Legal Issues and Ethics

• When a patient has a DNR order and needs a surgery with anesthesia, consider discussing the revoking the DNR order temporarily or focusing on what the patient wants for quality of life.
• Unrelated urgent surgery to terminal illness + DNR order = some hospitals rescind the DNR order x 24 hours with careful documentation of the time.
• High quality X-ray and multiple views of the X-ray may be required when looking for a possible retained sponge from surgery.
• Some surgeons believe that the patient should be informed when the sponge / instrument counts are inaccurate at the end of a case even if there is no retained objects found on X-ray.
• Laws vary regarding protection from apologizing.
• Negligence = failure to exercise standard of care (reasonably prudent person / same situation).
• First element of informed consent, decide whether the person is competent of making decisions on behave of themselves, their child or their family member.
• To honor a patient’s request to make a medical/surgical decision for them, you must have already established a relationship with the patient, no other good options, believe that the course of the option is best for the patient.
• Parents disagreeing, first determine if only one parent or both parents have the legal right to give permission.
• A durable power of attorney is a type of advanced directive which may include other legal issues such as financial issues.
• The advanced directive of a patient trumps the wishes or demands of a family member or surrogate.
• A surgeon’s fine motor skills doesn’t appear to decline with age.