Certified Lactation Specialist Lactation Specialist Ethical & Legal Aspects of Lactation Support 3 — Questions and Answers
Question 1: Under HIPAA, which of the following constitutes a permissible disclosure of protected health information (PHI) without written patient authorization?
- Sharing records with a client's employer upon request
- Disclosing information to another treating provider for care coordination (Correct answer)
- Releasing information to a client's adult sibling who asks about the visit
- Posting anonymized case details on social media for educational purposes
Correct answer: Disclosing information to another treating provider for care coordination
HIPAA permits disclosure of PHI to other healthcare providers involved in the patient's treatment without separate authorization.
Question 2: The WHO International Code of Marketing of Breast-milk Substitutes (1981) primarily restricts:
- Governments from subsidizing formula for low-income families
- Commercial promotion of breast-milk substitutes to the public and healthcare system (Correct answer)
- Healthcare providers from discussing formula with clients
- Insurance companies from covering formula costs
Correct answer: Commercial promotion of breast-milk substitutes to the public and healthcare system
The WHO Code restricts marketing of breast-milk substitutes, bottles, and teats directly to the public and through the healthcare system.
Question 3: A lactation specialist suspects a client is experiencing intimate partner violence. What is the most appropriate action?
- Immediately notify law enforcement without consulting the client
- Assess the situation, provide resources, and follow mandatory reporting laws applicable to the jurisdiction (Correct answer)
- Avoid the subject to respect the client's privacy
- Refer the client to another provider and close the case
Correct answer: Assess the situation, provide resources, and follow mandatory reporting laws applicable to the jurisdiction
Lactation specialists should assess safety, offer resources, and comply with applicable mandatory reporting requirements while maintaining a supportive relationship.
Question 4: Informed consent in lactation care requires that the client:
- Signs a form before any information is provided
- Receives information about risks, benefits, and alternatives before agreeing to a recommended intervention (Correct answer)
- Agrees with the lactation specialist's recommendation
- Consents only when invasive procedures such as frenotomy are planned
Correct answer: Receives information about risks, benefits, and alternatives before agreeing to a recommended intervention
Informed consent is an ongoing process requiring disclosure of relevant information so the client can make a voluntary, knowledgeable decision.
Question 5: A lactation specialist working in a hospital is asked by a nurse to share a client's breastfeeding records with a researcher studying postpartum outcomes. The specialist should:
- Share the records immediately as research benefits the public
- Verify that the client has signed a separate authorization or that an IRB waiver is in place before sharing (Correct answer)
- Refuse all research requests to protect confidentiality
- Share de-identified records without any additional approval
Correct answer: Verify that the client has signed a separate authorization or that an IRB waiver is in place before sharing
Research use of PHI typically requires patient authorization or an IRB-approved waiver of authorization under HIPAA's research provisions.
Question 6: When a lactation specialist disagrees with a physician's infant feeding recommendation, the most ethical course of action is to:
- Override the physician's advice and counsel the client directly
- Document the disagreement and remain silent to avoid conflict
- Communicate the concern through appropriate professional channels while supporting the client's informed decision-making (Correct answer)
- Instruct the client to find a new physician
Correct answer: Communicate the concern through appropriate professional channels while supporting the client's informed decision-making
Ethical practice requires raising clinical concerns professionally while ensuring clients can make informed choices based on complete information.
Question 7: The legal concept of 'duty of care' in lactation practice means the specialist must:
- Guarantee successful breastfeeding outcomes for all clients
- Provide competent services consistent with accepted professional standards (Correct answer)
- Accept all clients regardless of their needs or the specialist's competency
- Report all cases to public health authorities
Correct answer: Provide competent services consistent with accepted professional standards
Duty of care obligates practitioners to deliver services at the standard a reasonably competent professional in the same field would provide.
Certified Lactation Specialist Lactation Specialist Ethical & Legal Aspects of Lactation Support 3
Under HIPAA, which of the following constitutes a permissible disclosure of protected health information (PHI) without written patient authorization?