The document discusses end-of-life issues and various legal and ethical considerations surrounding patient autonomy, informed consent, and decision making at the end of life. It covers topics like advance directives, withdrawal/withholding of treatment, medical futility, euthanasia, physician-assisted suicide, definitions of death, organ donation, and research. It also summarizes several important court cases that have impacted patients' right to refuse treatment and determine the course of their own care.

1. Chapter 17
End-of-Life Issues
When we finally know we are dying,
And all other sentient beings are dying with us,
We start to have a burning,
almost heart-breaking sense
of the fragility and preciousness of each moment and each
being,
and from this can grow
a deep, clear, limitless compassion for all beings.
—Sogyal Rinpoche
Learning Objectives
Discuss the human struggle to survive and the right to
autonomous decision making.
Describe how patient autonomy has been impacted by case law
and legislative enactments.
Discuss the following concepts: preservation of life with limits,
euthanasia, advance directives, futility of treatment,
withholding and withdrawal of treatment, and do-not-resuscitate
orders.
Learning Objectives, cont’d
Explain end-of-life issues as they relate to autopsy, organ
donations, research, experimentation, and clinical trials.
Describe how human genetics and stem cell research can have
an impact on end-of-life issues.

2. Dreams of Immortality
Human Struggle to Survive
Desire to Prevent & Cure Illness
Advances in Medicine & Power to Prolong Life
Ethical & Legal Issues
Involving entire life span
From right to be born to right to die
Patient Autonomy
Right to make one’s own decisions
Patient has the right to accept or refuse care even if it is
beneficial to saving his or her life.
Autonomy may be inapplicable in certain cases.
Affected by one’s disabilities, mental status, maturity, or
incapacity to make decisions
No right is held more sacred, or is more carefully guarded, by
the common law, than the right of every individual to the
possession and control of his own person, free from all restraint
or interference of others, unless by clear and unquestioned
authority of law.
—Union Pac. Ry. Co. v. Botsford (1891)
Every human being of adult years and sound mind has a right to
determine what shall be done with his own body and a surgeon
who performs an operation without his patient’s consent
commits an assault, for which he is liable in damages, except in
cases of emergency where the patient is unconscious and where
it is necessary to operate before consent can be obtained.

3. —Schloendorff v. Society of New York Hospital (1914)
Why Courts Get Involved
End-of-Life Issues
Family members disagree as to the incompetent’s
wishes.
Physicians disagree on the prognosis.
A patient’s wishes are unknown because he or she has always
been incompetent.
Evidence exists of wrongful motives or malpractice.
In re Quinlan (1976)
Constitutional right to privacy protects patient’s right to self-
determination.
A state’s interest does not justify interference with one’s right
to refuse treatment.
In re Storar (1981)
Every human being of adult years and sound mind has the right
to determine what shall be done with his or her own body.
Superintendent of Belchertown State School v. Saikewicz
(1977)

4. Saikewicz allowed to refuse treatment.
Questions of life and death with regard to an incompetent
should be the responsibility of the courts.
Court took a “dim view of any attempt to shift ultimate
decision-making responsibility away from duly established
courts of proper jurisdiction to any committee, panel, or group,
ad hoc or permanent.”
In re Dinnerstein (1978)
“No code” orders are valid to prevent the use of artificial
resuscitative measures on incompetent terminally ill patients.
In re Spring (1980)
Patient’s mental impairment and his or her medical prognosis
with or without treatment must be considered prior to seeking
judicial approval to withdraw or withhold treatment from an
incompetent patient.
John F. Kennedy Memorial Hospital v. Bludworth (1981)
The Florida Supreme Court took the lead and accepted the
living will as persuasive evidence of an incompetent’s wishes.
The Court allowed an incompetent patient’s wife to act as his
guardian, and in accordance with the terms of a living will he
executed in 1975, she could substitute her judgment for that of
her husband.

5. Satz v. Perlmutter (1978)
Court required attending physician to certify patient was in a
permanent vegetative state
No reasonable chance for recovery
Before family member or guardian could request termination of
extraordinary means of medical treatment
Constitutional Right to
Refuse Care
The Supreme Court analyzed the issues presented in the Cruzan
case in terms of a Fourteenth Amendment liberty interest.
A competent person has a constitutionally protected right
grounded in the due-process clause to refuse life-saving
hydration and nutrition.
Legislative Response
Chief Justice Dore of the Washington Supreme Court voiced his
opinion that a legislative response to right-to-die issues
could be better addressed by the legislature.
Patient Self-Determination Act of 1990
Enacted to ensure that patients are informed of their rights to
execute advance directives and accept or refuse medical care
Patient Self-Determination Act of 1990
Enacted to ensure patients are informed of rights to execute
advance directives and accept or refuse medical care.
Each state is required under PSDA to provide a description of
the law regarding advance directives to providers.
Whether based on state statutes or judicial decisions
Providers must ensure written policies and procedures regarding
advance directives are established.

6. Defining Death
Brain Death Criteria
Black’s Law: “irreversible cessation of all brain functions
including the brain stem”
Harvard Ad Hoc Committee
Brain Death Criteria (1968)
Patient shows total unawareness to external stimuli and
unresponsiveness to painful stimuli.
No movements or breathing: All spontaneous muscular
movement, spontaneous respiration, and response to stimuli are
absent.
No reflexes: Fixed, dilated pupils; no eye movement even when
hit or turned, or when ice water is placed in the ear; no response
to noxious stimuli; no tendon reflexes.
American Medical Association
(1974)
Committee of the Harvard Medical School to Examine the
Definition of Brain Death
Death occurs when there is “irreversible cessation of all brain
functions, including the brain stem.”

7. New York Court of Appeals
Evidence of a patient’s intention to reject prolongation of life
by artificial means
Persistence statements regarding individual’s beliefs
Desirability of the commitment to those beliefs
Seriousness with which such statements were made
Inferences that may be drawn from surrounding
circumstances
—In re Westchester County Medical Center ex rel. O’Connor
Futility of Treatment
Physician recognizes effect of treatment will be of no benefit to
the patient.
Morally, a physician has a duty to inform the patient when there
is little likelihood of success.
Determination as to futility of medical care is a scientific
decision.
Do-Not-Resuscitate Orders
Do-not-resuscitate (DNR) orders written by a physician indicate
that in the event of cardiac or respiratory arrest no resuscitative
measures should be used to revive the patient.
Competent patients make their own DNR decisions.
Withholding and Withdrawal
of Treatment
Withholding of treatment
Decision not to initiate treatment or medical intervention for the
patient.

8. Withdrawal of treatment
Decision to discontinue treatment or medical interventions for
the patient when death is imminent & cannot be prevented
by available treatment.
Withholding & Withdrawal
of Treatment, cont’d
Considerations
Patient is in a terminal condition and there is a reasonable
expectation of imminent death of the patient.
Patient is in a non-cognitive state with no reasonable possibility
of regaining cognitive function.
Restoration of cardiac function will last for brief period.
Euthanasia
Mercy Killing
e.g., hopelessly ill, injured, incapacitation
Active Euthanasia
Intentional commission of an act
Administering the patient with a lethal drug
Passive Euthanasia
Withholding or Withdrawing life-saving treatment (e.g.,
removal of a respirator)
Euthanasia (cont’d)
Voluntary euthanasia
Occurs when suffering incurable patient makes decision to die
Involuntary euthanasia
Occurs when a person other than incurable makes decision to
terminate life of an incompetent or a non-consenting competent

9. person’s life
Euthanasia
Ramifications
Why
Why Not
How
Who
Where
When
Euthanasia
Issues Regarding Euthanasia
If lawful
Long-term ramifications
What about abortions?
Right to die
Civil wrong: Negligence
Criminal offense
Voluntary
Involuntary
Physician-Assisted Suicide
Michigan and assisted suicide
Oregon’s Death with Dignity Act of 1994
U.S. Supreme Court
Prohibition of assisted suicide ruled constitutional
Assisted suicide law ruled constitutional
States Legislate Assisted Suicide
California, D.C., Oregon, Montana, Washington, & Vermont

10. Advance Directives
Instructions specifying what actions should be taken in event
the individual becomes incapacitated and can no longer make
healthcare decisions due to incapacity
Obligation to make preferences known
Patients have an obligation to make care preferences known.
Uncertainty as to patient’s desires should be resolved in favor
of preserving life.
Advance Directives
Living Will
Instrument or legal document that describes those treatments an
individual wishes or does not wish to receive should he or she
become incapacitated & unable to communicate treatment
decisions
Dying without a living will
Living Will Declaration Upheld
Advance Directives
Healthcare Proxy
Legal document that allows a person to appoint a healthcare
agent to make treatment decisions in the event he or she
becomes incapacitated and is unable to make decisions for
himself or herself

11. Advance Directives
Durable Power of Attorney
Legal device that permits one individual, known as the
“principal,” to give to another person, called the “attorney-in-
fact,” the authority to act on his or her behalf
Advance Directives
Surrogate Decision Making
Agent who acts on behalf of a patient who lacks the capacity to
participate in a particular decision
Substituted judgment
Form of surrogate decision making where surrogate attempts to
establish what decision the patient would have made if that
patient were competent to do so
Advance Directives
Guardianship
Legal mechanism by which the court declares a person
incompetent and appoints a guardian

12. Autopsy
Autopsy Consent Statutes
Authorization by Decedent
Authorization by Other than Decedent
Autopsy, cont’d
Scope & Extent of Consent
Fraudulently Obtained Consent
Unclaimed Dead Bodies
Organ Donation & Transplantation
Federal regulations require hospitals to have, and implement,
written protocols regarding organization’s organ procurement.
Regulations impose notification duties concerning informing
families of potential donors.
Discretion and sensitivity should be used in dealing with
families.
Organ Donations, cont’d
Educating hospital staff on variety of issues involved with
donation matters, in order to facilitate timely donation and
transplantation
Who lives? Who dies? Who decides?
Determination of death
Uniform Anatomical Gift Act
Failure to obtain consent
Research, Experimentation, &

13. Clinical Trials
Institutional Review Board
Informed Consent
Research Subject’s Bill of Rights
Failure to Obtain Informed Consent
Duty to Warn
Research, Experimentation, and
Clinical Trials (cont’d)
Patents Delay Research
Nursing Facilities
Patient Understood Risks
Human Genetics
Describes the study of inheritance as it occurs in human beings
Genetic markers
DNA sequences with a known location on a chromosome that
can be used to identify specific cells and diseases, as well as
individuals and species
Genetic Information Nondiscrimination Act (2008)
Prohibits discrimination on the basis of genetic information
with respect to the availability of health insurance and
employment
Stem Cell Research

14. Embryonic stem cells are used to create organs and various
body tissues.
Opponents argue that use of stem cells is a slippery slope to
reproductive cloning and fundamentally devalues the worth of a
human being.
Medical researchers argue it is necessary to pursue embryonic
stem cell research because the resultant technologies could have
significant medical potential.
Review Questions
Describe how patient autonomy has been impacted by case law
& legislative enactments.
Discuss the following concepts: preservation of life with limits,
euthanasia, advance directives, futility of treatment,
withholding & withdrawal of treatment, and do-not-resuscitate
orders.
Explain end-of-life issues as they relate to autopsy, organ
donations, research experimentation, & clinical trials.
Review Questions (cont’d)
Describe how human genetics & stem cell research can have an
impact on end-of-life issues.
Discuss the importance of genetic markers.
Explain the reason the Genetic Information Nondiscrimination
Act was enacted.

15. Chapter 14
Patient Consent
Rights & Responsibilities
Learning Objectives
Discuss the difference between verbal, written, & implied
consent.
Describe the role of the patient, physician, nurse, & hospital in
informed consent.
Describe the theories under which the validity of consent might
be proven.
Explain how consent differs among competent patients, minors,
guardians, and incompetent patients.
Learning Objectives, cont’d
Discuss the importance of understanding patient rights.
Discuss the importance of understanding patient
responsibilities.
Patient Consent
[N]o right is held more sacred, or is more carefully
guarded, by the common law, than the right of every individual
to the possession and control of his own person.
—Union Pacific Ry. Co. v. Botsford
Consent
Voluntary agreement by a person who possesses sufficient

16. mental capacity to make an intelligent choice to allow
something proposed by another to be performed on himself or
herself.
Forms of Consent
Express consent can take the form of
Verbal agreement
Written document authorizing medical care
Implied consent
Determined by some act or silence, which raises a presumption
consent has been authorized
Generally applicable to emergency situations
Informed Consent
Legal doctrine where a patient has a right to know potential
risks, benefits, & alternatives of a proposed procedure.
Patient has absolute right to know about & select from available
treatment options.
Predicated on duty of physician to disclose sufficient
information to enable a patient to evaluate proposed medical or
surgical procedures before submitting to them.
Informed Consent, cont’d
Verbal Consent
Binding as written consent
More difficult to prove
Written Consent
Visible proof of a patient’s wishes

17. Elements of Informed Consent
Nature of patient’s illness or injury
Procedure or treatment consented to
Purpose of proposed treatment
Risks & probable consequences of the proposed treatment
Probability proposed treatment will be successful
Elements of Informed Consent, cont’d
6. Alternative methods of treatment, risks & benefits
7. Risks & prognosis if no treatment is rendered
8. Patient understands nature of proposed treatment,
alternatives, risks, & probable consequences of treatment
9. Signatures of patient, physician, & witnesses
10. Date the consent is signed
Implied Consent
Unconscious patients are presumed under law to approve
treatment
Generally presumed when immediate action is required to
prevent death or permanent impairment
Unconscious patients presumed to approve treatment
Emergency from auto accident
Statutory Consent
Legislation Allow Emergency Care
Eliminating need for written consent.

18. Presumption
A reasonable person would consent to lifesaving medical
intervention.
Document need for immediate care
Attempt to contact family
Consider court order if necessary
2nd Opinion when in doubt
Judicial Consent
May be necessary in those instances where there is concern as
to the absence or legality of consent.
Judge should be contacted only after alternative methods have
been exhausted.
Some courts may require an attorney to initiate the call.
Written protocol should be available in ED.
Ensure staff education & training.
Physicians
Informed Consent
Physicians are expected to disclose to patients risks, benefits,
& alternatives of recommended procedures.
Disclosure should include what a reasonable person would
consider material to his or her decision of whether or not to
undergo treatment.
Doctrine of informed consent is firmly rooted in the notions of
liberty & individual autonomy.
Informed consent is not merely a tool to avoid lawsuits.

19. Physicians
Informed Consent Cases
Physicians Must Disclose Alternatives
Paternalism Fails
Physicians Duty to Advise: Delicate Medical Judgment
Adequacy of Consent
Lack of Consent
Course of Treatment
Case: Patient’s Decision
Elderly woman living alone fell & fractured her hip.
Orthopedic surgeon ordered bed rest
Plaintiff maintained independent style of living
Expert testimony
Bed rest inappropriate treatment
Patient successful in proving
she was not informed of alternative treatment
Course of Treatment
Case: Patient’s Decision, cont’d
Yes!
Court held “necessary to advise a patient when considering
alternative courses of treatment”
Physician should have explained alternatives
Risks & likely outcomes of alternatives
Matthies v. Mastromonaco

20. Lack of Consent
Riser v. American Medical Intern, Inc.
Patient had multiple medical diagnoses.
Physician ordered bilateral arteriograms to determine cause of
patient’s impaired circulation.
Hospital could not accommodate physician’s request & patient
was transferred to a radiologist at St. Jude Hospital.
He performed a femoral arteriogram, not the bilateral brachial
arteriogram ordered by the ordering physician.
Patient was prepared for transfer back to De La
Ronde Hospital.
Shortly after ambulance departed, the patient suffered a seizure
in the ambulance & was returned to St. Jude.
Lack of Consent
Riser v. American Medical Intern, Inc., cont’d
Patient’s condition deteriorated & died 11 days later
Plaintiffs claimed patient was a poor risk for procedure.
District court ruled for plaintiffs
The defendant appealed
What did the appeals court determine?
Lack of Consent
Riser v. American Medical Intern, Inc., cont’d
The Court of Appeals held that there was a breach in the
standard of care by subjecting the patient to a procedure that
would have no practical benefit to the patient.
The physician had failed to obtain informed consent from the

21. patient.
Information
to Be Disclosed
Physicians should provide as much information about treatment
options as is necessary.
based on a patient’s personal understanding of the physician’s
explanation of risks, & probable consequences of treatment.
Needs of each patient can vary depending on age, maturity, and
mental status.
Individual responsible for obtaining consent must weigh
importance of giving full disclosure to the patient against the
likelihood that such disclosure will adversely affect the
patient’s decision.
Information
to Be Disclosed, cont’d
Courts generally utilize an “objective” or “subjective” test to
determine whether a patient would have refused treatment if the
physician had provided adequate information as to the risks,
benefits, and alternatives of the procedure.
Hospitals
Informed Consent
Hospitals generally do not have an independent duty to obtain
informed consent.
Caveat: Cases where hospitals have been found to owe a duty to
provide patients with informed consent.
For example: CT scan involves injection of a contrast dye. Keel
was given no information concerning risks attendant to the
procedure. The dye was injected and the plaintiff developed a
thrombophlebitis at the site of the injection.

22. Hospitals
Informed Consent, cont’d
The Kentucky Supreme Court held that expert testimony was
not required to establish lack of informed consent and that the
hospital had a duty to inform the patient of the risks associated
with the procedure.
Keel v. St. Elizabeth Medical Center, Ky.
Hospitals
Life or Death: Right to Choose
Jehovah’s Witness, in Stamford Hospital v. Nelly E. Vega,
executed a release requesting that no blood or its derivatives be
administered during her hospitalization.
Hospital filed a complaint requesting the court issue an
injunction.
Connecticut Supreme Court determined hospital had no common
law right or obligation to thrust unwanted medical care on a
patient.
Nurses
Informed Consent
A nurse generally has no duty to
Advise a patient as to a procedure to be employed
A nurse may confirm with the patient that the physician has
explained the procedure.
Obtain a patient’s informed consent
Policy and procedures may provide that the nurse may witness
that the risks, benefits, and alternatives have been
explained.

23. Validity of Consent
Subjective test
Must determine if the individual patient would have chosen the
procedure if fully informed.
Objective test
Must show that a reasonable person would not have undergone a
procedure if properly informed.
Objective Test Preferred
Assessing Decision-Making Capacity
Includes patient’s ability to
Understand risks, benefits, and alternatives of a proposed test or
procedure
Evaluate information provided by the physician
Express his or her treatment preferences
Voluntarily make decisions regarding his or her treatment plan
Without undue influence by family, friends, or
medical personnel
Admission Consent Forms
Signed at the Time of Admission
For routine services
Limited Power of Attorney
School officials when other options lacking
Consent for Specific Procedures

24. Variety of consent forms
Specifically describe the risks, benefits, & alternatives of
particular procedures
anesthesia
cardiac catheterization
surgery
radiation & chemotherapy therapy
blood and blood by-products, etc.
Limited Power of Attorney
Authorizes, e.g.,
School officials, teachers, & camp counselors act on the
parents’ or legal guardian’s behalf
When seeking emergency care.
Limited protection
Active ongoing contact of family necessary
Who May Consent
Competent Patients
Guardianship
Parental Consent
Emancipated Minor
Incompetent Patients
When there is doubt as to a patient’s capacity to consent, the

25. consent of the legal guardian or next of kin should be obtained.
Ability to consent is a question of fact.
Physicians are in the best position to make that
determination.
Spousal consent.
Right to Refuse Treatment
& Religious Beliefs
Patients have a right to refuse treatment.
Must be conscious and mentally competent
Hospitals must honor a patient’s decisions when treatment is
refused.
Religious beliefs
Blood or blood products
Exculpatory Agreements
An agreement that relieves one from liability when he or she
has acted in good faith.
Exculpatory agreements in the medical setting are generally
considered invalid.
Case: Cudnik v. William Beaumont Hospital
Release Form
A patient’s refusal to consent to treatment, for any reason,
religious or otherwise, should be noted in the medical record,
and a release form should be executed.
A completed release provides documented evidence of a
patient’s refusal to consent to a recommended treatment.

26. Proving Lack of Consent
Reasonably prudent person in patient’s position would not have
undergone treatment if fully informed.
Lack of informed consent is proximate cause of injury for which
recovery is sought.
Informed Consent
Claims and Defenses
Risk not disclosed is commonly known.
Patient assured the practitioner that he or she would undergo
treatment regardless of the risk.
For example: Patient did not want to know about the risks.
Consent was not reasonably possible.
Practitioner reasonably believed manner & extent of disclosure
could reasonably be expected to adversely & substantially affect
patient’s condition.
Patient Rights
Patient Rights
Know One’s Rights
Patient’s Bill of Rights
Explanation of Rights
Know Caregivers
Ask Questions
Patient Rights, cont’d
Admission
Discrimination Prohibited

27. Government Facilities
Assessments and Reassessments
Participate in Care Decisions
Informed Consent
Patient Rights, cont’d
Right to Treatment
Refuse Treatment
Pain Management
Quality Care
Appoint a Surrogate Decision Maker
Patient Rights, cont’d
Have Special Needs Addressed
Execute Advance Directives
Compassionate Care
Confidentiality
Patient Rights, cont’d
Privacy and HIPAA
Disclosures Permitted without Patient Authorization
Limitations on Disclosures
Patient Advocate
Ethics Consultation
Chaplaincy Services

28. Patient Rights, cont’d
Discharge Orders
News: Don't Leave the Hospital Until You Know What Comes
Next
Discharge or Detainment
Release from Hospital Contraindicated Transfer
Failure to Override Physician’s Discharge Order
Patient Rights, cont’d
Transfer
Access Medical Records
Know Hospital’s Adverse Events
Know Third-Party Relationships
Patient Education
Patient Rights, cont’d
Transparency & Hospital Charges
Transparency & Hospital Charges
Failure to Disclose Insurance Applicants’ HIV Status
Transparency Not So Transparent
Patient Responsibilities

29. Patient Responsibilities
Historical Perspective
Cornwall General Hospital’s Rules for Patients (posted
in 1897)
1. Patients on admission to the Hospital must have a bath,
unless orders to the contrary are given by the Attending Medical
Attendant . . .
6. Patients must be quiet and exemplary in their behaviour
and conform strictly to the rules and regulations of the Hospital,
and carry out all orders and prescriptions of the various officers
of the establishment . . .
Patient Responsibilities
Historical Perspective, cont’d
8. No male patient shall, under any pretense whatever, enter
the apartments or wards for the females, nor shall a female
patient enter the apartments or wards for males, without express
orders from the Medical Attendant or Lady Superintendent . . .
10. Every patient shall retire to bed at 9 p.m. from First May to
First November, and at 8 p.m. from November to May; and
those who are able shall rise at 6 a.m. in the Summer and 7 a.m.
in the Winter . . .
11. Such patients as are able, in the opinion of the physicians
and surgeons, shall assist in nursing others, or in such services
as the Lady Superintendent may require . . .

30. Patient Responsibilities
Historical Perspective, cont’d
13. Patients must not take away bottles, labels or appliances
when leaving the Hospital.
14. No patients shall enter into the basement story, operating
theater, or any of the officers’ or attendants’ rooms, except by
permission of an officer of the Hospital . . .
Patient Responsibilities
Historical Perspective, cont’d
17. Any patient bringing spirituous liquors into the Hospital or
the grounds, or found intoxicated, will be discharged.
18. Whenever patients misbehave or violate any of the standing
rules of the Hospital, the Attending Physician may remove or
discharge them, as provided by clauses 91 and 93 of Rules for
Medical Staff.
Patient Responsibilities
Contemporary Perspective
Practice a Healthy Lifestyle
Maintain Current Medical Records
Keep Appointments
Provide Full Disclosure of Medical History
Accurately Describe Symptoms
Patient Responsibilities
Contemporary Perspective, cont’d
Responsibility to Disclose Information
Communicate Care Preferences

31. Stay Informed
Report Unexpected Changes in Health Status
Adhere to Agreed Upon Treatment Plan
Patient Responsibilities
Contemporary Perspective, cont’d
Avoid Self-Administration of Medications
Actively Participate in Care
Comply with Hospital Policy
Respect
Understand Medicine Has Limits
Patient Responsibilities
Contemporary Perspective, cont’d
Ask Questions
“What is this medication for?”
“What diet am I on?”
“Since you are going to change my dressing, did you wash your
hands?”
Tips for Patients
Help Prevent Medical Errors
Medications
Inform your doctors about medicine you are taking.
Bring your medicines and supplements to doctor visits.
Inform your doctor about any allergies and adverse reactions
you have had to medicines.
Make sure you can read your doctor’s prescription
order.

32. Tips for Patients
Help Prevent Medical Errors, cont’d
Medications, cont’d
Ask for information about your medicines in terms you
understand—both when your medicines are prescribed and when
you pick them up.
When you pick up your medicine from the pharmacy, ask: “Is
this the medicine that my doctor prescribed?”
Make queries about any questions and directions on your
medicine labels; don’t be afraid to ask.
Tips for Patients
Help Prevent Medical Errors, cont’d
Medicines (cont’d)
Ask your pharmacist for the best device to measure your liquid
medicine.
Ask for written information about the side effects your medicine
could cause.
Tips for Patients
Help Prevent Medical Errors, cont’d
Hospital stays
If you are in a hospital, consider asking all healthcare workers
who will touch you whether they have washed their hands.
When you are being discharged from the hospital, ask your
doctor to explain the treatment plan you will follow at home.

33. Tips for Patients
Help Prevent Medical Errors, cont’d
Surgery
If you are having surgery, make sure that you, your doctor, and
your surgeon all agree on exactly what will be done.
If you have a choice, choose a hospital where many patients
have had the procedure or surgery you need.
Tips for Patients
Help Prevent Medical Errors, cont’d
Other steps
Speak up if you have questions or concerns.
Make sure that someone, such as your primary care doctor,
coordinates your care.
Make sure doctors have your health information.
Tips for Patients
Help Prevent Medical Errors, cont’d
Other steps
Ask a family member or friend to go to appointments with you.
Know that “more” is not always better.
If you have a test, do not assume that no news is good news—be
sure to follow up.
Learn about your condition and treatments by asking your
doctor, nurses, and other reliable sources.
Review Questions
Discuss the rights and responsibilities of patients as reviewed in

34. this chapter.
Discuss the distinction between verbal, written, and implied
consent.
Describe the role of the patient, physician, nurse, and hospital
in obtaining informed consent.
Explain how consent differs among competent patients, minors,
guardians, and incompetent patients.
Review Questions, cont’d
5. Explain the available defenses for defendants as it relates to
informed consent.
Can a patient consent to a procedure and then withdraw it?
Discuss your answer.
Discuss under what circumstances parental consent for a minor
might not be necessary.
Review Questions, cont’d
8. Describe the rights & responsibilities of patients.
9. Why should caregivers should consider themselves patient
advocates.
10. Describe what can patients can do to help prevent medical
errors.