Scope, Consent and Ethics

This is Unit Twenty-Seven of Medical Assistant Prep. Unit Twenty-Six coded only what the record supports. This unit sets out the legal and ethical ground under all of the work: scope as a legal limit, the wrongs that lead to lawsuits, consent, advance directives, and the duty to report. Carry one idea through this lecture. A patient's consent is what makes care lawful, it can be withdrawn at any moment, and the medical assistant's part is to stop, tell the provider and document. Two constructed cases at the end show a refusal and an advance directive. By the end you will be able to explain torts, negligence and malpractice. To apply informed and implied consent, capacity and refusal. To support advance directives. And to name the ethical principles and the duties to report and to end care properly.

Eight entries on law: law and ethics, scope, torts, assault and battery, confidentiality, fraud, negligence and malpractice.

Rules and judgment.

MAS 651 Law and Ethics in Everyday Work

Law sets the rules a medical assistant must follow; ethics guides what is right when the rules do not settle a question. Laws come from the state and federal governments; ethical principles come from the professions and guide judgment in daily care. Something legal is not automatically ethical, and doubts go to the provider or supervisor.

A legal limit.

MAS 652 Scope of Practice Is a Legal Limit

Acting outside your scope of practice is not only poor judgment; it can create legal liability. Doing a task the state or practice does not permit, or one you are not trained for, exposes the patient to harm and you and the practice to legal action. When asked to do a task outside your scope, decline it and pass the request on.

A civil wrong.

MAS 653 What a Tort Is

A tort is a civil wrong, an act or failure to act that harms another person and can lead to a lawsuit. Torts are intentional, such as striking a person, or unintentional, such as harm from failing to follow policy. Negligence, an unintentional tort, can happen to anyone who skips a step or ignores policy.

Fear and contact.

MAS 654 Assault and Battery

Assault and battery are intentional torts. Assault is intentionally making a person reasonably fear harmful or offensive contact; battery is actually making harmful or offensive contact without consent. Touching a patient for a procedure they have refused can be battery, however well meant the touch is.

Private and true.

MAS 655 Breach of Confidentiality and Defamation

Breaching a patient's privacy, and defaming someone, are also intentional torts. Confidentiality is a person's right to have identifiable health information kept private; defamation means false, damaging statements, called slander when spoken and libel when written. Gossip about a patient or a coworker can become a legal problem as well as an ethical one.

Deception for gain.

MAS 656 Fraud

Fraud is deceiving someone for personal gain, and it is an intentional tort. In a medical office, fraud can include billing for services that were not provided or misusing a patient's money or information. Code and bill only what was documented and done, as unit twenty-six taught.

Reasonable care.

MAS 657 Negligence and Malpractice

Negligence is failing to act as a reasonable person with the same training would, and malpractice is professional negligence. It can come from doing something a reasonable professional would not do, or failing to do something they would. Following training, policy and orders, and documenting accurately, is the best protection.

Duty, breach, cause, harm.

MAS 658 The Four Elements of Malpractice

Proving malpractice takes four elements. Duty: a professional relationship created a duty of reasonable care. Breach: the standard of care was not met, and harm was foreseeable. Cause: the breach caused the injury. Harm: the injury resulted in damages. If any element is missing, the claim fails. The record is often the main evidence in a dispute, so accurate, timely documentation of what you did and why is what shows the standard was met. A court cannot assume care that was never recorded.

Four entries on consent: informed consent, implied consent, capacity, and the right to refuse.

The provider explains.

MAS 659 Informed Consent

Informed consent is the patient's right to accept or refuse care after receiving information about it. For medical procedures, the provider explains the risks, benefits and alternatives and obtains the patient's consent; that explanation is not the medical assistant's to give. If a patient seems unsure or asks questions about risks, bring the provider back before proceeding.

Understood from actions.

MAS 660 Implied Consent

Implied consent is permission that is not stated outright but is reasonably understood from the patient's actions and the situation. A patient who arrives for a scheduled vaccine and rolls up a sleeve is generally treated as consenting; in an emergency, an unconscious patient is presumed to consent to life-saving care. Implied consent covers routine care; significant procedures need express, informed consent.

One decision, one moment.

MAS 661 Capacity to Decide

Capacity means a person can make a particular medical decision in a particular situation; competence is a legal status decided by a judge. Signs that a patient may lack capacity include being unable to state a decision, blanket acceptance or refusal of care, hallucinations or intoxication. Judging capacity is outside your role; report your concerns to the provider.

Even recommended care.

MAS 662 The Right to Refuse

A patient with capacity has the right to refuse care, even care the provider recommends. When a patient refuses, stop, notify the provider, and document the refusal and the patient's stated reasons. Never pressure, trick or threaten a patient into agreeing; that undermines consent and can itself cause harm.

Three entries on advance directives: what they are, living wills and proxies, and DNR orders and POLST forms.

Wishes in advance.

MAS 663 Advance Directives

An advance directive is a legal document stating a person's wishes about medical care if they become unable to decide for themselves. It can also name someone to make decisions for them; forms and rules vary by state. Ask whether the patient has an advance directive, and make sure a copy is in the record if the practice keeps one.

Treatments and a proxy.

MAS 664 Living Wills and Health Care Proxies

Two common advance directives are the living will and the durable power of attorney for health care. A living will states which treatments a person would or would not want; a durable power of attorney for health care names a proxy who decides when the person cannot. A person can have both, and the proxy should have a copy.

Specific end-of-life choices.

MAS 665 DNR Orders, POLST and Donation Wishes

Some medical orders and documents record specific end-of-life wishes. A do-not-resuscitate order says CPR should not be attempted; a POLST form records specific choices, usually for people who are seriously ill; people may also document wishes about organ and tissue donation. Follow the documents the practice has on file, and alert the provider if wishes seem to have changed.

Nine entries on ethics and duty: principles, mandatory reporting, violations, Good Samaritan laws, ending care, and two constructed cases.

Naming what feels wrong.

MAS 666 Core Ethical Principles

Several principles guide health care decisions, and naming them helps explain what feels wrong. Autonomy respects a person's own choices, as an advance directive does. Beneficence acts for others' good, from compassion. Nonmaleficence avoids harm. Justice treats people fairly. Fidelity keeps promises, such as returning when you said you would. Veracity tells the truth, including uncomfortable truths about care. Principles can conflict, as when a patient's choice seems to risk harm to them. The provider and leadership work through those conflicts; your part is to raise the concern openly, not act on it quietly.

Required by law.

MAS 667 Mandatory Reporting

Health workers are legally required to report certain situations, and requirements vary by state. Commonly required reports include suspected abuse of children, older adults and other vulnerable people, some communicable diseases, and unsafe or illegal practice by team members. Report through the practice's process and the provider; the requirement covers suspected abuse, so you do not wait for certainty.

Coworkers.

MAS 668 Recognizing and Responding to Violations

When you see a coworker breaking the law or the practice's ethical standards, you have a responsibility to act. Examples include billing for services not provided, looking up records without a work reason, or performing tasks outside scope; report them through the practice's chain of command or compliance process. Staying silent can make you part of the problem.

Help outside work.

MAS 669 Good Samaritan Laws

Good Samaritan laws protect people who give reasonable emergency help outside their jobs. These laws are mostly set by states, and some states also have a duty to assist, requiring reasonable help at an emergency when it can be given safely. Know your own state's law, and never go beyond your training.

Not abandonment.

MAS 670 Ending a Patient Relationship

A provider may end a relationship with a patient, for reasons such as repeated noncompliance, threats to staff or a breakdown in the relationship. Ending care at an unreasonable time, without giving the patient a chance to find another provider, can be abandonment. The decision belongs to the provider; your role is the documentation and the steps that follow.

Notice, coverage, records.

MAS 671 Terminating Care Properly

Terminating care follows a written process, governed by state rules and the practice's policy. Common elements include a written notice, continued emergency care and medications for a period, often thirty days as a guideline, and an offer to transfer records with the patient's authorization. Some states set specific requirements, such as certified mail; follow your state's rules exactly.

Contacts and refusals.

MAS 672 Documentation Protects Against Abandonment Claims

Documenting missed appointments and refusals helps show that the practice tried to continue care. When a patient misses visits or declines follow-up, a dated note of each contact and the patient's response records the patient's choices. Undocumented contacts did not happen as far as the record is concerned.

A sleeve rolled down.

MAS 673 A Refused Injection

A constructed case pays off the opening idea. A vaccine is ordered and prepared, and as the assistant explains she is about to give it, the patient pulls her arm back; she has read something online and wants to think. She seemed agreeable, and the order stands, but the assistant stops at once. Her earlier rolled sleeve no longer counts, and injecting after a clear refusal could be battery. She does not argue or persuade; she says she will let the provider know. The provider talks with the patient, who decides to wait. The assistant documents the refusal, the reason and the discussion, and disposes of the dose by procedure. An honest talk with the provider answers a worry better than pressure from the person holding the syringe.

A proxy and a question.

MAS 674 A Question About an Advance Directive

A second constructed case supports advance care planning. Asked about an advance directive, an older patient says his daughter is his proxy but he is unsure about a living will, and asks what he should put in one. The assistant offers no opinion about treatments. She explains what a living will and a durable power of attorney for health care each do, says the provider can talk with him about his wishes, and mentions that forms vary by state. She records the proxy's name, asks him to bring a copy, and tells the provider about his questions. Next visit, she scans the form into his record. A proxy form in a drawer at home cannot guide anyone in an emergency.

Look at what you can now do. You can tell law from ethics, and explain scope as a legal limit, torts, negligence and the four elements of malpractice. You can apply informed and implied consent, report concerns about capacity, and stop when a patient refuses. You can explain living wills, proxies, DNR orders and POLST forms, and make sure they reach the record. And you can name the ethical principles, report what the law requires, and support ending care properly. Unit Twenty-Eight turns to privacy and the medical record.