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women who for physical or psychological reasons should not carry a pregnancy. For these woman, pregnancy becomes a threat to their own health and subjects the fetus to great risk of permanent injury or death. Fertility technology itself becomes a risk when it increases the probability of multiple births. Most fertility specialists are conscientious in counseling their patients about the risks and limitations of fertility treatment, but these physicians are reticent to deny a woman treatment if she is willing to assume the risks of the treatment. The legal problems arise because a woman does not have an unfettered right to waive her injured baby’s cause of action against the physician. The informed consent to fertility treatment must be complete and specific. Just reciting the risks is insufficient. The consequences of risks such as multiple births must be described in detail. Telling a woman that her baby may be premature does not give her the necessary information that a frequent complication of severe prematurity is brain damage. Although it may be improper to deny women the right to risk their lives and the health of their potential offspring for the sake of becoming pregnant, they must be told exactly what risks they are assuming. a) Medical Fitness The first question that should be asked is whether the woman is medically fit to carry a pregnancy. There are many protective mechanisms within the body that reduce fertility if the woman is in poor condition to conceive. Hormone therapies can often overcome these protective mechanisms without correcting the underlying problem and increasing the risk that there will be a poor outcome for mother or baby. An obese woman who has ceased to ovulate may not want to hear that she must lose weight to become pregnant. It is much easier to give her pills to stimulate ovulation. This apparently simple solution can lead to respiratory compromise and weeks of hospitalization for which the physician may be held liable. The physician should exercise the same caution in recommending fertility treatment as any other hazardous procedure. Studies on the products of spontaneous abortions point to a higher than normal rate of genetic problems. Given that the human body eliminates fetuses with genetic diseases in many cases, women who have had several unsuccessful pregnancies should be considered at risk for genetic disease. This is another situation in which medical science can sometimes overcome natural protective mechanisms. The couple who is disappointed at their lack of children may not realize that there could be a genetic problem with the babies. They should have a careful evaluation to rule out the presence of a genetic disease that might be complicating their efforts to carry a fetus to term. b) Psychiatric Problems It is important to rule out infertility caused by compulsive behavior that undermines a woman’s health. A woman who cannot conceive because she has an eating 571
disorder should not be helped to conceive by artificial means. The risk of turning a mild chronic psychiatric problem into an acute problem is substantial. If the woman continues to try to maintain a physiologically unreasonably low weight, the fetus may suffer substantial damage. Given the psychiatric basis of the problem, an informed consent to accept the risk of pregnancy is problematic. If the woman had control of her behavior, she would have been able to conceive by gaining weight. The patient should be referred for psychological evaluation before any risky therapies are instituted. c) Prospects for Successful Treatment In spite of all the advances in infertility treatment, not every couple will be able to conceive and bear a child. Any couple asking for infertility treatment should be given a realistic idea of their chances. Adoption is a long process in the United States today, and there are age limits placed on adoptive parents. A physician who is treating an infertile couple should be sure that they are not offered false hope that limits or excludes the possibility of adoption. Patients should be reminded that they should preserve their options while the various therapies are tried. d) Dealing with Multiple Gestation Some fertility drugs substantially increase the probability of multiple births. [ACOG Technical Bulletin 120. Medical Induction of Ovulation. September 1988.] In vitro fertilization techniques can also result in multiple gestations if more than one embryo is introduced, with a rate of twins of 15% to 18% and of triplets of 1% to 2% with four preembryos. [ACOG Technical Bulletin 140. New Reproductive Technologies. March 1990. [ACOG Technical Bulletin 140. New Reproductive Technologies. March 1990.] Multiple gestation poses grave risks to both the fetuses and the mother. [ACOG Technical Bulletin 120. Medical Induction of Ovulation. September 1988.] These risks should be explained in detail. The woman must understand that the risk is not that she will have twins or triplets (or more) but that one or more of the babies may be severely disabled and that she may suffer medical complications. The physician should also discuss the possibility of pregnancy reduction and selective fetal termination. A woman with multiple gestation must be informed of her options: 1. Abort all fetuses 2. Attempt to carry all fetuses to term 3. Terminate some of the fetuses [ACOG Committee on Ethics, Committee Opinion 94. Multifetal Pregnancy Reduction and Selective Fetal Termination. April 1991.] The introduction of multiple preembryos is intended to increase the success rate of in vitro fertilization. This benefits the patients by reducing the cost and medical risks of multiple procedures, but it is also critical to the success of the fertility center’s marketing. Few persons would be willing to undergo the risk and expense 572
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Public Health Law Map - Beta 5.7 I.
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1942.] The English statutory and co
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health or individual health officer
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actions through the district attorn
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3. The Judicial Branch The federal
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consumer protection, such as requir
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With these exceptions, most litigat
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the court in Los Angeles might allo
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subject matter and may also have in
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2. Implementing ADR The major benef
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III. Tort Claims against Private Pa
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cannot be proved, but it is clear t
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uterus, triggering a miscarriage. T
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first were passed immediately after
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years. If the practitioner violates
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defendant’s conduct or (for the d
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proving a case against a physician
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e important for their adult medical
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emoving the plantar wart. This emph
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Blake BL. Sgt. Friday, Dr. Welby, a
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Walter C, Richards EP. Keeping junk
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earning capacity. b) Medical Expens
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simple as installing wheelchair ram
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cases do not give rise to injury-re
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medical costs from the lawsuit. Som
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compilation of legal principles. It
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traditional sense. Fetal heart moni
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oxygen saturation. When saturation
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1993;56:12-14. King JY. Practice gu
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are handled through an administrati
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U.S.C. § 1491. As such, the Court
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waiving immunity provide the only m
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against the United States in federa
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A discretionary function is an act
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deviant sexual conduct by an Air Fo
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The government can be liable under
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decision of the hospital officials
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constitutional rights have been vio
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case basis. The critical element in
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allegedly defective product was a m
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that state law is displaced if it i
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adopted. Therefore, Congress may au
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alleged. The “color of state law
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Importantly, the DeShaney analysis
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In the context of public health, on
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Also, immunity from suit is preserv
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The mere fact a private corporation
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1. Absolute Immunity Absolute immun
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prisoners were infected with HIV an
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against physicians who sold prescri
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The key distinction between crimina
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it almost impossible for practition
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forced to give hair samples, blood
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medical care practitioner does not
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assume that a hospital has an incen
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fined not more than $25,000 or impr
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charitable, religious, or philanthr
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(2) The Everyone-Does-It Defense De
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automatically invoke attorney-clien
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The Federal government, and several
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e of no benefit to the community, t
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activities of the large professiona
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Some of these provisions, such as t
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not support the scheme to reduce ho
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(1) Sentencing Guideline Standards
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did not provide full information ab
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5. If an employee chooses not to re
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documents until the court had made
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Frech HE III, Danger KL. Exclusive
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1998;29:16-18. Stahl DA. Consolidat
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tampering. b) Search Warrants If th
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defense lawyers to fight claims tha
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a) Service of Process One distressi
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provide as little speculation from
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place for the deposition. Each part
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should include a signed release by
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juries will disregard scientific ev
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the jury may be out of the room for
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entered the patient’s description
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the information being presented is
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are situations where what is genera
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test so generously that it also gav
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defendant’s failure to render the
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fees may be construed as attempting
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Fish R, Rosen P. Physicians should
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$150,000 to fight a case that could
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case; rather, it encourages the att
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were below the acceptable standard
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A. Establishing Agencies For its fi
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local level because the employees a
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dispute before the court. The lawye
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c) The Goldberg Rights Persons whos
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the cost of butter. A public intere
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standards and who agree to complian
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a) Agency Interpretation of Law All
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Johnson JA. Court limits board of m
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persons—business law, constitutio
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5. Corporate Employers and Institut
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prohibited the attorney from asking
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supervising the work. A more fundam
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medical problems. Whether it is can
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for buying insurance is that it pay
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Lawyers working on a contingency do
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Review deposition summary: 30 Novem
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of an effective preventive law plan
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ibes were in the form of consulting
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detailed summaries of important doc
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A very important part of the invest
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cases. Houston Bar Assoc. 1996;34:2
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state civil rights laws and health
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must carry out these actions correc
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c) Informal Consultations One of th
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on relinquishing care and follow-up
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The manufacturers of emergency kits
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equire a consultation before certai
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any differences of opinion between
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to refer a patient to such an insti
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help the patient deal with the insu
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diagnostic interest to the physicia
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attendant duties. When they exercis
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physician must be notified at once.
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to find a specialist willing to see
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physicians, a recent U.S. Supreme C
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The law requires a physician to pro
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proper diagnosis. The physician los
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possible, the letter should be sent
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states than in others.) The best ra
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Medical licensing agencies and medi
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If there is a physician-patient rel
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(1) In general If any individual (w
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subject to a civil money penalty of
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condition described in paragraph (1
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(A) Placing the health of the indiv
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may not transfer the individual unl
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sent by certified mail, return rece
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Berlin L. Communication of the sign
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evaluation of distance medicine tec
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consent: reducing conflicts with pa
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) Children in the Emergency Room A
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such as cancer should be withheld f
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eing challenged over their good- fa
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would not require that the risk be
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usual in the community, and in othe
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consent to risks of the treatment b
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) Reasonable-Patient Standard This
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candidates for treatment if their u
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prospective reimbursement systems r
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The child’s legal status should b
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litigation. Most states allow a phy
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should be reported to the child pro
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mental suffering and injury. 5. No
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ensure that all other participants
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(1) The research involves no more t
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different dialects but with differe
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to consent to medical care. Convers
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person. The power of attorney may b
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eligious reasons. Parents may refus
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life-support technologies, patients
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use every possible avenue to prolon
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decision? The court found that Miss
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Cruzan really dead? Justice Rehnqui
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discussed in terms of the patient
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) Following the Patient’s Wishes
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Few termination of life-support cas
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than any element of human behaviora
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Law Policy. 1997;361. Brody, H. Com
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Furthermore, a physician who withdr
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Cunningham N. Fear and informed con
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Invest Radiol. 1996;31:109-113. Nic
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interests test. J Leg Med. 1991;12:
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esearch subjects: proposed guidelin
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1994;8:19-27. Silverman HJ. Ethical
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Insurance Portability and Accountab
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physician, just as the records of c
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and if the patient is the victim of
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Disabilities Act (ADA) limits an em
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that is part of routine medical car
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A description of each purpose of th
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services to the medical care provid
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Access to the records is subject to
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Use appropriate safeguards to preve
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when they were designing research s
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such as an antitrust or false claim
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contain, the potential for harm in
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identification of abnormal findings
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Anything that indicates special tre
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put in the chart to document that t
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keep personal notes, and often the
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night unless she has a serious conc
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difficult to authenticate, unless t
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225. Smith J. Good medical records
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The legal consequences of the corpo
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to set up their own practices or wo
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California. Independent Contractor:
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physician fail to obtain a proper i
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When a physician recommends unneces
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Because employers attempt to limit
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utilization review organization den
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to influence a treating doctor’s
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important if the employee injures a
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these rules vary greatly from state
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If, as frequently happens, the pati
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eviewed completely by the supervisi
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protocols become generic documentat
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the physician is directly supervisi
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a. Penicillin V potassium 250 mg q.
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they hospitalize or refer a patient
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patient’s right of privacy should
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Medical students are often enthusia
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unauthorized practice of medicine.
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staff knows that the orders are onl
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is injured by a fellow workers’ n
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limited due process restrictions on
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agreeing to reimburse the MCO for a
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collective action, a close reading
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Med Soc. 1996;148:341-343. Maurer W
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Fiesta J. Delegation, downsizing an
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XIV. Peer Review and Deselection HI
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the development of new legal theori
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juror’s perspective, peer review
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to deal fairly with citizens, these
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5. There is an overriding national
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a) Notice of a Right to a Hearing T
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equest, to the physician or practit
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subchapter. Information about malpr
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the standards set forth in the Act,
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2. The Problem of Bias Until recent
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from general disclosure, but it sho
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do cost-cutting that the physicians
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Med. 1997;18:521-538. Maguire D. Te
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Introduction All medical care pract
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we are due for another worldwide ep
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include nurses, dentists, veterinar
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marital disharmony. In the classic
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criticisms of the cost of contact t
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diseases such as the Marburg or Ebo
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organized, powerful political lobby
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homosexual activists and the religi
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eligion or conscience. Thus, he can
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high, amounting to several dollars
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1. Birth Certificates Normally the
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caused or contributed to by infecti
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D. Law Enforcement Reporting Every
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campus police. The campus police de
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the law enforcement authorities are
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when they are acting as officers of
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eporting practices. J Emerg Med. 19
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Starr P, Starr S. Reinventing vital
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October;51:132]. J Am Med Womens As
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laws governing air and water pollut
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the widespread occurrence of tooth
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within the power of the judiciary t
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[specify fluoridation measure at is
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Still other arguments center on all
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(Wash. 1955); Rogowski v. City of D
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adverse effects would occur was arb
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Kaul v. City of Chehalis, 277 P.2d
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Introduction There are special cons
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Under no circumstances should medic
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patients about high-risk behavior a
Page 521 and 522: arrier method that is only 70% effe
Page 523 and 524: injectable contraceptive that lasts
Page 525 and 526: that HIV is less of a threat than a
Page 527 and 528: for procedures affecting reproducti
Page 529 and 530: funded services to coerce a person
Page 531 and 532: The person who obtains the consent;
Page 533 and 534: The recognition of personal privacy
Page 535 and 536: medically necessary: On their face,
Page 537 and 538: Although abortion is still a surgic
Page 539 and 540: The presumption of legitimacy was a
Page 541 and 542: Unfitness is also narrowly defined
Page 543 and 544: consistent with public health and s
Page 545 and 546: constitutional protections or feder
Page 547 and 548: information in violation of confide
Page 549 and 550: Mary Sue’s ova were successfully
Page 551 and 552: But the rule does not contemplate t
Page 553 and 554: as not to violate this prohibition.
Page 555 and 556: committed before she knows the stre
Page 557 and 558: 1. Adoption 2. Family Planning and
Page 559 and 560: Soderberg H, Andersson C, Janzon L,
Page 561 and 562: Hum Reprod. 1992;7:1029-1033. Snowd
Page 563 and 564: condition. This conflict can take t
Page 565 and 566: eaching a level of 1 per 11 births
Page 567 and 568: who has finally conceived after thr
Page 569 and 570: should be sure that she understands
Page 571: The treatment of infertility poses
Page 575 and 576: Choosing a sperm donor can be legal
Page 577 and 578: prevent the spread of disease, and
Page 579 and 580: problems before they cause accident
Page 581 and 582: Beyond a structured prenatal care s
Page 583 and 584: patient’s decisions. The patient
Page 585 and 586: covered in signs that ask women if
Page 587 and 588: decisions not to use medical interv
Page 589 and 590: lifesaving care. Many physicians ig
Page 591 and 592: profound differences in the underly
Page 593 and 594: midwife’s skills and judgment, as
Page 595 and 596: who might sue on her behalf or on t
Page 597 and 598: contraception, but contraception ha
Page 599 and 600: One example has been the developmen
Page 601 and 602: Marshall BM. Ethical issues in assi
Page 603 and 604: 1995;115:39-43. Greely HT. Genetic
Page 605 and 606: 3. General Obstetrics Abrams FR. Co
Page 607 and 608: King NM. Informed consent and the p
Page 609 and 610: XIX. Occupational Medicine and Disa
Page 611 and 612: and balances inherent in having gen
Page 613 and 614: putative illness, requesting an exc
Page 615 and 616: compensation system. The company ma
Page 617 and 618: In some circumstances, the union ma
Page 619 and 620: ethical obligations concerning the
Page 621 and 622: Records concerning voluntary employ
Page 623 and 624:
employee’s health status.” In t
Page 625 and 626:
films shall be preserved in their o
Page 627 and 628:
Employees may also have a financial
Page 629 and 630:
available information on the proper
Page 631 and 632:
lood tests that are medically neces
Page 633 and 634:
hospital. Both the medical care pro
Page 635 and 636:
Section 504 was a remedial statute
Page 637 and 638:
or recurrent, that the key word was
Page 639 and 640:
government officials investigating
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incorrect, so this area of the law
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is to ensure that patients have eno
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problems. The Court also reiterated
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the medical problems have affected
Page 649 and 650:
normal eyes and kidneys and no peri
Page 651 and 652:
not constitute a disability. The pa
Page 653 and 654:
workplace, their legal status is no
Page 655 and 656:
hepatitis A, the onset of the disea
Page 657 and 658:
(2) The nature and severity of the
Page 659 and 660:
Many diseases are spread by insects
Page 661 and 662:
eporting duties that apply to the c
Page 663 and 664:
9. Bloodborne Pathogens All workpla
Page 665 and 666:
this includes all types of medical
Page 667 and 668:
clinics or home health visits. An i
Page 669 and 670:
Purtilo RB. Ethical issues in the h
Page 671 and 672:
Disabilities Act: a decision analys
Page 673 and 674:
occupational accidents and diseases
Page 675 and 676:
1998;13:241-272. Pollack R. Update
Page 677 and 678:
legislation, set minimum standards
Page 679 and 680:
hearing seems to be rooted in the l
Page 681 and 682:
ates among drug addicts. Beyond the
Page 683 and 684:
Team physicians’ duties are to th
Page 685 and 686:
first aid and training programs are
Page 687 and 688:
equired by the school is not accept
Page 689 and 690:
interfere with getting the child pr
Page 691 and 692:
4. Handicapped Children Handicapped
Page 693 and 694:
1996;35:237-242. Cheng TL, Savageau
Page 695 and 696:
Med Sci Law. 1995;35:45-47. Mitten
Page 697 and 698:
handling prisoners in a burns unit.
Page 699 and 700:
legislation. The FDA, DHHS, HCFA, a
Page 701 and 702:
of a lower court to a higher, appel
Page 703 and 704:
assaulted will bring a legal action
Page 705 and 706:
anesthesiologists and nurses with i
Page 707 and 708:
Negligence to consider the plaintif
Page 709 and 710:
declaratory judgments about the con
Page 711 and 712:
Durable Power of Attorney ensurance
Page 713 and 714:
fiduciary relationship, as is the r
Page 715 and 716:
Hearsay Rule Testimony of what anot
Page 717 and 718:
In Loco Parentis Literally, in the
Page 719 and 720:
to dangerous products such as drugs
Page 721 and 722:
filing of all official documents. I
Page 723 and 724:
Perjury The willful act of giving f
Page 725 and 726:
had that reasonable person been in
Page 727 and 728:
RICO The common abbreviation for st
Page 729 and 730:
person seeks damages or other legal
Page 731 and 732:
appropriateness. Vacate When a cour
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