Legal, Ethical, and Professional Practice
This domain covers the legal and ethical framework of care management: autonomy, beneficence, nonmaleficence, justice, veracity, and fidelity. Know informed consent elements (capacity, disclosure, comprehension, voluntariness) and decisional capacity (understanding, appreciation, reasoning, expressing a choice). Understand advance directives (living will, durable power of attorney for health care) and POLST/MOLST as actionable medical orders for seriously ill patients.
Know HIPAA basics: minimum necessary, permitted disclosures (treatment, payment, operations; public health and safety exceptions), and that state law may be stricter. Understand mandatory reporting (abuse, neglect, certain diseases), scope of practice, delegation rules, and documentation standards. Recognize ethical conflicts - resource allocation, conflicts of interest, patient wishes versus family wishes - and the role of ethics committees and chain of command.
Traps: assuming a family member can consent for a competent adult; confusing capacity (clinical, decision-specific) with competence (legal); treating an advance directive as an order (it guides; POLST is an order); breaching confidentiality "for the family's sake"; and acting outside scope of practice. Another trap is failing to document patient refusal and the education provided.
Rule of thumb: For any ethical dilemma, first identify the patient's expressed wishes and decision-making capacity; then use the least restrictive, most patient-centered option; escalate to ethics or chain of command when values conflict.
Worked example: A patient with capacity refuses a recommended treatment. The CM confirms capacity, educates on risks and alternatives, documents the informed refusal, and supports the patient's autonomous choice - involving family only with the patient's permission.