Chapter 11: Consent for Treatment and Withholding Consent

Question 1

According to Justice Cardozo in Schloendorff v. Society of New York Hospital, what is the legal basis for informed consent?
Options:
A) The doctor-patient relationship
B) Every human being of adult years and sound mind has a right to determine what shall be done with his own body
C) The hospital’s duty to protect patients
D) The physician’s oath to do no harm

Answer 1

B) Every human being of adult years and sound mind has a right to determine what shall be done with his own body.

Question 2

What is the legal standard for informed consent according to Cobbs v. Grant?
Options:
A) A patient must be given all information relevant to a meaningful decisional process
B) The physician must disclose what other physicians typically disclose
C) The patient must sign a detailed form listing all possible complications
D) The hospital must provide written materials about all procedures

Answer 2

A) A patient must be given all information relevant to a meaningful decisional process.

Question 3

Which of the following is NOT required for valid informed consent?
Options:
A) Information about the diagnosis or suspected diagnosis
B) Description of proposed treatment and alternatives
C) The consent form must be witnessed by at least two healthcare professionals
D) Explanation of risks and benefits of treatment

Answer 3

C) The consent form must be witnessed by at least two healthcare professionals.

Question 4

In a medical emergency, which of the following statements about consent is MOST accurate?
Options:
A) Written consent is always required
B) Consent is presumed if the patient is unconscious and delay would risk death or serious harm
C) Only a family member can provide consent
D) A court order is required before treatment

Answer 4

B) Consent is presumed if the patient is unconscious and delay would risk death or serious harm.

Question 5

The case of Truman v. Thomas established which principle?
Options:
A) Physicians must inform patients of the risks of refusing recommended care
B) Patients can refuse treatment even if it results in death
C) Hospital consent forms must be written in simple language
D) Physicians can override a patient’s refusal in emergencies

Answer 5

A) Physicians must inform patients of the risks of refusing recommended care.

Question 6

In the “reasonable doctor” standard for informed consent, the physician must disclose:
Options:
A) Everything known about the procedure
B) Only what the patient specifically asks about
C) Risks that a reasonable doctor would disclose under the circumstances
D) Only those risks that occur in more than 5% of cases

Answer 6

C) Risks that a reasonable doctor would disclose under the circumstances.

Question 7

In the “reasonable patient” standard for informed consent, the physician must disclose:
Options:
A) All possible risks no matter how remote
B) Facts and risks that would be material to a reasonable patient’s decision
C) Only what other physicians typically disclose
D) Only information that would not cause the patient anxiety

Answer 7

B) Facts and risks that would be material to a reasonable patient’s decision.

Question 8

Which of the following is NOT an element required for informed consent?
Options:
A) The diagnosis or suspected diagnosis
B) The risks and benefits of treatment
C) A statement that the physician guarantees a successful outcome
D) Alternatives to the proposed treatment

Answer 8

C) A statement that the physician guarantees a successful outcome.

Question 9

According to the text, who is responsible for obtaining informed consent for a surgical procedure?
Options:
A) The hospital admission staff
B) The physician who will perform the procedure
C) The nurse in the pre-operative area
D) A hospital administrator

Answer 9

B) The physician who will perform the procedure.

Question 10

Which US Supreme Court case established that a person has a constitutional right to refuse life-sustaining treatment?
Options:
A) Cruzan v. Director, Missouri Department of Health
B) Roe v. Wade
C) Griswold v. Connecticut
D) Buck v. Bell

Answer 10

A) Cruzan v. Director, Missouri Department of Health.

Question 11

The concept of “substituted judgment” in end-of-life decision making refers to:
Options:
A) The hospital ethics committee making decisions for unconscious patients
B) A guardian determining what the patient would want if able to decide
C) A judge substituting their judgment for that of the patient
D) A physician making decisions instead of asking the family

Answer 11

B) A guardian determining what the patient would want if able to decide.

Question 12

In the case of a mature minor seeking medical treatment:
Options:
A) Parental consent is always legally required
B) The minor can never consent to their own treatment
C) Courts in some states recognize that mature minors may consent to their own treatment
D) Only a court can authorize treatment

Answer 12

C) Courts in some states recognize that mature minors may consent to their own treatment.

Question 13

What is a “living will”?
Options:
A) A financial document distributing property after death
B) A document expressing a person’s wishes regarding life-sustaining treatment in case of terminal illness
C) A power of attorney for financial decisions
D) A document protecting physicians from liability

Answer 13

B) A document expressing a person’s wishes regarding life-sustaining treatment in case of terminal illness.

Question 14

Which of the following situations would legally justify treatment without consent?
Options:
A) A patient refuses treatment but the physician believes it’s in their best interest
B) The family wants treatment but the competent patient refuses
C) An emergency where delay would risk death or serious harm and the patient is unconscious
D) When treatment is simple and risk-free

Answer 14

C) An emergency where delay would risk death or serious harm and the patient is unconscious.

Question 15

The Patient Self-Determination Act of 1991 requires healthcare facilities to:
Options:
A) Force all patients to complete advance directives
B) Make all treatment decisions for incompetent patients
C) Inform patients of their right to make medical decisions and document any advance directives
D) Seek court approval for all end-of-life decisions

Answer 15

C) Inform patients of their right to make medical decisions and document any advance directives.

Question 16

A durable power of attorney for healthcare differs from a traditional power of attorney because it:
Options:
A) Remains effective even when the patient becomes incapacitated
B) Only applies to financial decisions
C) Expires after one year
D) Can only be held by a family member

Answer 16

A) Remains effective even when the patient becomes incapacitated.

Question 17

In the case of an incompetent, previously competent adult with no advance directive, courts generally look to:
Options:
A) The patient’s past statements about end-of-life care
B) What the physician thinks is best
C) What most patients would want
D) What the hospital ethics committee recommends

Answer 17

A) The patient’s past statements about end-of-life care.

Question 18

What is the primary purpose of a POLST (Physician Orders for Life-Sustaining Treatment) form?
Options:
A) To serve as an advance directive for all adults
B) To provide specific medical orders for seriously ill or frail individuals near the end of life
C) To replace a living will for healthy adults
D) To give physicians complete control over end-of-life decisions

Answer 18

B) To provide specific medical orders for seriously ill or frail individuals near the end of life.

Question 19

In the Quinlan case, the New Jersey Supreme Court based its decision primarily on:
Options:
A) Federal law
B) Religious doctrine
C) The patient’s constitutional right to privacy
D) The physician’s right to practice medicine

Answer 19

C) The patient’s constitutional right to privacy.

Question 20

What legal issue was central to the Bush v. Schiavo case?
Options:
A) Whether hospitals can refuse to treat uninsured patients
B) Whether the Florida legislature’s law giving the governor power to override court decisions violated separation of powers
C) Whether physicians can be forced to provide care they believe is futile
D) Whether medical malpractice had occurred

Answer 20

B) Whether the Florida legislature’s law giving the governor power to override court decisions violated separation of powers.

Question 21

What does the term “persistent vegetative state” (PVS) refer to?
Options:
A) A temporary condition that eventually resolves
B) A condition where the patient is conscious but paralyzed
C) A permanent condition where the patient appears awake but has no detectable awareness
D) A condition that requires only short-term treatment

Answer 21

C) A permanent condition where the patient appears awake but has no detectable awareness.

Question 22

In the Supreme Court’s Cruzan decision, what standard of evidence did the Court allow Missouri to require for decisions to withdraw treatment?
Options:
A) Beyond a reasonable doubt
B) Preponderance of evidence
C) Clear and convincing evidence
D) Substantial evidence

Answer 22

C) Clear and convincing evidence.

Question 23

What does the term “brain death” legally mean?
Options:
A) When a patient is in a coma
B) The complete cessation of all functions of the entire brain, including the brain stem
C) When a patient cannot speak or communicate
D) Any condition requiring life support

Answer 23

B) The complete cessation of all functions of the entire brain, including the brain stem.

Question 24

Which of the following statements about parental consent for treatment of minors is MOST accurate?
Options:
A) Parents can always refuse treatment for their children for any reason
B) Courts may override parental refusal if necessary to protect the child’s life or health
C) Only the mother’s consent is legally required
D) Religious objections always trump medical necessity

Answer 24

B) Courts may override parental refusal if necessary to protect the child’s life or health.

Question 25

In the case of Superintendent of Belchertown State School v. Saikewicz, what was the court addressing? Options: A) Whether a public school could require vaccinations B) Whether treatment could be withheld from an incompetent adult who had never been competent C) Whether minors could consent to contraception D) Whether hospitals were required to provide emergency care

Answer 25

B) Whether treatment could be withheld from an incompetent adult who had never been competent.

Question 26

What is a "conscience clause" in the context of abortion and sterilization? Options: A) A provision requiring physicians to follow their conscience in all cases B) A statutory provision permitting hospitals and physicians to refuse to perform these procedures on moral or religious grounds C) A requirement that patients consider moral implications D) A statement required in all consent forms

Answer 26

B) A statutory provision permitting hospitals and physicians to refuse to perform these procedures on moral or religious grounds.

Question 27

What is the legal status of extending surgery beyond the scope of consent if an unexpected condition is found? Options: A) Always permitted if medically necessary B) Never permitted under any circumstances C) Permitted only in a true emergency; otherwise, a second procedure is required D) Permitted only for minor additional procedures

Answer 27

C) Permitted only in a true emergency; otherwise, a second procedure is required.

Question 28

Which of the following is the most accurate statement about general consent forms? Options: A) They typically cover all procedures a patient might undergo B) They are usually signed during the registration process and cover routine care and nursing services C) They eliminate the need for specific surgical consent D) They are not legally required

Answer 28

B) They are usually signed during the registration process and cover routine care and nursing services.

Question 29

What is "therapeutic privilege" in informed consent? Options: A) The right of physicians to charge more for certain treatments B) The rarely applied concept that information may be withheld if disclosure would be harmful to the patient C) The requirement that therapists obtain special consent D) The obligation to provide therapeutic alternatives

Answer 29

B) The rarely applied concept that information may be withheld if disclosure would be harmful to the patient.

Question 30

In cases where parents refuse life-saving treatment for their child based on religious beliefs: Options: A) Courts always uphold parental rights B) Courts generally override parental refusal to protect the child's life C) Only federal courts can intervene D) Physicians must always respect the parents' wishes

Answer 30

B) Courts generally override parental refusal to protect the child's life.

Question 31

According to the text, which statement is most accurate regarding informed consent for innovative therapy? Options: A) No special consent is required because all therapy involves innovation B) Informed consent is especially important and requires specially drafted forms C) Only verbal consent is needed D) Only institutional review board approval is needed

Answer 31

B) Informed consent is especially important and requires specially drafted forms.

Question 32

What distinguishes innovative therapy from clinical research? Options: A) Innovative therapy is designed to benefit the individual patient, while research tests hypotheses to develop new knowledge B) Innovative therapy requires FDA approval, while research does not C) Innovative therapy is always experimental, while research uses established methods D) There is no meaningful distinction between them

Answer 32

A) Innovative therapy is designed to benefit the individual patient, while research tests hypotheses to develop new knowledge.

Question 33

Under what circumstances might a spouse's consent be required for a competent adult's medical treatment? Options: A) For any major surgery B) For end-of-life decisions C) For procedures affecting reproductive capacity like artificial insemination D) For emergency care

Answer 33

C) For procedures affecting reproductive capacity like artificial insemination.

Question 34

What is implied consent in healthcare? Options: A) Consent that is assumed because the patient came to the hospital B) Consent manifested by the patient's actions rather than explicit words C) Consent given by family members D) Consent assumed for all routine procedures

Answer 34

B) Consent manifested by the patient's actions rather than explicit words.

Question 35

In end-of-life decision making, what does the "best interests" standard refer to? Options: A) What the hospital determines is financially best B) What the physician believes is medically indicated C) An objective assessment of what would be best for the patient when their wishes are unknown D) What the family wants for the patient

Answer 35

C) An objective assessment of what would be best for the patient when their wishes are unknown.

Question 36

Which case established that patients must be informed of the risks of treatment before consenting? Options: A) Roe v. Wade B) Canterbury v. Spence C) Buck v. Bell D) Griswold v. Connecticut

Answer 36

B) Canterbury v. Spence.

Question 37

What is the status of death with dignity laws (physician aid in dying) as of the textbook's publication? Options: A) Legal in all 50 states B) Illegal in all states C) Legal in several states including Oregon, Washington, and California D) Only permitted in hospitals

Answer 37

C) Legal in several states including Oregon, Washington, and California.

Question 38

In Baxter v. State, what did the Montana Supreme Court decide about physician aid in dying? Options: A) It is unconstitutional under all circumstances B) A terminally ill patient's consent to physician aid in dying constitutes a statutory defense to homicide charges C) It requires a constitutional amendment to be permitted D) Only family members can make such decisions

Answer 38

B) A terminally ill patient's consent to physician aid in dying constitutes a statutory defense to homicide charges.

Question 39

Apply the IRAC method to analyze a case where a surgeon performed a mastectomy without explaining alternatives or obtaining proper informed consent.

Answer 39

Issue: Whether performing surgery without proper informed consent constitutes a legal violation * Rule: Patients have a right to receive information about diagnosis, proposed treatment, risks/benefits, alternatives, and consequences of refusal * Analysis: Surgeon failed to explain alternatives or adequately inform patient; patient unable to make informed decision; performing procedure without informed consent violates patient autonomy * Conclusion: Surgeon likely liable for battery or negligence based on failure to obtain proper informed consent

Question 40

Explain the key differences between express consent and implied consent in medical treatment.

Answer 40

* Express consent: Given through specific words (written or verbal) * Implied consent: Shown through actions indicating agreement * Both require patient competence and understanding * Express consent typically documented on forms for procedures * Implied consent often applies in emergency situations * Express consent preferred for legal documentation * Implied consent may be inferred from patient's cooperation * Both must be based on adequate information about the treatment

Question 41

Compare and contrast the "reasonable doctor" standard and the "reasonable patient" standard for informed consent.

Answer 41

* Reasonable doctor standard: Based on what physicians customarily disclose * Reasonable patient standard: Based on what would be material to patient's decision * Doctor standard focuses on medical community practices * Patient standard focuses on patient's right to know * Doctor standard requires expert testimony to establish breach * Patient standard allows lay testimony about materiality of information * Most jurisdictions now favor patient standard * Patient standard emerged from Canterbury v. Spence and Cobbs v. Grant * Reflects shift toward patient autonomy in healthcare decisions

Question 42

Describe the legal and ethical issues surrounding decisions to withdraw artificial nutrition and hydration from patients in persistent vegetative states.

Answer 42

* Legal recognition that artificial nutrition is medical treatment that can be refused * Courts generally permit withdrawal when clear evidence of patient's wishes exists * Substituted judgment standard applied when patient's wishes known * Best interests standard may apply when wishes unknown * Ethical tension between sanctity of life and quality of life considerations * Religious and cultural viewpoints often conflict on this issue * Requires careful procedural protections to prevent abuse * Family disagreements often lead to litigation (Schiavo case) * Advance directives can help prevent such conflicts * Courts generally defer to family decisions absent clear contrary evidence

Question 43

Explain the role of advance directives in healthcare decision-making and their legal limitations.

Answer 43

* Document patient wishes while competent for future incapacity * Types include living wills and durable powers of attorney for healthcare * Legally recognized in all states but with varying requirements * Limitations: May be too vague for specific situations * May not address unforeseen medical developments * May be unavailable in emergencies * May not be followed if unknown to providers * May be interpreted differently by different providers * PSDA requires facilities to inform patients of rights and document directives * POLST forms complement advance directives for seriously ill patients

Question 44

Discuss the legal standards for parental refusal of life-saving treatment for minor children.

Answer 44

* Parents generally have authority to make medical decisions for children * Authority limited when decisions threaten child's life or health * Courts can override parental refusal to protect child's welfare * Religious objections generally not sufficient to refuse life-saving treatment * State's parens patriae power supports intervention for child protection * Emergency exception permits treatment without consent when necessary * Courts balance parental rights against state's interest in protecting children * Threshold higher for non-life-threatening conditions * Child's increasing maturity may factor into decisions * Best interests of the child remains paramount consideration

Question 45

Analyze the concept of the "substituted judgment" doctrine and its application in cases involving never-competent patients.

Answer 45

* Attempts to determine what the patient would want if able to decide * Based on patient's previously expressed values and preferences * Works best for previously competent patients with known values * Problematic for never-competent patients (Saikewicz case) * For never-competent patients: More fiction than reality * Courts recognize limitations but still attempt to apply * Often blends with best interests standard in practice * Requires evidence of patient's values from multiple sources * Guardian must set aside personal preferences * Goal is to preserve patient autonomy to extent possible

Question 46

Explain the legal concept of brain death and how it relates to decisions about withdrawing life support.

Answer 46

* Legal definition: Complete cessation of all brain functions including brain stem * Legally recognized as death in all states * Differs from persistent vegetative state (PVS) * No legal or ethical duty to treat a dead body * Once declared, life support may be withdrawn without consent * Requires specific medical tests and often multiple physician confirmation * Uniform Determination of Death Act provides standard definition * Cultural and religious perspectives may conflict with legal definition * Time of death determined by brain death declaration, not cessation of cardiac function * Physicians have legal authority to declare death based on established criteria

Question 47

Describe the evolution of "right-to-die" jurisprudence from Quinlan to Cruzan to more recent cases.

Answer 47

* Quinlan (1976): Established right to privacy includes refusing treatment * Introduced substituted judgment doctrine and ethics committee role * Saikewicz (1977): Applied substituted judgment to never-competent patients * Various state cases developed procedures for withdrawal decisions * Cruzan (1990): First US Supreme Court case; recognized liberty interest in refusing treatment * Allowed states to require "clear and convincing evidence" standard * Schiavo (2005): Highlighted conflict between judicial and legislative/executive branches * Court upheld separation of powers against legislative intervention * Recent focus on advance directives and POLST to avoid conflicts * Aid-in-dying laws in several states represent latest development

Question 48

Discuss the legal and ethical principles involved in the mature minor doctrine.

Answer 48

* Recognizes some minors have sufficient maturity to make healthcare decisions * Factors: age, maturity, understanding of risks/benefits, nature of treatment * Generally applied case-by-case rather than fixed age threshold * Balances parental authority against minor's developing autonomy * Often applied in reproductive health and mental health contexts * Most effective when parents and minor disagree but minor shows good judgment * Tennessee case articulated factors for determining maturity * Varies significantly by state law and jurisdiction * Providers should document assessment of minor's maturity * Represents evolution away from strict age-based decision-making

Question 49

Explain the legal requirements for hospitals regarding consent for clinical research versus innovative therapy.

Answer 49

* Clinical research: Must follow federal regulations for human subjects * Requires IRB approval and specific detailed consent forms * Must distinguish research goals from patient treatment * Innovative therapy: Not primarily research but non-standard treatment * Requires thorough informed consent about uncertain risks/benefits * Hospital must ensure proper documentation of non-standard approach * Research requires additional protections beyond standard consent * Both require disclosure that approach is not standard practice * Hospital policies must distinguish between research and innovation * Both require documentation of patient's understanding of uncertainties

Question 50

Analyze the key legal issues in the Cruzan case and its significance for end-of-life decision making.

Answer 50

* First US Supreme Court case on right to refuse life-sustaining treatment * Recognized liberty interest in refusing unwanted medical treatment * Allowed states to require "clear and convincing evidence" of patient wishes * Found no constitutional violation in Missouri's evidentiary standard * Avoided creating absolute right to refuse treatment for incompetent patients * Balanced individual liberty against state interest in preserving life * Distinguished between competent refusal and surrogate decision-making * Established framework for subsequent end-of-life cases * Led to increased emphasis on advance directives * Recognized state interests can sometimes outweigh individual preferences

Question 51

Express consent

Answer 51

Consent given in words (spoken or written) by a patient or surrogate to authorize medical treatment. To be valid, the person giving consent must be legally competent and possess reasonable knowledge and understanding about the proposed treatment.

Question 52

Implied consent

Answer 52

Consent that is manifested by the patient's actions rather than words. Like express consent, it requires the patient to be legally competent and possess knowledge about the treatment. Often applies in emergency situations when a patient cannot expressly consent.

Question 53

General consent form

Answer 53

A form signed during patient registration that grants the hospital permission to provide routine care and nursing services (e.g., taking vital signs, medical history). Documents that the patient understands the nature of basic care and that various healthcare workers will be involved in treatment.

Question 54

Special consent form

Answer 54

Form signed by a patient/surrogate when surgery or special diagnostic procedures are indicated. Must be obtained after the physician has explained necessary information and answered questions in a language the individual understands. Should name the physician, list procedures in lay terms, and state the patient understands the risks.

Question 55

Schloendorff v. Society of New York Hospital (1914)

Answer 55

Landmark case where Justice Cardozo stated: "Every human being of adult years and sound mind has a right to determine what shall be done with his own body." Established that unauthorized treatment may constitute battery, except in emergencies when the patient is unconscious and treatment is necessary before consent can be obtained.

Question 56

Rogers v. Lumbermens Mutual Casualty Company

Answer 56

Case where a patient signed a consent form but thought she was consenting to an appendectomy when the doctor actually performed a hysterectomy. Court ruled the consent was invalid because the patient didn't understand what she was consenting to, even though the surgery was medically advisable and skillfully performed.

Question 57

Reasonable-doctor rule

Answer 57

A standard for informed consent requiring the physician to disclose all risks that a reasonable doctor would disclose under the circumstances. This is highly favorable to physicians but has been largely replaced by the reasonable-patient rule in most jurisdictions.

Question 58

Reasonable-patient rule (right-to-know rule)

Answer 58

Standard for informed consent that focuses on what information a reasonable patient would want to know to make an informed decision, rather than what other doctors typically disclose. Eliminates the need for expert testimony on what other physicians do, turning instead on lay testimony.

Question 59

Cobbs v. Grant (1972)

Answer 59

Landmark California case establishing that informed consent is not governed by standard practice in the medical community but is a duty imposed by law. Established the reasonable-patient standard: "What would a prudent person in the patient's position have decided if adequately informed of all significant perils?"

Question 60

Informed refusal

Answer 60

Extension of informed consent doctrine requiring physicians to inform patients of the risks of refusing recommended treatment. Established in Truman v. Thomas where a physician was liable for failing to explain the risks of refusing a Pap test to a patient who later died of cervical cancer.

Question 61

Therapeutic privilege

Answer 61

Rarely accepted doctrine allowing physicians to withhold information from patients for sound therapeutic reasons. Modern view strongly disfavors this paternalistic approach, and circumstances justifying withholding information are extremely rare.

Question 62

Innovative therapy vs. clinical research

Answer 62

Innovative therapy: Treatment designed to benefit the specific patient that is reasonably expected to be successful but not yet standard practice. Clinical research: Departure from standard practice intended to test a hypothesis or develop new knowledge, regardless of benefit to the individual patient. Both require specially drafted informed consent forms.

Question 63

Substituted judgment doctrine

Answer 63

Legal standard where a surrogate decision-maker attempts to establish what decision the patient would have made if competent. Different from deciding what the guardian thinks is best for the patient. Established in Quinlan and applied in Saikewicz.

Question 64

In re Quinlan (1976)

Answer 64

Landmark case involving 22-year-old Karen Ann Quinlan in PVS. The New Jersey Supreme Court allowed her father to be appointed guardian and disconnect her respirator based on her right of privacy. Established the substituted judgment doctrine and the practice of consulting ethics committees in such decisions.

Question 65

Superintendent of Belchertown State School v. Saikewicz

Answer 65

Case involving a 67-year-old with profound intellectual disability and leukemia. Court applied the substituted judgment doctrine despite the fact he was never competent to express his intentions. Ruled that chemotherapy could be withheld based on weighing factors for and against treatment from the patient's perspective.

Question 66

Cruzan v. Director, Missouri Department of Health (1990)

Answer 66

U.S. Supreme Court's first right-to-die case. Upheld Missouri's requirement for "clear and convincing evidence" of an incompetent person's wishes before withdrawing life support. Recognized a competent person's right to refuse treatment but allowed states to impose heightened evidentiary requirements to protect incompetent patients.

Question 67

Persistent vegetative state (PVS)

Answer 67

Condition where a patient is alive and appears awake but has no detectable awareness. A permanent organic brain syndrome resulting from prolonged anoxia characterized by absence of higher mental functions. The PVS patient responds only reflexively to external stimuli and cannot perform voluntary acts.

Question 68

Brain death

Answer 68

Complete cessation of all functions of the entire brain, including the brain stem. Most states have adopted brain death as the legal standard for diagnosing death, as opposed to the traditional definition based on cessation of respiration and circulation.

Question 69

Emancipated minor

Answer 69

A person under the age of majority who is legally recognized as independent from parental control. Typically includes minors who are married, on active military duty, or have received a court declaration of emancipation. Emancipated minors can consent to their own medical care.

Question 70

Mature minor doctrine

Answer 70

Common law doctrine allowing mature minors to consent to medical procedures on their own initiative without parental involvement. Considers factors like age, ability, education, maturity, and judgment of the minor, as well as the nature of the treatment and risks involved.

Question 71

Luka v. Lowrie

Answer 71

Case where a 15-year-old's foot was amputated in an emergency without parental consent. Court ruled the emergency justified proceeding without consent, noting that requiring physicians to wait for parental consent in emergencies "would result in the loss of many lives which might otherwise be saved."

Question 72

The Baby Doe case (1982)

Answer 72

Case involving an infant born with Down syndrome and a surgically correctable feeding condition. Parents refused consent for surgery and decided to withhold food and water. Court found parents had made a reasonable choice among acceptable medical alternatives. Case prompted national debate about treatment for disabled newborns.

Question 73

Advance directive

Answer 73

Legal document allowing individuals to express their wishes regarding medical treatment if they become unable to communicate. Includes living wills, which specify treatments to be provided or withheld, and healthcare powers of attorney, which designate someone to make decisions. Protected by state statutes and the federal Patient Self-Determination Act.

Question 74

Durable power of attorney (DPOA) for healthcare

Answer 74

Legal document allowing individuals to designate a proxy who will make healthcare decisions for them if they become incompetent. Unlike a regular power of attorney, it remains effective during incapacity. Proxy can consent to or refuse treatments applying the substituted judgment doctrine.

Question 75

Uniform Health-Care Decisions Act (UHCDA)

Answer 75

Model statute adopted by many states that affirms individuals' right to decline life-sustaining treatment, allows designation of healthcare agents, permits designated surrogates to make decisions, provides a model form for directives, requires providers to comply with patients' instructions, and outlines dispute resolution processes.

Question 76

Patient Self-Determination Act of 1991 (PSDA)

Answer 76

Federal law requiring facilities receiving federal funding to inform patients of their rights to make medical decisions, provide a summary of facility policies regarding advance directives, and document in medical records any advance directives patients have executed. Also requires staff education on these issues.

Question 77

POLST (Physician Orders for Life-Sustaining Treatment)

Answer 77

Medical order form that documents a patient's wishes regarding end-of-life care. Unlike advance directives for all adults, POLST forms are only for those with serious illness or advanced frailty. Serves as standing orders that emergency personnel can follow if the patient cannot communicate.

Question 78

Aid-in-dying laws (Death with Dignity)

Answer 78

State laws allowing terminally ill, mentally competent adult patients to request and receive prescription medication from physicians to hasten death. First passed in Oregon (1997), now in multiple states. Typically require two oral requests separated by 15 days, a written request, confirmation of terminal diagnosis by two physicians, and physician disclosure of alternatives.

Question 79

Baxter v. State (Montana, 2009)

Answer 79

Case where Montana Supreme Court ruled that physician aid in dying is not against public policy and that a terminally ill patient's consent constitutes a statutory defense to homicide charges against the physician. Concluded that when a patient self-administers prescribed medication, this doesn't violate public policy under Montana's Rights of the Terminally Ill Act.

Question 80

Bush v. Schiavo (2004)

Answer 80

Florida Supreme Court case declaring "Terri's Law" unconstitutional. The law had allowed Governor Jeb Bush to order reinsertion of Terri Schiavo's feeding tube after courts had permitted its removal. Court ruled the law violated separation of powers by allowing the executive branch to interfere with final judicial determinations.

Question 81

Corn v. French

Answer 81

Case where a doctor told a patient he had "no intentions of removing your breast" but then performed a mastectomy. The patient had signed a consent form but didn't know what "mastectomy" meant. Court held there was sufficient evidence of battery to proceed to trial, as the doctor misrepresented the proposed treatment.

Question 82

Bang v. Charles T. Miller Hospital

Answer 82

Case establishing that patients are entitled to know the inevitable consequences of surgery. Patient consented to a prostate procedure but wasn't told it would render him sterile. Court held the surgeon liable for lack of informed consent, ruling patients must be informed of certain consequences and alternative treatments.

Question 83

Natanson v. Kline

Answer 83

Case where a patient received radiation therapy after breast cancer surgery but wasn't informed of the risk of tissue damage. Court established the reasonable-doctor rule, stating physicians must make "reasonable disclosures" of hazards that other medical practitioners would make under similar circumstances.

Question 84

Mitchell v. Robinson

Answer 84

Case where a patient receiving electroshock and insulin therapy wasn't informed that 18-25% of patients suffer convulsions. When the patient experienced convulsions that fractured vertebrae, court ruled the jury should decide what constituted reasonable disclosure, even though there was no negligence in treatment.

Question 85

Uniform Determination of Death Act (UDDA)

Answer 85

Model statute adopted by most states defining death as either: (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem. Determination must be made according to accepted medical standards.