TBI TBI Legal & Ethical Considerations 2 — Questions and Answers
Question 1: Which legal standard is used to determine whether a TBI patient should receive life-sustaining treatment when preferences are unknown?
- Reasonable physician standard
- Substituted judgment (what the patient would have wanted) or best interests standard (Correct answer)
- Family majority vote
- Institutional ethics committee vote only
Correct answer: Substituted judgment (what the patient would have wanted) or best interests standard
Surrogate decision-makers first apply substituted judgment (known values and wishes), and if unknown, fall back on the best interests standard.
Question 2: Under the ADA, an employer is NOT required to provide a reasonable accommodation for a TBI employee in which circumstance?
- When the accommodation costs more than $500
- When the accommodation creates an undue hardship (excessive cost or operational disruption) for the employer (Correct answer)
- When the employee has been with the company less than one year
- When the TBI occurred outside of work
Correct answer: When the accommodation creates an undue hardship (excessive cost or operational disruption) for the employer
The ADA's 'undue hardship' provision allows employers to decline accommodations that impose significant difficulty or expense, based on factors like employer size and financial resources.
Question 3: What is 'malingering' in TBI legal evaluations, and which neuropsychological tools help detect it?
- Genuine memory impairment; detected by brain imaging
- Deliberate exaggeration of symptoms for secondary gain; detected by symptom validity tests (SVTs) and performance validity tests (PVTs) (Correct answer)
- Post-traumatic amnesia; detected by the Westmead scale
- Chronic pain; detected by pain inventories
Correct answer: Deliberate exaggeration of symptoms for secondary gain; detected by symptom validity tests (SVTs) and performance validity tests (PVTs)
Malingering involves intentional symptom fabrication for financial or legal gain; SVTs and PVTs are embedded in neuropsychological batteries to detect invalid performance.
Question 4: Workers' compensation claims for TBI require documentation of which essential element?
- Pre-existing mental health history
- A causal connection between the workplace incident and the brain injury (Correct answer)
- Employer's prior negligence
- The employee's wage history only
Correct answer: A causal connection between the workplace incident and the brain injury
Workers' compensation requires establishing that the TBI arose out of and in the course of employment — the work-relatedness nexus.
Question 5: The concept of 'eggshell skull' rule in TBI tort law means which of the following?
- Helmets must be worn at all times
- A defendant is liable for full harm even if the plaintiff's pre-existing vulnerability made the TBI worse than expected (Correct answer)
- Only severe TBI cases qualify for legal action
- Thin skulls are a complete defense for defendants
Correct answer: A defendant is liable for full harm even if the plaintiff's pre-existing vulnerability made the TBI worse than expected
The eggshell skull rule holds defendants liable for all consequences of their negligent act, even if the victim had unusual pre-existing fragility that amplified the harm.
Question 6: Guardianship for a TBI patient is a legal process that differs from healthcare proxy in which important way?
- Guardianship only applies to financial decisions
- Guardianship involves court appointment and oversight, removing broader legal rights; healthcare proxy is limited to medical decisions only (Correct answer)
- They are identical legal instruments
- Healthcare proxy requires court approval, guardianship does not
Correct answer: Guardianship involves court appointment and oversight, removing broader legal rights; healthcare proxy is limited to medical decisions only
Full guardianship is a more sweeping court-supervised process that can restrict many civil rights, while a healthcare proxy is a narrower, less restrictive advance directive.
TBI TBI Legal & Ethical Considerations 2
Which legal standard is used to determine whether a TBI patient should receive life-sustaining treatment when preferences are unknown?