ACC Ethical and Legal Considerations 3 — Questions and Answers
Question 1: A POLST (Physician Orders for Life-Sustaining Treatment) form is different from a living will because it:
- Is written by the patient alone without physician involvement
- Is a physician's medical order that is immediately actionable by emergency responders (Correct answer)
- Only applies to patients in hospice care
- Requires court approval before it can be followed
Correct answer: Is a physician's medical order that is immediately actionable by emergency responders
A POLST is a medical order signed by a physician that emergency and healthcare providers can act on immediately, unlike a living will which is a directive.
Question 2: An Alzheimer's patient wanders out of the facility at night. Which type of legal liability may the facility face?
- Breach of fiduciary duty
- Negligence for failure to provide adequate supervision (Correct answer)
- False imprisonment
- Intentional infliction of emotional distress
Correct answer: Negligence for failure to provide adequate supervision
Facilities have a duty of care to provide adequate supervision; a preventable elopement resulting in harm can constitute negligence.
Question 3: What does the term 'guardianship' mean in the context of Alzheimer's care?
- A voluntary agreement between the patient and a trusted family member
- A court-appointed authority over a person who lacks legal capacity (Correct answer)
- A type of advance directive completed before diagnosis
- A caregiver's certification to manage medications
Correct answer: A court-appointed authority over a person who lacks legal capacity
Guardianship is a legal relationship established by a court that grants another person authority to make decisions for an incapacitated individual.
Question 4: HIPAA regulations require Alzheimer's caregivers to:
- Share all health information with anyone who requests it
- Protect the confidentiality of the patient's health information (Correct answer)
- Discuss patient cases openly in group settings for learning purposes
- Provide medical records to family members upon request without consent
Correct answer: Protect the confidentiality of the patient's health information
HIPAA mandates that protected health information be kept confidential and only shared with authorized individuals.
Question 5: A caregiver physically restrains an Alzheimer's patient to prevent them from falling, without a physician's order. This action may constitute:
- Appropriate fall prevention
- False imprisonment or unauthorized use of restraints (Correct answer)
- Standard dementia care practice
- Emergency protective intervention
Correct answer: False imprisonment or unauthorized use of restraints
Using physical restraints without a physician's order and proper justification can constitute false imprisonment and is considered a form of abuse.
Question 6: When balancing autonomy and safety for an Alzheimer's patient who wants to continue driving, what is the most ethically sound approach?
- Allow driving since it supports independence
- Immediately confiscate car keys regardless of driving ability
- Conduct a formal driving assessment and involve the physician in the decision (Correct answer)
- Let the family decide without professional input
Correct answer: Conduct a formal driving assessment and involve the physician in the decision
A formal driving evaluation by a qualified professional, in consultation with the physician, balances the patient's autonomy with public safety concerns.
Question 7: What is the primary purpose of an ethics committee in a healthcare facility caring for Alzheimer's patients?
- To discipline staff who make errors
- To provide guidance on complex ethical dilemmas in patient care (Correct answer)
- To approve or deny all care plans
- To manage legal disputes between families and facilities
Correct answer: To provide guidance on complex ethical dilemmas in patient care
Ethics committees offer consultation and guidance when care teams face difficult ethical decisions, such as end-of-life care or treatment conflicts.
ACC Ethical and Legal Considerations 3
A POLST (Physician Orders for Life-Sustaining Treatment) form is different from a living will because it: