Law and Ethics
Law and Ethics
Distinguish legal duties from ethical obligations. Core legal areas: informed consent (capacity, disclosure, voluntariness, documentation), HIPAA privacy and security (minimum necessary, permitted disclosures, breach notification), EMTALA (screening and stabilization regardless of ability to pay), negligence (duty, breach, causation, damages), and fraud and abuse (False Claims Act, Anti-Kickback Statute, Stark law). Know that Stark is a strict-liability physician self-referral statute while the Anti-Kickback Statute requires intent.
Ethical frameworks: autonomy, beneficence, nonmaleficence, justice; plus veracity, fidelity, and confidentiality. Know how ethics committees and advance directives function, and the difference between decision-making capacity (clinical) and legal competence (judicial).
Traps: equating a HIPAA violation with a malpractice claim; assuming consent is just a signature (it is a process); confusing capacity with competence; treating an ethical dilemma as having one legally mandated answer. Watch for questions where the "most ethical" answer is not the legally required one-read the stem carefully.
Worked rule of thumb: for a conflict, apply the four principles in order of the patient's expressed wishes when the patient has capacity; when capacity is absent, use substituted judgment (what the patient would have wanted) before best interests.
Documentation is the common thread: consent discussions, refusals, and disclosures should be recorded contemporaneously.