express wish. "Sometimes it's patronizing. The clinician may say, 'Let's do it now, we can always undo it later,'" says Pope.
Doctors may argue that life support treatment is reversible, while stopping or stopping it is permanent. "That's a fair decision if you're honestly unclear and there's a gray and fuzzy situation as to whether the living will applies to the situation or what it means," Pope admits. However, the situation is completely different when a clear living will, a POLST and a representative say in unison not to intubate the patient. In such cases, doctors have no reason to intubate. "When there is a conflict, advance directives typically tend to refuse treatment, and surrogates tend to demand treatment," notes Pope.
Ethicists can help by reminding clinicians of the appropriate standards for healthcare decision-making and the relevant decision-making standards for incapacitated patients. Normally these standards are not up for debate. "There's generally a really well-established set of rules that's embedded in the law and probably in their own institutional policies," says Pope.
There are situations where the patient's deputy decision-maker is reluctant to assume the responsibilities assigned to him, even after he has agreed to serve in that capacity. "The authorized representative can get in conflict with other family members, which makes decision-making difficult," he saysRobert S. Olick, JD, PhD, Associate Professor Emeritus of Bioethics and Humanities at SUNY Upstate Medical University in Syracuse, NY. "On rare occasions, the proxy may act out of self-interest."
A clear example of this would be someone who insists on prolonging aggressive treatment in order to continue receiving Social Security benefits even though the patient wishes to refuse life support. It is also problematic if the patient has made statements that contradict the living will. "There can be uncertainty as to whether the patient's current circumstances are consistent with those that the policy seeks to anticipate and provide for," says Olick.
New treatment options may have become available since the policy was created. "Beyond the written document, careful consideration of the patient's wishes is required," says Olick.
If the patient's life is unlawfully extended for only a short time, and families have time to grieve, Olick says they are less likely to later seek compensation. The behavior of the hospital and the health team are also critical. "When families feel respected and supported, even in the face of serious disagreements, they are less likely to turn to the courts," Olick says.
Courts may be called upon to intervene and resolve disputes over whether to remove life support before the decision is made. For example, the proxy might make decisions that appear to conflict with the advance directive. "These cases tend to focus on a statement of rights, who has the final say in the decision and whether the living will, if any, needs to be honored," explains Olick.
To avoid conflict, Hodge says, ethicists should emphasize to clinicians the importance of respecting patients' decisions at the end of life, both morally and legally. “One should not wait until the decision is made to talk about the problem. At this point, emotions are running high and logic can't prevail," Hodge emphasizes.
Living wills are important tools to enable people to exercise their autonomy and should be respected in most cases. “But they are imperfect instruments. A common misconception is that living wills are mandatory documents that should simply be followed,” says Olick.
In reality, living wills are designed to anticipate a future condition of serious illness and diseases and medical conditions where the patient wishes to have life support withdrawn or withheld. Ethics advisers can help interpret living wills and resolve family disagreements. “But the role of the ethics adviser is only advisory. The decision-making power lies in the patient-doctor-alternative relationship,” warns Olick.
Proxies are often the preferred approach to predictive care planning. Because the proxy can apply personal knowledge of the patient's values and desires to the current medical situation in order to make the best possible decision. "The proxy steps into the role of the patient and enters an informed consent dialogue," adds Olick.
- Lanzetta v. Montefiore Med. Ctr.(Bronx Sup Ct NY, Februar 2021).
- Greenberg gegen Montefiore Hosp.(Bronx Sup Ct NY, 5. Februar 2021).
- Span P.File a “fake living” lawsuit. Die New York Times. Updated January 26, 2021.
- Hodge SD. Unlawful Life Extension – A plea that may finally have made its way into the mainstream.Quinnipiac Law Review2019;37:167-198.
- Anderson vs. St. Francis-St. George Hosp., 671 N.E.2d 225 (Ohio, 1996).
- Allore v. Flower Hosp., 699 N.E.2d 560 (Ohio Ct App, 1997).
- Wright gegen Johns Hopkins Health Sys. Corp., 728 A.2d 166 (MD, 1999).
- Taylor v. Muncie Med. Inv'rs, 727 N.E.2d 466 (Ind Ct App, 2000).
- Scheible v. Joseph L. Morse Geriatric Ctr., Inc., 988 Also. 2d 1130 (Fla Dist Ct App, 2008).
- Cron v. Cron Jamaica Hosp. Med. Ctr., 875 N.Y.S.2d 222 (NY App Div, 2009).
- Physicians Hosp. of Augusta, LLC v. Alicea, 788 SE2d 392 (GA, 2016).
- Complaint at 2, Weisman v. Md. Gen. Hosp., Inc., Nr. 24-C-16-004199 (Baltimore City Cir Ct, 25. Juli 2016).
- Körner v. Bhatt, Nr. L-002983-13 (NJ Super Ct Law Div, Morris Cty, 2017).
- Pope TM Legal information: New penalties for violating living wills and DNR orders.J Clin Ethik2017;28:74-81.
- Pope TM Physicians may not administer life-sustaining treatment without consent: civil, criminal and disciplinary sanctions.J Health Biomed Law2013;9:213-296.
What are ethical issues in malpractice? ›
Ethics Violations That Can Be Considered Medical Malpractice
For example, improperly prescribing medication because a doctor is being paid to promote it may be considered medical malpractice. Failing to obtain informed consent for a medical procedure before beginning it may also be considered medical malpractice.
It contains standards of ethical behavior for healthcare executives in their professional relationships. These relationships include colleagues, patients or others served; members of the healthcare executive's organization and other organizations; the community; and society as a whole.What happens if a doctor goes against a patient's wishes? ›
Advocating on behalf of patients whose rights were violated by doctors. One of the freedoms we have in this country is the right to refuse medical treatment. A patient who is given treatment against his or her express wishes is a victim of medical malpractice.Can a doctor go against your wishes? ›
Doctors are not permitted to perform surgeries against the wishes of their patients, even if the patient is incapacitated at the time of the procedure (provided that the patient previously made their wishes known, such as through a living will).What are the 4 things that must be proven to win a medical malpractice suit? ›
To do so, four legal elements must be proven: (1) a professional duty owed to the patient; (2) breach of such duty; (3) injury caused by the breach; and (4) resulting damages.What happens when ethics is violated in healthcare? ›
Any action taken by a medical professional that violates the principles of non-maleficence, beneficence, patient autonomy, or justice could potentially rise to the level of medical malpractice.What are the top 5 ethical issues in healthcare? ›
- Do-Not-Resuscitate Orders. ...
- Doctor and Patient Confidentiality. ...
- Malpractice and Negligence. ...
- Access to Care. ...
- Physician-Assisted Suicide.
Working while impaired by alcohol or drugs. Becoming romantically involved with patients or family members of a patient. Cherry-picking patients. Breaching patient confidentiality (violating HIPAA regulations)What are six ethical issues in healthcare? ›
- 21% Balancing care quality and efficiency.
- 17% Allocating limited medications or tools of support.
- 17% Addressing end-of-life issues.
- 15% Addressing access to care.
- 15% Doctor and patient confidentiality.
- 13% Allocating limited donor organs.
However, there are circumstances where a hospital may override a patient's decision to refuse treatment. These circumstances typically involve a patient who is not competent to make a decision about their care, or a patient who is a danger to themselves or others.
Who decides to take someone off life support? ›
Typically, the person the patient designated as the medical power of attorney gets to decide whether life support should remain active or not. In the event that the patient has not designated medical power of attorney to anyone, the patient's closest relative or friend receives the responsibility.What should you not say to a patient? ›
- Never make a promise. ...
- Do not offer a guarantee. ...
- Do not overstate qualifications or what is possible. ...
- Never offer personal opinions. ...
- Do not let patients and visitors hear staff griping. ...
- Avoid topics in the news that are related to a patient's care. ...
- Never tell a patient that care is substandard.
This anger seems to manifest itself in different ways, ranging from generalized irritability to actively lashing out at others both within and outside of medicine and, unfortunately, patients. There are certainly things in medicine to be angry about, many of which predate our current disrupted times.Can a doctor overrule a DNR? ›
A physician may override a DNR if the patient's medical conditions have changed or believe that the DNR was made in error. Similarly, a patient may override the DNR if they believe it was written in error or they simply change their mind.Can you refuse a blood pressure check? ›
A doctor can't force anything on a patient who is competent to make medical decisions and refuses care.What are the odds of winning a malpractice suit? ›
By the Numbers: The Odds of Winning a Malpractice Lawsuit
80 to 90 percent of jury trials involving weak evidence of medical negligence. 70 percent of jury trials in borderline cases. 50 percent of cases with strong evidence of medical negligence.
Proving Negligence. Most civil lawsuits for injuries allege the wrongdoer was negligent. To win in a negligence lawsuit, the victim must establish 4 elements: (1) the wrongdoer owed a duty to the victim, (2) the wrongdoer breached the duty, (3) the breach caused the injury (4) the victim suffered damages.Are malpractice suits hard to win? ›
It can be difficult to win this type of case, as malpractice insurance lawyers work hard to defend their clients. However, if your medical malpractice lawyer presents enough facts in your favor, in a compelling way, you can win a malpractice lawsuit.What is an example of ethical violation? ›
Ethics violations such as discrimination, safety violations, poor working conditions and releasing proprietary information are other examples. Situations such as bribery, forgery and theft, while certainly ethically improper, cross over into criminal activity and are often dealt with outside the company.What are 3 legal and ethical issues that occur with end of life patient? ›
These issues include patients' decision-making capacity and right to refuse treatment; withholding and withdrawing life-sustaining treatment, including nutrition and hydration; "no code" decisions; medical futility; and assisted suicide.
What are the consequences of ethical misconduct? ›
Unethical behaviour has serious consequences for both individuals and organizations. You can lose your job and reputation, organizations can lose their credibility, general morale and productivity can decline, or the behaviour can result in significant fines and/or financial loss.What are the three 3 types of ethical issues? ›
There are three main types of ethical issues: Utilitarian, Deontological, and Virtue. Utilitarian ethics focus on the consequences of an action, while deontological ethics focus on the act itself. Virtue ethics focuses on the character of the person acting.What is the top US ethical issue? ›
Harassment and discrimination are arguably the largest ethical issues that impact business owners today. Should harassment or discrimination take place in the workplace, the result could be catastrophic for your organization both financially and reputationally.What is unprofessional behavior in healthcare? ›
In general, examples of unprofessional conduct include, but are not limited to, physical abuse of a patient, inadequate record keeping, not recognizing or acting upon common symptoms, prescribing drugs in excessive amounts or without legitimate reason, personal impairment (mental or physical) that hinders safely ...What is the most common complaints in a hospitals? ›
- Staff/Patient Communication: 53 percent.
- Long Wait Times: 35 percent.
- Practice Staff Behavior: 12 percent.
- Billing Discrepencies: 2 percent.
The four principles of Beauchamp and Childress - autonomy, non-maleficence, beneficence and justice - have been extremely influential in the field of medical ethics, and are fundamental for understanding the current approach to ethical assessment in health care.What are some ethical and legal issues in healthcare? ›
- Patient Privacy and Confidentiality. The protection of private patient information is one of the most important ethical and legal issues in the field of healthcare. ...
- Transmission of Diseases. ...
- Relationships. ...
- End-of-Life Issues.
- Advance directives.
- Surrogate decision making.
- Refusal of treatment.
- Conflicts with caregivers.
- Foregoing life-sustaining treatment.
- Do Not Attempt Resuscitation (DNAR) orders.
- Other issues perceived as ethical problems.
Two of the most significant ethical issues that HR professionals and managers face are discrimination and harassment. The consequences of discrimination and harassment in the workplace can negatively impact the finances and reputation of the organisation.When can patient autonomy be overruled? ›
Full autonomy ceases to exist when another person takes over the decision-making role. Subsequently, autonomy is limited because of one's cultural and traditional beliefs. The argument is therefore that autonomy is not absolute and it can be limited in accordance to a person's cultural, traditional and legal systems.
What can override autonomy? ›
Now, getting to the extent of autonomy: autonomy is limited when its exercise causes harm to someone else or may harm the patient. When harm to others is sufficiently grave, it overrides the principle of autonomy.How can autonomy be violated? ›
A patient's autonomy is violated when family members or members of a healthcare team pressure a patient or when they act on the patient's behalf without the patient's permission (in a non-emergency situation).How long can a hospital keep you on life support? ›
More invasive life support, such as heart/lung bypass, is only maintained for a few hours or days, but patients with artificial hearts have survived for as long as 512 days. Read more: Are near-death experiences just hallucinations? Do people in a coma dream?Can a hospital remove someone from life support? ›
If a critically injured patient does not respond to treatment, his or her life support will be removed. Patients who are permanently vegetative have no control over their condition and must be artificially removed.Can hospital turn off life support without permission? ›
Can a hospital take a patient off life support without family consent? ' no. patient autonomy is the highest value of medical ethics. that means that the patient (or power of attorney) makes medical decisions, and doctors respect their wishes.Why can't you say quiet in healthcare? ›
Ascertainment bias occurs when your thinking is shaped by your expectations (you see what you expect to see). After someone says “quiet”, any new patients, even if less than average, might be interpreted as a surge because that is what you were expecting.What should you not tell your doctor? ›
- Anything that is not 100 percent truthful. ...
- Anything condescending, loud, hostile, or sarcastic. ...
- Anything related to your health care when we are off the clock. ...
- Complaining about other doctors. ...
- Anything that is a huge overreaction.
- Maria's appointment with her physician didn't go so well today. ...
- Take ownership for your feelings. ...
- A little compassion can go a long way. ...
- Try some humor. ...
- But don't hesitate to be straightforward. ...
- And don't forget that scolding can be a way of expressing concern.
Being an overworked and unfulfilled physician could lead to traumatic stress in some individuals. “In addition to experiencing trauma, the cumulative stress of practice may cause PTSD,” Dr. Lazarus explained.Do doctors gossip? ›
A recent study published by researchers at the University of California concluded that “Gossip is ubiquitous.”
What happens if you accidentally resuscitate someone with a DNR? ›
The main point is this: as a bystander, i.e. a non-medical professional, you cannot get into any legal trouble for giving CPR to a person with a DNR, and should always give CPR as soon as possible to all victims of sudden cardiac arrest.Can a hospital make a decision on DNR? ›
DNACPR is sometimes called DNAR (do not attempt resuscitation) or DNR (do not resuscitate) but they all refer to the same thing. DNACPR means if your heart or breathing stops your healthcare team will not try to restart it. A DNACPR decision is made by you and/or your doctor or healthcare team.Why do doctors push DNR? ›
Its purpose is to let medical professionals know you do not want to be resuscitated if you suddenly go into cardiac arrest or stop breathing. People who are chronically ill often regard a DNR as a graceful way to leave the world on their terms.What can throw off a blood pressure test? ›
- Stress and Anxiety. ...
- A Full Bladder. ...
- Crossed Legs. ...
- Blood Pressure Cuff Placement. ...
- Eating (Or Not Eating) ...
- Alcohol, Caffeine, and Tobacco. ...
- Too Much Talking. ...
- Cold Temperatures.
The resulting anxiety can elevate blood pressure 10 points or more.” Studies have shown that clinics rarely take two or more blood pressure readings, even though the ACC/AHA guidelines suggest that doing so could reduce the effects of WCH.How do you beat a blood pressure test? ›
Focus on deep breathing for 10-15 minutes before your appointment. The most effective technique for lowering blood pressure is inhaling through the nose and holding for 5-6 seconds, then exhaling through the mouth for one second longer than the inhale.Is medical malpractice an ethical issue? ›
The ethical obligations of healthcare providers are at the heart of medical malpractice suits. However, medical malpractice as a whole is a complex interplay of ethical obligation, involving not only providers but their patients as well.What are some issues related to malpractice? ›
- Failure to diagnose or misdiagnosis.
- Misreading or ignoring laboratory results.
- Unnecessary surgery.
- Surgical errors or wrong site surgery.
- Improper medication or dosage.
- Poor follow-up or aftercare.
- Premature discharge.
- Disregarding or not taking appropriate patient history.
One of the biggest legal and ethical issues in healthcare is patient confidentiality which is why 15% of survey respondents noted that doctor-patient confidentiality is their top ethical issue in practicing medicine.
The Difficulties of Proving Fault in Medical Malpractice Cases. Medical malpractice lawsuits can be difficult to win in large part because of the complexity of the subject that is being discussed in the lawsuit. Doctors have years and years of training to understand medical terminology, illnesses, and medications.
Which element of malpractice is hardest to prove? ›
Many articles discuss what negligence is and how to prove it, but the least understood element among these four is causation. Additionally, out of these four elements, causation is typically the most difficult to prove, especially in medical malpractice cases.How much are most medical malpractice settlements? ›
Average award of medical malpractice lawsuits
The average medical malpractice settlement in the United States awards $242,000. Those that go to trial average around $1,000,000. Minor settlements only pay out-of-pocket expenses.
- Duty: The duty of care owed to patients.
- Dereliction: Or breach of this duty of care.
- Direct cause: Establishing that the breach caused injury to a patient.
- Damages: The economic and noneconomic losses suffered by the patient as a result of their injury or illness.
- A patient-doctor relationship existed.
- The doctor owed you a duty of care.
- The doctor fell below the expected standard of care.
- Their actions caused the injuries you have suffered.
Whether it is covering for someone who shows up late or altering a timesheet, misusing company time tops the list. This category includes knowing a co-worker is conducting personal business on company time.What are the four types of ethical conflict? ›
In the field of ethical conflict, the four forms or categories of ethical conflict identified are: moral uncertainty, moral dilemma, moral distress, and moral outrage.What is an ethical conflict in healthcare? ›
Ethical issues happen when choices need to be made, the answers may not be clear and the options are not ideal. The result could be declines in the quality of patient care; problematic clinical relationships; and moral distress, which is defined as knowing the right thing to do but not being allowed or able to do it.What are the most important ethical problems faced by a general hospital? ›
Patient Privacy and Confidentiality
The protection of private patient information is one of the most important ethical and legal issues in the field of healthcare. Conversations between a physician and a patient are strictly confidential, as is information about an individual's medical condition.