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Law and Ethics in Psychiatry

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In order to successfully sue for medical malpractice, a plaintiff must prove four elements. Three of these elements are negligent performance of patient care, harm to the patient as a direct result of the physician's actions, and damage or harm to the patient. Which of the following is the fourth element?

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a. The patient was not informed of the actions the physician was taking.

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b. The patient was not in agreement with the treatment plan.

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c. Notes were not kept in an orderly and complete fashion.

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d. There was a duty on the part of the physician to treat the patient.

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e. There was intent to harm the patient.

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The answer is d. (Kaplan and Sadock, p 1381.) In a malpractice lawsuit, the plaintiff must show by a preponderance of evidence that the four elements of malpractice are present. These are the so-called four Ds of malpractice: (1) a duty existed toward the patient on the part of the psychiatrist, (2) a deviation from the standard of practice occurred, (3) this deviation bore a direct causal relationship to the untoward outcome, and (4) damages occurred as a result.

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A 56-year-old woman in the last stages of amyotrophic lateral sclerosis asks for her life support to be stopped and to be allowed to die. Her family members disagree with her decision and go to court to keep the patient alive. A psychiatric evaluation finds the patient mentally sound and fully able to understand the consequences of her decision, and a judge declares her competent. Which of the following actions should be taken next?

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a. The family's desires overrule the patient's wishes, so the patient's life support should be continued.

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b. Terminating one's life is illegal, so the patient's life support should be continued.

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c. A guardian must be appointed to make decisions on behalf of the patient so that a neutral third party can decide this issue.

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d. Since the patient's life expectancy is more than 2 weeks, she cannot be allowed to die and her life support should be continued.

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e. The patient has the right to refuse unwanted medical treatment—her life support should be withdrawn.

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The answer is e. (Kaplan and Sadock, pp 1386, 1388.) A 981 court case rules that patients have an absolute right to refuse treatment. If they are not competent, a guardian may then authorize treatment. In this case, the patient ...

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