Healthcare Reform - Medical Justice

Can a Wife With Dementia Consent to Sex With Her Husband?

August 15, 2024December 19, 2014 by Jeffrey Segal, MD, JD

Consent is intertwined with all aspects of medical care. A patient must give consent before undergoing treatment by a physician. If the patient presents emergently (in the absence of an advance directive) and cannot signal consent, our laws presume consent – namely a reasonable person would want everything done to save his life. And, if … Read more

Selective Breeding in Humans – A Slippery Slope? Nah.

August 15, 2024December 12, 2014 by Jeffrey Segal, MD, JD

October 26^th, 60 Minutes featured a segment on selective breeding in humans. The story focused on Genesis Genetics, a company which developed the technology for identifying those embryos within a larger set which have defective genes. Once identified, the family can choose the other “disease-free” embryos to implant via standard in-vitro fertilization techniques. When born, such children would be disease-free.

Steamed About a $15 Copay For Medication. Try $400,000 For Some Drugs.

August 15, 2024December 5, 2014 by Jeffrey Segal, MD, JD

The genomics revolution is here. We are accumulating new information almost daily about how our genes cause various diseases. More importantly, the door is opening to new treatments. As we fine tune our diagnostic capabilities, we are discovering small groups of individuals who can be effectively treated, but at a very high cost. In that model, the cost is high because the development cost is high, as it is for all pharmaceuticals. But for these small groups, the cost cannot be spread out among millions of patients. “Specialty pharmaceutical companies” are racing to create and distribute these high priced treatments.

Definition of Disability. It Depends What the Meaning Of “Is” Is.

August 15, 2024November 28, 2014 by Jeffrey Segal, MD, JD

Ever heard of the name Gary Muhrcke? He won the first NYC marathon in 1970.

He was also a firefighter. He injured his back in a burning building and was retired with ¾ disability pension. In 1975, he started running again. He said he felt better while exercising compared to taking medication for the pain.

Refusing to Treat Patients – When You Want Distance From a Patient’s Infection, Morality, and Politics – Part 2

August 15, 2024November 21, 2014 by Jeffrey Segal, MD, JD

We return to our discussion of can you refuse to treat a patient.

2. Moral opposition to a treatment

The analysis again starts with the contractual nature of the physician-patient relationship. The patient seeks care and the doctor agrees to provide it. In that idealized situation both parties remain in full agreement on the care.

However, along the way the doctor and patient disagree as to what treatments are “moral.” This raises the question to what extent the doctor may step away from that care. A patient may also seek care from the start that the doctor finds morally objectionable but the patient may not have reasonable alternatives (such as very rural area or a very specialized type of practice).

Word to the Wise. Not All Subpoenas to Doctors Are the Same.

August 15, 2024November 21, 2014 by Jeffrey Segal, MD, JD

Doctors receive subpoenas all the time. Lawyers send subpoenas for medical records when their client has been injured in a fender-bender; is seeking money from worker’s compensation; and when suing a doctor for negligence. In each of these cases, the lawyer is seeking the medical record to serve his client – (the patient).

What happens when a lawyer sends a subpoena for medical records when his client’s interests are adverse to the patient? This can create a pickle for the doctor. We are taught to comply with subpoenas. We are also taught to respect patient privacy.

Refusing to Treat Patients – When You Want Distance From a Patient’s Infection, Morality, and Politics – Part 1

August 15, 2024November 14, 2014 by Jeffrey Segal, MD, JD

Can you refuse to treat a patient? The simple answer is “Yes – of course.” But, when it comes to the law, there are layers to that answer.

How to Avoid Being Burned as an Employer

August 15, 2024November 14, 2014 by Jeffrey Segal, MD, JD

I’ve spoken with several doctors over the past couple of months. All were dragged into litigation related to their role as an employer. They were being sued by ex-employees. The allegations varied – sexual harassment; improper termination; discrimination. In 2011, the Equal Employment Opportunity commission (EEOC) received over 100,000 charges of employment discrimination. The … Read more

What Do You Do When Your Patient Is Sporting a Swastika Tattoo?

August 15, 2024November 7, 2014 by Jeffrey Segal, MD, JD

Any physician who has spent time taking care of trauma patients has been cursed at, spit at, and more. If you are a woman or member of racial or ethnic minority, some patients have belittled you. If you are from another country and speak with an accent, some patients have requested another doctor.

Not Your Everyday Informed Consent Issues

August 15, 2024November 7, 2014 by Jeffrey Segal, MD, JD

It’s no secret that availability of organs for transplantation in the US pales in comparison to demand. Many die each year waiting for an organ. The systems that oversee transplantation define rules which allow one to “wait in line.” You get an organ based on the seriousness of your condition, your place in line, and whether you can persuade a living donor to participate. (For a living donor, this assumes it’s a “non-vital” organ – eg: one of the donor’s two kidneys, liver, etc. Obviously a living donor cannot donate his heart.)

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