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Law Ethics For Health Professions 10th Edition Karen Judson

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0% found this document useful (0 votes)
92 views86 pages

Law Ethics For Health Professions 10th Edition Karen Judson

The document promotes instant access to various health profession ebooks available for download at ebookgate.com, including titles like 'Law Ethics for Health Professions' and 'Psychology in Action.' It provides a brief overview of the contents of the 'Law and Ethics for Health Professions' textbook, highlighting its focus on legal and ethical issues faced by healthcare professionals. Additionally, it mentions updates in the tenth edition of the textbook, including new information on informed consent, telemedicine, and public health responsibilities.

Uploaded by

nyemkhung57
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
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Law & Ethics
for Health Professions
TENTH EDITION
This page intentionally left blank
Law & Ethics
for Health Professions
TENTH EDITION

Karen Judson, BS
Carlene Harrison, EdD, CMA (AAMA)
Tammy Albright, CMA (AAMA)
LAW & ETHICS FOR HEALTH PROFESSIONS

Published by McGraw Hill LLC, 1325 Avenue of the Americas, New York, NY 10019. Copyright ©2024
by McGraw Hill LLC. All rights reserved. Printed in the United States of America. No part of this
publication may be reproduced or distributed in any form or by any means, or stored in a database or
retrieval system, without the prior written consent of McGraw Hill LLC, including, but not limited to,
in any network or other electronic storage or transmission, or broadcast for distance learning.

Some ancillaries, including electronic and print components, may not be available to customers outside
the United States.

This book is printed on acid-free paper.

1 2 3 4 5 6 7 8 9 LWI 28 27 26 25 24 23

ISBN 978-1-266-27394-0
MHID 1-266-27394-8

Cover Image: Geir Olav Lyngfjell/Shutterstock, vitstudio/Shutterstock, ktsdesign/


Shutterstock, Wesley VanDinter/E+/Getty Images

All credits appearing on page or at the end of the book are considered to be an extension of the
copyright page.

The Internet addresses listed in the text were accurate at the time of publication. The inclusion of a
website does not indicate an endorsement by the authors or McGraw Hill LLC, and McGraw Hill LLC
does not guarantee the accuracy of the information presented at these sites.

mheducation.com/highered
Brief Contents

Preface x

CHAPTER 1 Introduction to Law and Ethics 1

CHAPTER 2 Making Ethical Decisions 25

CHAPTER 3 Working in Health Care 45

CHAPTER 4 Law, the Courts, and Contracts 70

CHAPTER 5 Professional Liability 100

CHAPTER 6 Defenses to Liability Suits 130

CHAPTER 7 Medical Records and Health Information


Technology 154

CHAPTER 8 Privacy, Security, and Fraud 178

CHAPTER 9 Public Health Responsibilities of Health


Care Practitioners 204

CHAPTER 10 Workplace Legalities 230

CHAPTER 11 The Beginning of Life and Childhood 256

CHAPTER 12 Death and Dying 284

CHAPTER 13 Stakeholders, Costs, and Patients’ Rights 314


Glossary 342
Index 349


Contents

Preface x 4.5 Physicians’ and Patients’ Rights and

1
Responsibilities 88
Chapter 1 Chapter Summary 93
Chapter 4 Review 95
Introduction to Law and Ethics 1

5
1.1 Why Study Law and Ethics? 3
1.2 Comparing Aspects of Law and Ethics 8
Chapter 5
1.3 Qualities of Successful Health Care Professional Liability 100
Practitioners 14 5.1 Liability 101
Chapter Summary 19 5.2 Standard of Care and Duty of Care 103
Chapter 1 Review 20 5.3 The Tort of Negligence 106

2
5.4 Elements of a Lawsuit 110
Chapter 2 5.5 Alternative Dispute Resolution 114
5.6 Informed Consent 117
Making Ethical Decisions 25
Chapter Summary 122
2.1 Value Development Theories 26
Chapter 5 Review 123
2.2 Value Choices Theories 30

6
2.3 Principles of Health Care Ethics 33
Chapter Summary 39 Chapter 6
Chapter 2 Review 40 Defenses to Liability Suits 130

3
6.1 Preventing Liability Suits 131
Chapter 3 6.2 Types of Defenses 138
6.3 Risk Management 142
Working in Health Care 45
6.4 Professional Liability Insurance 144
3.1 Licensure, Certification, Registration, and Scope
of Practice 46 Chapter Summary 147
3.2 Accreditation 50 Chapter 6 Review 148

7
3.3 Practice Acts and Professional Boards 55
3.4 Business Aspects of Health Care 57 Chapter 7
3.5 Managed Care Organizations 59
Medical Records and Health
Chapter Summary 63
Information Technology 154
Chapter 3 Review 64

4
7.1 Medical Records 156
7.2 Medical Records Ownership, Retention, Storage,
Chapter 4 and Destruction 159
Law, the Courts, and Contracts 70 7.3 Records Release 163
4.1 The Basis and Primary 7.4 Health Information Technology (HIT) 166
Sources of Law 71 7.5 Social Media in Health Care 168
4.2 Classifications of Law 74 7.6 Telemedicine 170
4.3 Tort Liability 77 Chapter Summary 172
4.4 Contracts 82 Chapter 7 Review 173

vi Contents
8
Chapter 8 11.3 Genetic Engineering 263
11.4 Conception and the Beginning of Life 268
Privacy, Security, and Fraud 178 11.5 Rights of Children 271
8.1 The U.S. Constitution and Federal Privacy
Chapter Summary 277
Laws 179
Chapter 11 Review 279
8.2 Privacy, Confidentiality, and Privileged

12
Communication 182
8.3 HIPAA’s Privacy and Security Rules 185 Chapter 12
8.4 Controlling Health Care Fraud and Abuse 192 Death and Dying 284
Chapter Summary 198 12.1 Attitudes Toward Death and the Determination of
Chapter 8 Review 199 Death 285

9
12.2 Legal Documents for Patients with Terminal
Chapter 9 Illness 288
12.3 Health Care Services for Patients with Terminal
Public Health Responsibilities of Illness 291
Health Care Practitioners 204 12.4 The Right to Die Movement 294
9.1 Vital Statistics 205 12.5 The National Organ Transplant Act 299
9.2 Public Health Functions 208 12.6 The Grieving Process 302
9.3 Reportable Diseases and Injuries 209 Chapter Summary 305
9.4 Drug Regulations 220 Chapter 12 Review 307

13
Chapter Summary 223
Chapter 9 Review 225 Chapter 13

10
Stakeholders, Costs, and Patients’
Chapter 10
Rights 314
Workplace Legalities 230 13.1 The Stakeholders 315
10.1 Basic Employment Law 231 13.2 Cost of Health Care 319
10.2 OSHA’s Workplace Priorities 238 13.3 Access and Quality 324
10.3 OSHA, CDC, and CLIA 13.4 Paying for Health Care 330
Guidelines and Regulations 239
13.5 Patients’ Bill of Rights 333
10.4 Workers’ Compensation
Chapter Summary 335
and Unemployment Insurance 245
Chapter 13 Review 337
10.5 Hiring and the New Employee 246
Chapter Summary 249
Glossary 342
Chapter 10 Review 250 Index 349

11
Chapter 11
The Beginning of Life and
Childhood 256
11.1 Family History as a Predictor 257
11.2 DNA Testing 260


This page intentionally left blank
About the Authors
Karen Judson, BS
Karen Judson has taught college and high school sciences and grades kindergarten, one, and
three. Judson has also worked as a laboratory and X-ray technician and completed 2 years of
nursing while earning a degree in biology. Judson has also published numerous science and
relationship articles and books for adult and young adult readers.

Carlene Harrison, EdD, CMA (AAMA)


Carlene Harrison was an administrator in a variety of outpatient health care facilities for
20 years in Colorado, Texas, and Florida. She became a full-time faculty member at Hodges
University in 2000 serving first as a professor and program chair in both medical assisting and
health administration. In 2007, she was named Dean of the School of Allied Health. During
her 15 years at Hodges, she was responsible for adding six academic programs to the School
of Allied Health, retiring in 2015. Even though she is retired from full-time academia, she
continues to work part time at a local public health department, coordinating with universities
and colleges to provide a variety of internships and clinicals for students in the fields of pub-
lic health, nursing, medicine, health information technology, dietetics, and social work.

Tammy Albright, CMA (AAMA)


Tammy Albright has been an Associate Professor in the Medical Assisting Department in
Raleigh, North Carolina for the last 17 years. She has taught classes in Medical Law and Eth-
ics, Administrative Office, Exam Room Procedures, Diet Therapy/Nutrition, Drug Therapy, and
Infection/Hazard Control. Before becoming a professor, Albright worked as a full time Medical
Assistant for seven years. She has experience in Internal Medicine and Urgent Care. Outside
of the classroom, she enjoys going to the beach and spending time with family and friends.


Preface
Law and Ethics: For Health Professions explains how to from a business perspective and includes a review of
navigate the numerous legal and ethical issues that the basic types of insurance coverage. It also contains
health care professionals face every day. Topics are a discussion of patients’ rights. There is also up to date
based upon real-world scenarios and dilemmas from a information regarding the Nations Health Care Dollar.
variety of health care practitioners. Through the presen- • All statistics and court cases have been updated, as
tation of Learning Outcomes, Key Terms, From the well as content relevant to laws passed since the
Perspective of . . ., Ethics Issues, Chapter Reviews, Case eighth edition.
Studies, Internet Activities, Court Cases, and Videos, • Connect has been updated to reflect updates in the
students learn about current legal and ethical problems chapters and feedback from customers. It contains
and situations. In the tenth edition, material has been all Check Your Progress questions, all end-of-chapter
revised to reflect the current health care environment. questions, additional Case Studies with related
As students progress through the text, they will get the questions, and simple interactives.
opportunity to use critical thinking skills to learn how
• MHE Application-Based Activities are highly interac-
to resolve real-life situations and theoretical scenarios
tive, automatically graded online exercises that provide
and to decide how legal and ethical issues are relevant
students a safe space to practice using problem-solving
to the health care profession in which they will practice.
skills to apply their knowledge to realistic scenarios.
Each scenario addresses key concepts and skills that
New to the Tenth Edition students must use to work through and solve course
specific problems, resulting in improved critical think-
A number of updates have been made in the tenth edi- ing and relevant workplace skills.
tion to enrich the user’s experience with the product,
• Connect Law and Ethics for Health Professions
including revisions to most of the “From the Perspective
Application-Based Activities: Video Cases
of . . .” features in each chapter:
▪▪ Students watch different scenarios and are
• Chapter 5, “Professional Liability,” now includes the instructed on the different laws and ethical
book’s coverage of informed consent. considerations that are relevant to those
• Chapter 7, “Medical Records and Health Information scenarios. Students apply their knowledge
Technology,” provides more information about elec- of the subject by answering periodic ques-
tronic health records, telemedicine, and updated tions throughout each video.
information about social media applications in health
care and VA telehealth visits.
To the Student
• Chapter 9, “Public Health Responsibilities of Health
Care Practitioners” contains new information regard- As you study to become a health care provider, you have
ing COVID-19. undoubtedly realized that patients are more than the sum
of their medical problems. In fact, they are people with
• Chapter 10, “Workplace Legalities,” contains the up­
loved ones, professions, worries, hobbies, and daily rou-
dated OSHA priorities.
tines that are probably much like your own. However,
• Chapter 11, “The Beginning of Life and Childhood,”
because patients’ lives and well-being are at stake as they
includes updated information about genetic testing.
seek and receive health care, in addition to seeing each
• Chapter 12, “Death and Dying” has updated infor- patient as an individual, you must carefully consider the
mation on the right to die argument timeline. complex legal, moral, and ethical issues that will arise as
• Chapter 13, “Stakeholders, Costs, and Patients’ you practice your profession. And you must learn to
Rights,” discusses the changing face of health care resolve such issues in an acceptable manner.

x Preface
Law and Ethics: For Health Professions provides an over- • Review the Case Studies, and use your critical think-
view of the laws and ethics you should know to help you ing skills to answer the questions.
give competent, compassionate care to patients that is • Complete the Internet Activities at the end of the
also within acceptable legal and ethical boundaries. The chapter to become familiar with online resources and
text can also serve as a guide to help you resolve the many to see what additional information you can find about
legal and ethical questions you may reasonably expect to selected topics.
face as a student and, later, as a health care provider. • Complete the Connect assignments from your instruc-
To derive maximum benefit from Law and Ethics: tor, including any SmartBook modules assigned, as
For Health Professions:
well as additional Case Studies and the Application-
• Review the Learning Outcomes and Key Terms at Based Activities (Video Cases).
the beginning of each chapter for an overview of the • Study each chapter until you can answer correctly
material included in the chapter. questions posed by the Learning Outcomes, Check
• Complete all Check Your Progress questions as they Your Progress, and Review questions.
appear in the chapter, and correct any incorrect answers.
• Review the legal cases to see how they apply to topics Instructor Resources
in the text, and try to determine why the court ruled
You can rely on the following materials to help you and
as it did.
your students work through the material in this book.
• Study the Ethics Issues at the end of each chapter, and All of the resources in the following table are available
answer the discussion questions. in the Instructor Resources under the Library tab in Con-
• Complete the Review questions at the end of the nect (available only to instructors who are logged into
chapter, correct any incorrect answers, and review the Connect).
material again.

Supplement Features
Instructor’s Manual Each chapter includes:
• Learning Outcomes
• Overview of PowerPoint Presentations
• Teaching Points
• Answer Keys for Check Your Progress and End-of-Chapter Questions
PowerPoint Presentations • Key Concepts
• Accessible
Electronic Test Bank • Computerized and Connect
• Word version
• Questions are tagged with learning outcomes, level of difficulty, level of
Bloom’s taxonomy, feedback, topic, and the accrediting standards of ABHES
and CAAHEP, where appropriate
Tools to Plan Course • Correlations by learning outcomes to ABHES and CAAHEP
• Sample syllabi
• Asset Map—a recap of the key instructor resources, as well as information on
the content available through Connect

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Guided Tour
Chapter Openers
The chapter opener sets the stage for what will be learned in the chapter. Key terms are first introduced in
the chapter opener so the student can see them all in one place; they are defined in the margins throughout
the chapter for easy review, as well as in the glossary. Learning Outcomes are written to reflect the revised
version of Bloom’s taxonomy and to establish the key points the student should focus on in the chapter. In
addition, major chapter heads are structured to reflect the Learning Outcomes, and the Learning Outcomes for
easy reference. From the Perspective of . . . boxes illustrate real-life experiences related to the text. Each
quotes health care providers as they encounter problems or situations relevant to the material about to be
presented in the chapter.

FROM THE PERSPECTIVE OF. . .


LINDA AND CAROL HAVE BEEN FRIENDS FOR ABOUT 4 YEARS.
THEY ARE BOTH RETIRED from careers in health care. Linda had been
a medical records supervisor in a 500-bed hospital and Carol had been
an LPN in a family practice and was married to a physician who had

1
Stockbyte/Getty Images retired, but still had an active license in another state. They met at the

Introduction to Law
local gym after retirement. They get together every few weeks for either
lunch or a movie. Over time, a friendship developed.
One day at lunch, the conversation was about health issues. Carol

and Ethics talked about the variety of her chronic health problems that required
medication. She was a patient insured by Medicare. Initially, several
medications cost over $1,000 a month. Carol had them filled in Canada
Key Terms for $400 a month, but the Canadian company went out of business. She
began to use her Medicare plan at $1,000 a month. In the meantime,
bioethicists
she discovered that her sister’s health plan would cover all but $50 of
bioethics the monthly cost of any medication. Her sister had private insurance.
LEARNING OUTCOMES codes of ethics Carol admitted to Linda that her husband had written a prescription for
common sense her sister for one of the expensive medications. Her sister lived in the
After studying this chapter, you should be able to: compassion
state where Carol’s husband still had a medical license. Carol’s sister
courtesy
LO 1.1 Explain why knowledge of law and ethics is critical thinking
filled the prescription and sent it to her.
important to health care practitioners. defendant Linda recently was diagnosed with endometrial cancer. She had a
ethics radical hysterectomy and then began chemotherapy. Her oncologist
LO 1.2 Define law, ethics, and moral values as used in ethics committees prescribed Zofran for any nausea or vomiting. Linda had used only 3
ethics guidelines
health care by health care practitioners. of the 30 tablets when she finished chemotherapy. She mentioned that
etiquette
fraud
to Carol.
LO 1.3 Discuss the characteristics and skills most likely health care practitioner The lunch discussion changed to other topics and Linda decided to
to lead to a successful career in one of the Hippocratic oath forget about the conversation, as she knew what Carol’s husband had
health care professions. law done was illegal. Carol’s sister had also violated the law.
liable
The next time Linda and Carol got together, the conversation was
litigious
medical ethicists about vacations. Carol was going on a 3-week cruise, and she mentioned
moral values that she sometimes got a little seasick. She asked Linda if she could have
plaintiff her remaining Zofran tablets. Linda quickly changed the subject and
COURT CASE Patients Sue Hospitals precedent
protocol
Carol did not bring it up again.
From Carol’s perspective, it was all about saving money. She knew
summary judgment
what her husband had done was wrong, but felt justified in having
In 2018, lawsuits against a variety of hospitals, phy- she now has permanent incontinence. Source:
her husband and sister commit a minor crime. She thought that since
sicians, lawyers, nursing homes, and even power www.abajournal.com
no one was harmed, and she was helped, that her behavior was not
companies that were moving through various courts • In Florida, family members of nursing home that bad.
included: patients who died during Hurricane Irma are From Linda’s perspective, she was uncomfortable about learning what
suing nursing home administrators and staff Carol and her family had done, but decided to ignore it as the end result
• A dermatologist posted videos of herself sing- for failing to evacuate the facility after the air was that Carol had her needed medication. She did a bit of research and
ing and dancing during cosmetic surgery. Four learned that Zofran was not used to treat seasickness, and she already
conditioning crashed and the temperature
malpractice suits have already been settled, knew that it wasn’t all that expensive. She decided that if Carol brought
spiked. The families are also suing Florida
including one by a woman who suffered perma- it up again, she was going to tell Carol that she had thrown the medi-
Power and Light for failing to prioritize nursing cation away, since she no longer needed it.
nent brain damage following surgery. Several
home power restoration. Source: www.miamiherald
other lawsuits are expected to be filed in the .com
coming months. Source: www.abajournal.com
(All of the above cases were still in litigation as the
• Frightened into surgery by a medical litigation 1
As you progress through Law & Ethics for the Health Professions, try to
ninth edition of Law & Ethics for Health Professions
law company, an Arkansas woman had surgery interpret the court cases, laws, case studies, and other examples or
to remove vaginal mesh. She has filed a lawsuit was prepared for publication, but perhaps the
situations cited from the perspectives of everyone involved.
against her former law firm and the litigation underlying reasons for filing the lawsuits are already
funding company that financed the operation as apparent to you.) 2 Chapter 1 | Introduction to Law and Ethics

COURT CASE 911 Operators Sued


Court Cases
In 2006, just before 6 pm, a 5-year-old boy called The boy’s older sister sued the two 911 operators on Several court cases are presented
911. He told the 911 operator that his “mom has behalf of the dead woman’s estate and on behalf of
passed out.” When the operator asked to speak her son. The lawsuit alleged gross negligence causing in every chapter. Each summarizes
to the boy’s mother, he said, “She’s not gonna a death and intentional infliction of emotional distress.
talk.” The operator scolded the boy and logged The 911 operators argued that they were entitled a lawsuit that illustrates points
the call as a child’s prank. Three hours later, the to government immunity, that they owed no duty to
boy called 911 again. A different operator answered,
and she also scolded the boy for playing a prank,
provide assistance to the woman who died, and
that their failure to summon medical aid was not
made in the text and is meant to
but she did send a police officer to the boy’s
home. The officer discovered the boy’s mother
gross negligence.
A trial court and an appeals court found for the
encourage students to consider
lying unresponsive on the floor and summoned
emergency medical services. The EMS workers
plaintiff, and the case was appealed to the Michigan
Supreme Court, where in January 2012, the court
the subject’s relevance to their
arrived 20 minutes later and determined that the
woman was dead and had probably died within
denied further appeals.
Source: Estate of Turner v. Nichols, 807 N.W.2d 164, 490 Mich.
health care specialty. The legal
the past 2 hours.
citations at the end of each case
988 (2012).

indicate where to find the com-


material fact. In other words, a motion for summary judgment states that
one party is entitled to win as a matter of law. Summary judgment is
plete text for that case. “Land-
available only in a civil action. (Chapter 4 distinguishes between criminal
and civil actions.) mark” cases are those that
The following court cases illustrate that a wide variety of legal ques-
tions can arise for those engaged directly in providing health care ser- established an ongoing precedent.
vices, whether in a hospital, in a medical office, or in an emergency
situation. Health care equipment and product dealers and manufacturers

Chapter 1 | Introduction to Law and Ethics 5

xiv Guided Tour


In the American cultural environment, however, acting morally
toward another usually requires that you put yourself in that individual’s
place. For example, when you are a patient in a physician’s office, how
do you like to be treated? As a health care provider, can you give care
to a person whose conduct or professed beliefs differ radically from your
own? In an emergency, can you provide for the patient’s welfare with-
out reservation?

Check Your Progress Check Your Progress


Questions
1. Name two important reasons for studying law and ethics.
These questions appear at 2. Which state laws apply specifically to the practice of medicine?
various points in the chapters 3. What purpose do laws serve?
4. How is the enforcement of laws made possible?
to allow students to test their
5. What factors influence the formation of one’s personal set of ethics and values?
comprehension of the material 6. Define the term moral values.
they just read. These ques- What are the basic principles of health care ethics? 7. Explain how one’s moral values affect one’s sense of ethics.
LO 2.3 Define the
basic principles of
• Autonomy or self-determination
tions can also be answered
health care ethics.
in • Beneficence
• Nonmaleficence
Connect. • Justice
Chapter 1 | Introduction to Law and Ethics 9

• Confidentiality

End-of-Chapter
• Role fidelity

Chapter Summary • Veracity


What are social determinants of health?

• Living conditions that affect health, such as shelter, food, income, education, a stable environment,
Resources
Learning Outcome Summary sustainable resources, social justice and equity.

LO 1.1 Explain why Why study law and ethics? What is health disparity?
The Chapter Summary is in a
knowledge of law and
ethics is important to
• Health care practitioners• who
knowledge of law and ethics.
Living conditions
function at the that affect
highest health,levels
possible such as shelter,
have
sustainable resources, social justice and equity.
food, income, education, a stable environment,
a working tabular, step-by-step format
health care practitioners.
• What is health equity?
Knowing the law relevant to your profession can help you avoid legal entanglements that
threaten your ability to earn a living. Court cases illustrate how health care practitioners,
organized by Learning Out-
• Striving for the highest possible standard of health for all people and giving special attention to the
health care facilities, and drug and medical device manufacturers can be held accountable
in a court of law.
needs of those at greatest risk of poor heath, based on social conditions. comes to help with review of
• A knowledge of law and ethics will also help familiarize you with the following areas:
• The rights, responsibilities, and concerns of health care consumers the material. Ethics Issues are
• The legal and ethical issues facing society, patients, and health care practitioners as
the world changes issues and related discussion
• The impact of rising costs on the laws and ethics of health care delivery
questions based on interviews
LO 1.2 Define law, ethics, What are the basic aspects of law and ethics, and how do they compare?
and moral values as used

Chapter 2 Review
Laws are considered the minimum standard necessary to keep society functioning. Many conducted with ethics
in health care by health
laws govern the health care professions, including criminal and civil statutes and medical
care practitioners.
practice acts.
Applying Knowledge counselors within the profes-
• Ethics are principles and standards that govern behavior. Most health care professions
25. A medical assistant greetsLOa have
patient andofstates
2.1 a code ethics “I am Jonathan
members and Itowill
are expected be your medical assistant today.”
follow. sional organizations for health
This is an example of • Bioethics is the discipline dealing with the ethical implications of biological research
1. methods
What isandanother term for inyour personal concept of right and wrong?
a. Empathy
• Moral
results, especially medicine.
c. Common sense care providers, as well as with
a. Utilitarianism
values define one’s personal concept of right and wrong.
b. Trustworthiness d. Courtesy
• Etiquette refers to manners and courtesy.
b. Beneficence bioethics experts. Each
• Protocol is a code prescribing correct behavior in a specific situation, such as in a medical
c. Moral values
office.
Ethics Issue 3:
Chapter Review includes
LO 1.3 Discuss the Whatd.characteristics
Role fidelity and skills will most likely help a health care practitioner achieve
Ethics Issues
characteristics and skills Martha is the
Introduction
success? to administrative
End-of-Chapterassistant to Valerie,
Ethics the practice manager in a five-physician practice. Salaries of
Discussions Applying Knowledge questions
most likely to lead to a 2. staff
Whyare didconfidential.
Tom and Bill, Sincein this
payrollchapter’s
is handled opening
by anscenario, come to different
outside company, only the practice manager has knowledge
• People skills, such as listening to others and communicating well, are an asset to health
successful career in one of
Learning Outcomes
the health care professions.for
ofdecisions?
care
the out
who
Ethics
makes what salary. Valerie has gone to lunch and left her door open. Several people have been in and
practitioners.
Issues office
of Valerie’s Feature at theoffEnd
dropping of Each
reports or otherChapter
information. Martha goes in the office to place a report on
that reinforce the concepts the
• Technical
a. Because skills,of their age
including differences
a basic knowledge of computers, and a foundation in science
After studying the material in each Valerie’s
and
take
chapter’s
math are desk
a thinking
quick of
and notices
Ethics
necessary
look,
Issues
to achievethatana education
feature,
especiallyinsince
budget
you should
Martha
worksheet
in thebe ablelisting
health
believes
care all staff salaries is in clear view. It would be easy to
to: sciences.
shesituation
is paid lessprovide
than other employees with fewer responsibil-
students have just learned.
b. Because
• Critical differences
skills are required their
for you societal,
to correctlycultural,
assess a and family
and influences
the
1. Discuss current ethical issues of concern to health care practitioners.
2. Compare ethical guidelines to
ities. Martha
proper
c.
If the
response.backs
Because
IIdentifying
should
law as not of Solving
their
know
discussed
out
what
of the through
problems
different
in
office and
relationships
everyone
each
locks
critical
else isofbeing
chapter
with
Valerie’s
thinking
their
door without looking at the sheet. She thinks to herself,
involves:
supervisor
paid, then no one else should either.
the text.
These questions can be
1. and clarifying the problem
2.d.
3. Practice critical thinking skills
Curtis
None
asGathering
isofinformation
you consider
one
these of the employees who had left information on Valerie’s desk before Martha closed the door. He
medical, legal, and ethical issues for each situation presented.
also sees the budget sheet but does not stop to look at it. It did not occur to him to look at it, although it would
answered in Connect.
3. 3.How is
in Abraham
Evaluating
texttotoMaslow’s
the evidence
thattheory ofbeing
needs-based motivation best defined?He puts his file down on Valerie’s
have
4. Relate the ethical issues presented been thegreat know
the health
4. Considering alternatives and implications
desk
hecare
wasprofession paidyoumore thantoother
intend employees.
practice. Case Studies are scenarios with
Health care practitioners are bound a. It and
by
thinks
is astate
five-step
and
to progression
himself, I will
federal the laws,
warn
that sees Valerie that as
theypleasure
shetheneeds to be more
primary careful about what she leaves on her desk
motivation
ethical for all human
bestbut are also bound by certain
standards—both personal standards
5.
for Choosing
What
anyone
behavior.
and
and
to
those set
questions
implementing
see.
canforth
help youby professional
alternative
determine if a codesdecisionofisethics
ethical?and ethical guidelines and
exercises that allow students to
by bioethicists. Many professional b.organizations
IfItyou
Discussion is perform
a progression for health
Question calledcare practitioners employ an ethics consultant who
youbeneficence.
1.
is available to speak with organization members
employing
this act, have
who need
organization’s
followed relevant laws and kept within your
help with an ethical dilemma. “We serve as a third
policy? practice their critical thinking
19c. ItAccording
party who can stand outside a situation is and
a theory to that
facilitatevirtue ethics,
says human
communication,” whobehavior
is says
moreDr. ethical—Martha,
is based onParadis,
Carmen thean
specific one
human tempted
ethics con- tothat
needs lookmust
but doesn’t,
often beor Curtis,
met in a
2. Will this act promote a win–win situation for as many of the involved individuals as
who isn’t
specific
sultant with the Cleveland Clinic’s possible?
Department even
order. tempted toAtlook?
of Bioethics. Defend your
the Cleveland answer.
Clinic, ethics consultations are skills to decide how to resolve
available to health care practitioners,
3.d.How patients,
It iswould
a system family
you feel members,
of ifmoral
this actvalues.and others involved with patient
were to be publicized in the newspapers or other decisions.
Medical facility ethics committeesmedia? can also serve as consultants. In larger health care facilities, such commit- the real-life situations and theo-
tees usually deal with institutional matters,
4. Would you butwantin smaller
your communities
family members to know? where ethics consultants may not be
available, members of an ethics40 committee
5. If youChapter may
perform
also function
2 | Making
this act, Ethical
can you
as ethics consultants.
Decisions
look at yourself in a mirror? retical scenarios presented.
Keep in mind as you read the Ethics Issues feature for each chapter that ethical guidelines are not law but
Case Studies
deal solely with ethical conduct for health care practitioners. Most guidelines published for professional health Internet Activities include exer-
care practitioner organizations emphasize this difference. For example, as stated in Guidelines for Ethical Conduct
for the Physician Assistant Profession:
Use your critical thinking skills to answer the questions that follow each case study. cises designed to increase stu-
Physician Assistants are expected to behave both legally and morally. They should know and understand
the laws governing their practice.
LO 2.3Likewise, they should understand the ethical responsibilities of being
Chapter | Introduction to agreement.
Law and Ethics
dents’ knowledge of the chapter
a health care professional. Legal requirements and ethical expectations will 1not always be in 19
Generally speaking, the lawSusan, a nursing
describes
delineate the highest moral astandards
minimumstudent,
standardsisofarguing
flu shot.of behavior.
with
acceptable her friend
behavior, Linda,
and ethical also a nursing student, over the benefits of getting
principles topics and help them gain more
“I’m not getting a flu shot this year,” Linda declares. “I paid $14 for one last year, and I still got sick. I had
Source: www.aapa.org/wp-content/uploads/2017/02/16-EthicalConduct.pdf, ©American Academy of PAs.
a horrible sinus infection that kept me out of school for days.” internet research expertise.
Internet Activities
The ethical guidelines for various health
is that health care practitioners are
“I remember,
older people to
obligated with
but thathave
care professions
weakened
provide
wasn’t
the best
the flu,”
several
immune
pointsSusan
systems—don’t
care possible
argues. but
in common, “Since
firstwe
youpatient
for every think we,
andsee
and of
so many people in the clinic—especially
foremost
to all people, should be immunized against
protect
the safety, privacy, and welfare ofthe flu?”patient.
every
LOState
2.3 and federal laws may differ The argumentfrom
somewhat continues
an ethical at length, withFor
principle. Linda finally araising
example, state’sher
lawvoice
may and
not stomping off.
require
Complete physicians to routinely
the activities inquire
and answer about
theyour physical,
questions sexual, and psychological abuse as part of a patient’s
thatis follow.
20. In opinion, the question of whether or not the nursing students should get a flu vaccination an
medical history, but the physician may feel an ethical duty to patients to do so.
25.Furthermore,
Locate the Web site that
for the ethics question?
organization Explain
representing your answer. you plan to practice. Check the orga-
the fact a health care practitioner whothe hasprofession
been charged with illegal conduct is acquitted
nization’sdoes
codenot
of ethics. 21. the
Does If you decide that tothistheis seven
an ethics question, which care
theory of moral reasoning best applies?
or exonerated necessarily meancode that conform
the health care principles
practitioner actedofethically.
health ethics? Explain
your answer.
The term ethical as used here Ethan refers tois an orderly
matters in a skilled
involving nursing care facility. He is charged with supervising patients in the dining room
the following:
on a day when two of his coworkers have called in sick, leaving the facility shorthanded. On this day, several
26. Visit the
1. Moral Web site
principles or for the National Center for Ethics in Health Care at www.ethics.va.gov. In the list of
practices
patients seem agitated and Ethan is kept busy calming them. He also worries about patients prone to choking
resource publications, click on any of the subjects listed. Which link did you choose? How might these
2. Matters of social policy involving episodes
issuesand of finds himself
morality in the feeling harried
practice and stressed.
of medicine
resources prove useful to you?
Wallace, an 80-year-old in a wheelchair, demands that Ethan help him back to his room. “It’s too crowded
The term unethical refers to professional conduct that fails to conform to these moral standards or policies.
27.The
Visit Santa Clara University’s andWeb
hecticsite:inwww.scu.edu/ethics/practicing/decision/.
here today,” he shouts. Ethan knows he Under cannot “What
leave his post and panics when Wallace heads for
is and
ethics?”
ethical issues raised are from the real-life experiences of a variety of health care practitioners are
list three things that, the door.
according
recounted throughout the text to raiseto awareness
the site, ethics
of theare not. Do
ethical you agree?
dilemmas many Explain your answer.
practitioners (If this
face daily andURL
to
is no longer available, do a Ethan
Web searchrunsforahead of Wallace,
“framework for shuts theethically.”
thinking double doors
What towas
thethe
dining
numberroom, and locks them.
one
stimulate discussion.
result for this search, and how 22. might
Has Ethan you make
acted use of the Explain
ethically? source?)your answer.
22 23.
Chapter 1 | Introduction to Law andWhat
Ethics would you do in a similar situation? Use steps one through five for ethical decision making to reach
a solution. Describe how each step was used.
24. Do you believe your solution is more ethical than Ethan’s? Why or why not?

Chapter 2 | Making Ethical Decisions 43


Acknowledgments
Author Acknowledgments Charles Bowie and SmartBook, especially with review
Tennessee State University feedback. They include:
Tammy Albright
Julie Alles, DHA, RHIA
A special thank you to Monica Toledo for Howard Callman, AHI(AMT)
guiding me through my first book! Thank Grand Valley State University
New Age Training
you for your patience and direction in this Angela M. Chisley, AHI, RMA, CMA,
adventure. Leslie Cox AMCA
Also I extend a great amount of gratitude Hussian College/Daymar College
Gwinnett College
to all of the McGraw Hill members who
invested time and effort in the production Kelly J. Fast, MS, RHIA Latoya Dennard Davis, RHIT
of this new edition. Missouri Western State University Albany State University

Reviewer Acknowledgments Susan Grant, EdD, RN Laura Diggle, MS, CMA


Suggestions have been received from fac- Harper College Ivy Tech Community College
ulty and students throughout the country. Terri Fleming, EdD
Sharon Imperiale
This is vital feedback that is relied on for
Unitek Learning/Brookline College Ivy Tech Community College
product development. Each person who
has offered comments and suggestions has Debra Glover, RN, BSN, MSN
our thanks. The efforts of many people are Nikki Marhefka, Ed.M., MT(ASCP),
CMA(AAMA) Goodwin College
needed to develop and improve a product.
Among these people are the reviewers and Central Penn College Janis A. Klawitter, AS, CPC, CPB,
consultants who point out areas of concern, CPC-I, Provider Audits/Analytics
cite areas of strength, and make recom- Jillian McDonald
Bakersfield Family Medical Center
mendations for change. In this regard, the Goodwin University
following instructors provided feedback that Samuel Newberry DC
was enormously helpful in preparing the Nicole Procise, MS, PBT (ASCP), CMA
Bryant & Stratton College
book and related products. (AAMA)
Ivy Tech Community College Janna Pacey, DHA, RHIA
10e Technical Editing/Accuracy Grand Valley State University
Panel Kathleen Schreiner
Multiple instructors participated in a survey Montgomery County Community College Kristi Perillo-Okeke, DC, CMRS
to help guide the revision of the book and Bryant & Stratton College
to verify its accuracy. Lynn Ward, Ed.D, RHIA, CPHIMS
Southern New Hampshire University Shauna Phillips, RMA, AHI, CCMA,
Kathleen Behan, EdD CMAA, CPT
Beckfield College PIMA Medical Institute
Digital Tool Development
Sandra Bhatnagar, LVN Special thanks to the instructors who Kemesha Spears, CUTAIL
Arlington Career Institute helped with the development of Connect Albany State University

xvi Acknowledgments
1
Stockbyte/Getty Images

Introduction to Law
and Ethics
Key Terms
bioethicists
bioethics
LEARNING OUTCOMES codes of ethics
common sense
After studying this chapter, you should be able to: compassion
courtesy
LO 1.1 Explain why knowledge of law and ethics is critical thinking
important to health care practitioners. defendant
ethics
ethics committees
LO 1.2 Define law, ethics, and moral values as used in
ethics guidelines
health care by health care practitioners. etiquette
fraud
LO 1.3 Discuss the characteristics and skills most likely health care practitioner
to lead to a successful career in one of the Hippocratic oath
law
health care professions.
liable
litigious
medical ethicists
moral values
plaintiff
precedent
protocol
summary judgment


FROM THE PERSPECTIVE OF. . .
LINDA AND CAROL HAVE BEEN FRIENDS FOR ABOUT 4 YEARS.
THEY ARE BOTH RETIRED from careers in health care. Linda had been
a medical records supervisor in a 500-bed hospital and Carol had been
an LPN in a family practice and was married to a physician who had
retired, but still had an active license in another state. They met at the
local gym after retirement. They get together every few weeks for either
lunch or a movie. Over time, a friendship developed.
One day at lunch, the conversation was about health issues. Carol
talked about the variety of her chronic health problems that required
medication. She was a patient insured by Medicare. Initially, several
medications cost over $1,000 a month. Carol had them filled in Canada
for $400 a month, but the Canadian company went out of business. She
began to use her Medicare plan at $1,000 a month. In the meantime,
she discovered that her sister’s health plan would cover all but $50 of
the monthly cost of any medication. Her sister had private insurance.
Carol admitted to Linda that her husband had written a prescription for
her sister for one of the expensive medications. Her sister lived in the
state where Carol’s husband still had a medical license. Carol’s sister
filled the prescription and sent it to her.
Linda recently was diagnosed with endometrial cancer. She had a
radical hysterectomy and then began chemotherapy. Her oncologist
prescribed Zofran for any nausea or vomiting. Linda had used only 3
of the 30 tablets when she finished chemotherapy. She mentioned that
to Carol.
The lunch discussion changed to other topics and Linda decided to
forget about the conversation, as she knew what Carol’s husband had
done was illegal. Carol’s sister had also violated the law.
The next time Linda and Carol got together, the conversation was
about vacations. Carol was going on a 3-week cruise, and she mentioned
that she sometimes got a little seasick. She asked Linda if she could have
her remaining Zofran tablets. Linda quickly changed the subject and
Carol did not bring it up again.
From Carol’s perspective, it was all about saving money. She knew
what her husband had done was wrong, but felt justified in having
her husband and sister commit a minor crime. She thought that since
no one was harmed, and she was helped, that her behavior was not
that bad.
From Linda’s perspective, she was uncomfortable about learning what
Carol and her family had done, but decided to ignore it as the end result
was that Carol had her needed medication. She did a bit of research and
learned that Zofran was not used to treat seasickness, and she already
knew that it wasn’t all that expensive. She decided that if Carol brought
it up again, she was going to tell Carol that she had thrown the medi-
cation away, since she no longer needed it.

As you progress through Law & Ethics for the Health Professions, try to
interpret the court cases, laws, case studies, and other examples or
situations cited from the perspectives of everyone involved.

2 Chapter 1 | Introduction to Law and Ethics


1.1 Why Study Law and Ethics?
There are two important reasons for you to study law and ethics:
• To help you function at the highest possible professional level, provid-
ing competent, compassionate health care to patients
• To help you avoid legal entanglements that can threaten your ability to
earn a living as a successful health care practitioner health care practitioners
Those who are trained to administer
We live in a litigious society, in which patients, relatives, and others are medical or health care to patients.
inclined to sue health care practitioners, health care facilities, manufac- litigious
turers of medical equipment and products, and others when medical Prone to engage in lawsuits.
outcomes are not acceptable. This means that every person responsible
for health care delivery is at risk of being involved in a health care–
related lawsuit. It is important, therefore, for you to know the basics of
law and ethics as they apply to health care, so you can recognize and
avoid those situations that might not serve your patients well or that
might put you at risk of legal liability.
In addition to keeping you at your professional best and helping you
avoid litigation, knowledge of law and ethics can also help you gain
perspective in the following three areas:
1. The rights, responsibilities, and concerns of health care consumers. Health
care practitioners not only need to be concerned about how law and
ethics impact their respective professions but they must also under-
stand how legal and ethical issues affect the patients they treat. With
the increased complexity of medicine has come the desire of con-
sumers to know more about their options and rights and more about
the responsibilities of health care providers. Today’s health care con-
sumers are likely to consider themselves partners with health care
practitioners in the healing process and to question fees and treat-
ment modes. They may ask such questions as, Do I need to see a
specialist? If so, which specialist can best treat my condition? Will I
be given complete information about my condition? How much will
medical treatment cost? Will a physician treat me if I have no health
insurance?
In addition, as medical technology has advanced, patients have
come to expect favorable outcomes from medical treatment, and
when expectations are not met, lawsuits may result.
2. The legal and ethical issues facing society, patients, and health care prac-
titioners as the world changes. Nearly every day the media report news
events concerning individuals who face legal and ethical dilemmas
over biological/medical issues. For example, a grief-stricken husband
must give consent for an abortion in order to save the life of his wife,
who is critically ill and unconscious. Parents must argue in court
their decision to terminate life-support measures for a daughter
whose injured brain no longer functions. Patients with HIV/AIDS
fight to retain their right to confidentiality.
While the situations that make news headlines often involve larger
social issues, legal and ethical questions are resolved daily, on a
smaller scale, each time a patient visits a physician, dentist, physical
therapist, or other health care practitioner. Questions that must
often be resolved include these: Who can legally give consent if the
patient cannot? Can patients be assured of confidentiality, especially

Chapter 1
since computer technology and online access have become a way of
life? Can a physician or other health care practitioner refuse to treat
a patient? Who may legally examine a patient’s medical records?
Rapid advances in medical technology have also influenced laws
and ethics for health care practitioners. For example, recent court
cases have debated these issues: Does the husband or the wife have
ownership rights to a divorced couple’s frozen embryos? Will a sur-
rogate mother have legal visitation rights to the child she carried to
term? Should modern technology be used to keep those patients
alive who are diagnosed as brain-dead and have no hope of recovery?
How should parenthood disputes be resolved for children resulting
from reproductive technology?
3. The impact of rising costs on the laws and ethics of health care delivery.
Rising costs, both of health care insurance and of medical treatment
in general, lead to questions concerning access to health care ser-
vices and allocation of medical treatment. For instance, should the
uninsured or underinsured receive government help to pay for health
insurance? And should everyone, regardless of age or lifestyle, have
the same access to scarce medical commodities such as organs for
transplantation or very expensive drugs?

COURT CASES ILLUSTRATE RISK OF LITIGATION


As you will see in the court cases used throughout this text, sometimes
when a lawsuit is brought, the trial court or a higher court must first
plaintiff decide if the plaintiff has a legal reason to sue, or if the defendant is
The person bringing charges in a liable. When a court has ruled that there is a standing (reason) to sue
lawsuit.
and that a defendant can be held liable, the case may proceed to reso-
defendant lution. Often, once liability and a standing to sue have been established,
The person or party against whom
criminal or civil charges are brought in
the two sides agree on an out-of-court settlement. Depending on state
a lawsuit. law, an out-of-court settlement may not be published. For this reason,
the final disposition of a case is not always available from published
liable
Legally responsible or obligated. sources. The published cases that have decided liability, however, are still
case law, and such cases have been used in this text to illustrate specific
points.
In addition, sometimes it takes time after the initial trial for a case to
be settled. For example, perhaps a patient dies after surgery in 2022 and
the family files a wrongful death suit soon after. This case may go through
several appeals and finally be settled in 2026.
It is also important to remember that while the final result of a case
is important to the parties involved, from a legal standpoint, the most
important aspect of a court case is not the result but whether the case
represents good law and will be persuasive as other cases are decided.
Although recent cases published have been sought for illustration in
precedent
Decisions made by judges in the vari-
this text, sometimes a dated case (1995, 1970, 1980, 1991, etc.) is used
ous courts that become rule of law and because it established important precedent.
apply to future cases, even though they Court cases appear throughout each chapter of the text to illustrate
were not enacted by a legislature; also
known as case law.
how the legal system has resolved complaints brought by or against
health care service providers and product manufacturers. Some of these
summary judgment cases involve summary judgment. Summary judgment is the legal term
A decision made by a court in a lawsuit
in response to a motion that pleads for a decision made by a court in a lawsuit in response to a motion that
there is no basis for a trial. pleads there is no basis for a trial because there is no genuine issue of

4 Chapter 1 | Introduction to Law and Ethics


COURT CASE Patients Sue Hospitals
In 2018, lawsuits against a variety of hospitals, phy- she now has permanent incontinence. Source:
sicians, lawyers, nursing homes, and even power www.abajournal.com
companies that were moving through various courts • In Florida, family members of nursing home
included: patients who died during Hurricane Irma are
suing nursing home administrators and staff
• A dermatologist posted videos of herself sing- for failing to evacuate the facility after the air
ing and dancing during cosmetic surgery. Four conditioning crashed and the temperature
malpractice suits have already been settled, spiked. The families are also suing Florida
including one by a woman who suffered perma- Power and Light for failing to prioritize nursing
nent brain damage following surgery. Several home power restoration. Source: www.miamiherald
other lawsuits are expected to be filed in the .com
coming months. Source: www.abajournal.com
(All of the above cases were still in litigation as the
• Frightened into surgery by a medical litigation
ninth edition of Law & Ethics for Health Professions
law company, an Arkansas woman had surgery
to remove vaginal mesh. She has filed a lawsuit was prepared for publication, but perhaps the
against her former law firm and the litigation underlying reasons for filing the lawsuits are already
funding company that financed the operation as apparent to you.)

COURT CASE 911 Operators Sued


In 2006, just before 6 pm, a 5-year-old boy called The boy’s older sister sued the two 911 operators on
911. He told the 911 operator that his “mom has behalf of the dead woman’s estate and on behalf of
passed out.” When the operator asked to speak her son. The lawsuit alleged gross negligence causing
to the boy’s mother, he said, “She’s not gonna a death and intentional infliction of emotional distress.
talk.” The operator scolded the boy and logged The 911 operators argued that they were entitled
the call as a child’s prank. Three hours later, the to government immunity, that they owed no duty to
boy called 911 again. A different operator answered, provide assistance to the woman who died, and
and she also scolded the boy for playing a prank, that their failure to summon medical aid was not
but she did send a police officer to the boy’s gross negligence.
home. The officer discovered the boy’s mother A trial court and an appeals court found for the
lying unresponsive on the floor and summoned plaintiff, and the case was appealed to the Michigan
emergency medical services. The EMS workers Supreme Court, where in January 2012, the court
arrived 20 minutes later and determined that the denied further appeals.
woman was dead and had probably died within Source: Estate of Turner v. Nichols, 807 N.W.2d 164, 490 Mich.
the past 2 hours. 988 (2012).

material fact. In other words, a motion for summary judgment states that
one party is entitled to win as a matter of law. Summary judgment is
available only in a civil action. (Chapter 4 distinguishes between criminal
and civil actions.)
The following court cases illustrate that a wide variety of legal ques-
tions can arise for those engaged directly in providing health care ser-
vices, whether in a hospital, in a medical office, or in an emergency
situation. Health care equipment and product dealers and manufacturers

Chapter 1
can be held indirectly responsible for defective medical devices and prod-
ucts through charges of the following types:
• Breach of warranty
• Statements made by the manufacturer about the device or product
that are found to be untrue
• Strict liability, for cases in which defective products threaten the
fraud personal safety of consumers
Dishonest or deceitful practices in
depriving, or attempting to deprive,
• Fraud or intentional deceit (Fraud is discussed in further detail in
others of their rights. Chapters 4 and 8.)

LANDMARK COURT CASE  upreme Court Shields Medical Devices


S
from Lawsuits
An angioplasty was performed on a patient, Charles a violation of FDA regulations; the state duties in
Riegel, in New York. During the procedure, the cath- such a case “parallel,” rather than add to, federal
eter used to dilate the patient’s coronary artery requirements (Lohr, 518 U.S., at 495, 116 S.Ct. 2240).
failed, causing serious complications. The patient The Riegel case reached the U.S. Supreme Court,
sued the catheter’s manufacturer, Medtronic, Inc., where the question to be decided was this: Does
under New York state law, charging negligence in Section 360k(a) of the Medical Device Amendments
design, manufacture, and labeling of the device, to the Food, Drug, and Cosmetic Act preempt state
which had received Food and Drug Administration law claims seeking damages for injuries caused by
(FDA) approval in 1994. Medtronic argued that Riegel medical devices that received premarket approval
could not bring state law negligence claims because from the Food and Drug Administration?
the company was preempted from liability under In February 2008, the U.S. Supreme Court held
Section 360k(a) of the Medical Device Amendments in this case that makers of medical devices are
(MDA) of the U.S. Food, Drug, and Cosmetic Act. immune from liability for personal injuries as long as
State requirements are preempted under the MDA the FDA approved the device before it was mar-
only to the extent that they are “different from, or in keted and it meets the FDA’s specifications.
addition to” the requirements imposed by federal
Source: Appeals Court Case: Riegel v. Medtronic, Inc., 451 F.3d
law. Thus, 360k(a) does not prevent a state from 104 (2006); Supreme Court Case: Riegel v. Medtronic, Inc., 552
providing a damages remedy for claims premised on U.S. 312, 128 S.Ct. 999, 2008.

The extent of liability for manufacturers of medical devices and prod-


ucts may be changing, however, since a 2008 U.S. Supreme Court deci-
sion held that makers of medical devices such as implantable
defibrillators or breast implants are immune from liability for personal
injuries as long as the Food and Drug Administration (FDA) approved
the device before it was marketed and it meets the FDA’s specifications.
(See the previous Medtronic Inc. case.)
Drugs and medical devices are regulated under separate federal laws,
and an important issue in deciding drug injury cases is whether or not
the drug manufacturer made false or misleading statements to win FDA
approval. For example, the case Warner-Lambert Co. v. Kent, filed in 2006,
involved a group of Michigan residents who claimed injury after taking
Warner-Lambert’s Rezulin diabetes drug. The case was brought under a
Michigan tort reform law that said a drug company could be liable for
product injury if it had misrepresented the product to win FDA approval.
In this case, the question before the court was: Does a federal law pro-
hibiting fraudulent communications to government agencies preempt a

6 Chapter 1 | Introduction to Law and Ethics


Table 1-1 Damage Awards can be Substantial
• Drug: Talcum Powder (2018) A jury in Missouri found that Johnson and Johnson
should pay 22 women a total of $4.69 billion for causing ovarian cancer. There are
over 9,000 more lawsuits involving other talc-based products in state and federal
courts
• Drug: Juxtapid (2017) Aegerion Pharmaceuticals will pay more than $35 million to
settle criminal and civil charges related to the cholesterol drug Juxtapid. The sales
staff continued to distribute samples as a general treatment for high cholesterol.
Juxtapid was approved to treat just those patients who have a rare genetic disease
call homozygous familial hypercholesterolemia.
• Drug: Epipen (2017) The Department of Justice brought charges against Mylan and
Mylan, makers of the Epipen for classifying the Epipen as a generic drug. Mylan
and Mylan did this to avoid paying Medicaid rebates. The company is paying $465
million to settle allegations.

Source: www.drugwatch.com.

state law permitting plaintiffs to sue for faulty products that would not
have reached the market absent the fraud?
A federal appeals court eventually heard the case and ruled that the
Michigan “fraud on the FDA” law was preempted by a federal law that
allowed the FDA itself to punish misrepresentations. This decision was
appealed to the U.S. Supreme Court, and in a March 2008 decision, the
Supreme Court affirmed the appeals court, thus leaving the previous
state of the law unchanged and unclarified.
In this case, the people who sued the drug manufacturer were not
allowed to collect damages. But when courts find that drugs are misrep-
resented so that developers can win FDA approval, drug manufacturers
could be held legally responsible and forced to pay damages. Table 1-1
lists several settlements.

COURT CASE Patient Sues over Drug-Labeling Issue


In 2000, Diana Levine, a Vermont woman in her new trial. Levine was awarded $7 million in dam-
fifties, sought medical help for migraine headaches. ages for the amputation of her arm. The Supreme
As part of the treatment, the anti-nausea drug Phen- Court of Vermont affirmed this ruling on appeal,
ergan, made by Wyeth, was injected in her arm. An holding that the FDA requirements merely provide
artery was accidentally damaged during the injec- a floor, not a ceiling, for state regulation. Therefore,
tion, gangrene set in, and Levine’s right arm was states are free to create more stringent labeling
amputated. The amputation was devastating for requirements than federal law provides.
Levine, a professional musician who had released The U.S. Supreme Court eventually heard the
16 albums, and she filed a personal injury action case and issued a decision in March 2009. Wyeth
against Wyeth in Vermont state court. had argued that because the warning label had
Levine asserted that Wyeth should have included been accepted by the FDA, any Vermont state
a warning label describing the possible arterial inju- regulations making the label insufficient were pre-
ries that could occur from negligent injection of the empted by the federal approval. The U.S. Supreme
drug. Wyeth argued that because the warning label Court affirmed the Vermont Supreme Court, hold-
had been deemed acceptable by the FDA, a federal ing that federal law did not preempt Levine’s state
agency, any Vermont state regulations making the law claim that Wyeth’s labeling of Phenergan
label insufficient were preempted by the federal failed to warn of the dangers of intravenous
approval. The Superior Court of Vermont found in administration.
favor of Levine and denied Wyeth’s motion for a Source: Wyeth v. Levine, 555 U.S. 555, 173 L.Ed.2d 51 (2009).

Chapter 1
Federal preemption—a doctrine that can bar injured consumers from
suing in state court when the products that hurt them had met federal
standards—has become an important concern in product liability law.
One such case, Wyeth v. Levine, decided by the U.S. Supreme Court in
2009, will become precedent for future cases involving drug manufactur-
ers and consumers.

1.2 Comparing Aspects of


Law and Ethics
To understand the complexities of law and ethics, it is helpful to define
and compare a few basic terms. Table 1-2 summarizes the terms described
in the following sections.

LAW
law A law is defined as a rule of conduct or action prescribed or formally
Rule of conduct or action prescribed or recognized as binding or enforced by a controlling authority. Govern-
formally recognized as binding or
enforced by a controlling authority.
ments enact laws to keep society running smoothly and to control behav-
ior that could threaten public safety. Laws are considered the minimum
standard necessary to keep society functioning.

Table 1-2 Comparing Aspects of Law and Ethics

Law Ethics Moral Values

Definition Set of governing rules Principles, standards, Beliefs formed through the influence
guide to conduct of family, culture, and society

Main purpose To protect the public To elevate the standard To serve as a guide for personal
of competence ethical conduct

Standards Minimal—promotes smooth Builds values and ideals Serves as a basis for forming a
functioning of society personal code of ethics

Penalties of Civil or criminal liability. Upon Suspension or eviction Difficulty in getting along with
violation conviction: fine, imprisonment, from medical society others
revocation of license, or other penalty membership, as decided
as determined by courts by peers

Bioethics Etiquette Protocol

Definition Discipline relating to ethics Courtesy and manners Rules of etiquette applicable to
concerning biological research, one’s place of employment
especially as applied to medicine

Main purpose To allow scientific progress in a To enable one to get To enable one to get along with
manner that benefits society in all along with others others engaged in the same
possible ways profession

Standards Leads to the highest standards Leads to pleasant Promotes smooth functioning of
possible in applying research to interaction workplace routines
medical care

Penalties of Can include all those listed under Ostracism from chosen Disapproval from one’s professional
violation “Law,” “Ethics,” and “Etiquette”; as groups colleagues; possible loss of
current standards are applied and as business
new laws and ethical standards evolve
to govern medical research and
development, penalties may change

8 Chapter 1 | Introduction to Law and Ethics


Enforcement of laws is made possible by penalties for disobedience,
which are decided by a court of law or are mandatory as written into
the law. Penalties vary with the severity of the crime. Lawbreakers may
be fined, imprisoned, or both. Sometimes lawbreakers are sentenced to
probation. Other penalties appropriate to the crime may be handed
down by the sentencing authority, as when offenders must perform a
specified number of hours of volunteer community service or are ordered
to repair public facilities they have damaged.
Many laws affect health care practitioners, including criminal and civil
statutes as well as state practice acts. Every licensed health profession
has some form of practice act at the state level. Licensed health care
professionals convicted of violating criminal, civil, or medical practice
laws may lose their licenses to practice. (Practice acts are discussed fur-
ther in Chapter 3. Laws and the court system are discussed in more
detail in Chapter 4.)

ETHICS
An illegal act by a health care practitioner is always unethical, but an
unethical act is not necessarily illegal. Ethics are concerned with stan- ethics
dards of behavior and the concept of right and wrong, over and above Standards of behavior, developed as a
result of one’s concept of right and
that which is legal in a given situation. Moral values—formed through wrong.
the influence of the family, culture, and society—serve as the basis for
moral values
ethical conduct. One’s personal concept of right and
The United States is a culturally diverse country, with many residents wrong, formed through the influence of
who have grown up within vastly different ethnic environments. For the family, culture, and society.
example, a Chinese student in the United States brings a unique set of
religious and social experiences and moral concepts that will differ from
that of a German, Japanese, Korean, Italian, or Canadian classmate.
Therefore, moral values and ethical standards can differ for health care
practitioners, as well as patients, in the same setting.
In the American cultural environment, however, acting morally
toward another usually requires that you put yourself in that individual’s
place. For example, when you are a patient in a physician’s office, how
do you like to be treated? As a health care provider, can you give care
to a person whose conduct or professed beliefs differ radically from your
own? In an emergency, can you provide for the patient’s welfare with-
out reservation?

Check Your Progress

1. Name two important reasons for studying law and ethics.


2. Which state laws apply specifically to the practice of medicine?
3. What purpose do laws serve?
4. How is the enforcement of laws made possible?
5. What factors influence the formation of one’s personal set of ethics and values?
6. Define the term moral values.
7. Explain how one’s moral values affect one’s sense of ethics.

Chapter 1
CODES OF ETHICS AND ETHICS GUIDELINES
While most individuals can rely on a well-developed personal value sys-
code of ethics tem, organizations for the health occupations also have formalized codes
A list of principles intended to govern of ethics to govern behavior of members and to increase the level of
behavior—here, the behavior of those
entrusted with providing care to the sick.
competence and standards of care within the group. Included among
these are the American Nurses Association Code for Nurses, American
Medical Association Code of Medical Ethics, American Health Informa-
tion Management Association Code of Ethics, American Society of
Radiologic Technologists Code of Ethics, and the Code of Ethics of the
American Association of Medical Assistants. Codes of ethics generally
consist of a list of general principles and are often available to laypersons
as well as members of health care practitioner organizations.
Many professional organizations for health care practitioners also pub-
ethics guidelines lish more detailed ethics guidelines, usually in book form, for members.
Publications that detail a wide variety of Generally, ethics guideline publications detail a wide variety of ethical
ethical situations that professionals (in
this case, health care practitioners) might situations that health care practitioners might face in their work and
face in their work and offer principles for offer principles for dealing with the situations in an ethical manner. They
dealing with the situations in an ethical are routinely available to members of health care organizations and are
manner.
typically available to others for a fee.
One of the earliest medical codes of ethics, the code of Hammurabi,
was written by the Babylonians around 2250 b.c.e. This document dis-
cussed the conduct expected of physicians at that time, including fees
that could be charged.
Sometime around 400 b.c.e., a pledge for physicians known as the
Hippocratic oath Hippocratic oath was published. The oath was probably not actually writ-
A pledge for physicians, influenced by ten by Hippocrates, the Greek physician known as the Founder of Med-
the practices of the Greek physician
Hippocrates.
icine. Authorship has been attributed to one or more of his students and
to the Pythagoreans, but scholars indicate it was probably derived from
Hippocrates’s writings (see Figure 1-1).
Percival’s Medical Ethics, written by the English physician and philos-
opher Thomas Percival in 1803, superseded earlier codes to become the
definitive guide for a physician’s professional conduct. Earlier codes did
not address concerns about experimental medicine, but according to
Percival’s code, physicians could try experimental treatments when all
else failed, if such treatments served the public good.
When the American Medical Association met for the first time in
Philadelphia in 1847, the group devised a code of ethics for members
based on Percival’s code. The resulting American Medical Association Prin-
ciples, currently called the American Medical Association Principles of Med-
ical Ethics, has been revised and updated periodically to keep pace with
changing times. The current statements may be found at www.ama-assn
.org/delivering-care/ama-code-medical-ethics. This Web site details the
AMA’s guidance on a variety of areas to include patient and physician
actions, treatments and use of technologies and professional relation-
ships, and self-regulation.
The AMA code is written for physicians but could also pertain to other
health care professions. Another organization that has recently revised
its code of ethics is the National Association for Healthcare Quality
(NAHQ). The NAHQ has compiled a Code of Ethics for the Healthcare
Quality Profession and Code of Conduct that was issued in April 2018.
It identifies a variety of behaviors that may be appropriate for a variety

10 Chapter 1 | Introduction to Law and Ethics


FIGURE 1-1
Hippocratic Oath

(photo): Rijksmuseum, Amsterdam; (art): The Hippocratic Oath

of health care professions. The Code is located at https://nahq.org


/about/code-of-ethics.
Figure 1-2 is an example of a code of ethics from the American Asso-
ciation of Medical Assistants. Professional health care practitioners may
look to their professional association for guidance when they are trou-
bled by unethical behavior of other health care practitioners. They may
also look to peers and supervisors. Illegal behavior must always be
reported to the appropriate authorities.

BIOETHICS bioethics
A discipline dealing with the ethical
Bioethics is a discipline dealing with the ethical implications of biologi- implications of biological research meth-
cal research methods and results, especially in medicine. As biological ods and results, especially in medicine.

Chapter 1
FIGURE 1-2  ode of Ethics and Creed of the American Association
C
of Medical Assistants (AAMA)

The Medical Assisting Code of Ethics of the AAMA sets forth principles of ethical and moral conduct as they relate to the medical
profession and the particular practice of medical assisting.

Members of AAMA dedicated to the conscientious pursuit of their profession, and thus desiring to merit the high regard of the entire
medical profession and the respect of the general public which they serve, do pledge themselves to strive always to:

A. Render service with full respect for the dignity of humanity.

B. Respect confidential information obtained through employment unless legally authorized or required by responsible
performance of duty to divulge such information.

C. Uphold the honor and high principles of the profession and accept its disciplines.

D. Seek to continually improve the knowledge and skills of medical assistants for the benefit of patients and professional
colleagues.

E. Participate in additional service activities aimed toward improving the health and well-being of the community.

The Medical Assisting Creed of the AAMA sets forth medical assisting statements of belief:

I I believe in the principles and purposes of the profession of medical assisting.

II I endeavor to be more effective.

III I aspire to render greater service.

IV I protect the confidence entrusted to me.

V I am dedicated to the care and well-being of all people.

VI I am loyal to my employer.

VII I am true to the ethics of my profession.

VIII I am strengthened by compassion, courage and faith.

Copyright by American Association of Medical Assistants. All rights reserved. Used with permission.

research has led to unprecedented progress in medicine, medical prac-


titioners have had to grapple with issues such as these:
• What ethics should guide biomedical research? Do individuals own
all rights to their body cells, or should scientists own cells they have
altered? Is human experimentation essential, or even permissible, to
advance biomedical research?
• What ethics should guide organ transplants? Transplant organs are
in high demand but is the search for these organs inhumane? Should
certain categories of people have lower priority than others for organ
transplants?

12 Chapter 1 | Introduction to Law and Ethics


• What ethics should guide fetal tissue research? Some say such
research, especially stem cell research, is moral because it offers hope
to people with diseases, while others argue that it is immoral.
• Do reproductive technologies offer hope to the childless, or are they
unethical? Are the multiple births that sometimes result from taking
fertility drugs an acceptable aspect of reproductive technology, or are
those multiple births too risky for women and their fetuses and even
immoral in an allegedly overpopulated world?
• Should animals be used in research?
• How ethical is genetic research? Should the government regulate it?
Will genetic testing benefit those at risk for genetic disease, or will
it lead to discrimination? Should cloning of human organs for trans-
plantation be permitted? Should cloning of human beings ever be
permitted?
Society is attempting to address these questions, but because the issues
are complicated, many questions may never be completely resolved.

THE ROLE OF ETHICS COMMITTEES


Health care practitioners may be able to resolve the majority of the eth-
ical issues they face in the workplace from their own intuitive sense of
moral values and ethics. Some ethical dilemmas, however, are not so
much a question of right or wrong, but more a question of “Which of
these alternatives will do the most good and the least harm?” In these
more ambiguous situations, health care practitioners may want to ask
the advice of a medical ethicist or members of an institutional ethics
committee.
Medical ethicists or bioethicists are specialists who consult with medical ethicist or bioethicist
physicians, researchers, and others to help them make difficult deci- Specialists who consult with physicians,
researchers, and others to help them
sions, such as whether to resuscitate premature infants with brain dam- make difficult ethical decisions regarding
age or what ethics should govern privacy in genetic testing. Hospital patient care.
or medical center ethics committees usually consist of physicians, ethics committee
nurses, social workers, clergy, a patient’s family, members of the com- Committee made up of individuals who
munity, and other individuals involved with the patient’s medical care. are involved in a patient’s care, includ-
ing health care practitioners, family
A medical ethicist may also sit on the ethics committee if such a spe-
members, clergy, and others, with the
cialist is available. When difficult decisions must be made, any one of purpose of reviewing ethical issues in
the individuals involved in a patient’s medical care can ask for a con- difficult cases.
sultation with the ethics committee. Larger hospitals have standing
ethics committees, while smaller facilities may form ethics committees
as needed.
When a case is referred to the ethics committee, the members meet
and review the case. The committee does not make binding decisions
but helps the physician, nurse, patient, patient’s family, and others
clarify the issue and understand the medical facts of the case and the
alternatives available to resolve the situation. Ethics committees may
also help with conflict resolution among parties involved with a case.
They do not, however, function as institutional review boards or mor-
als police looking for health care workers who have committed uneth-
ical acts.
See Chapter 2 for a more detailed discussion of the processes involved
in making ethical decisions.

Chapter 1
ETIQUETTE
While professional codes of ethics focus on the protection of the patient
and the patient’s right to appropriate, competent, and humane treat-
etiquette ment, etiquette refers to standards of behavior that are considered good
Standards of behavior considered to be manners. Every culture has its own ideas of common courtesy. Behavior
good manners among members of a
profession as they function as individuals
considered good manners in one culture may be bad manners in another.
in society. For example, in some Middle Eastern countries, it is extremely discour-
teous for one male acquaintance to ask another, “How is your wife?” In
Western culture, such a question is well received. Similarly, within nearly
every profession, there are recognized practices considered to be good
manners for members.
Most health care facilities have their own policies concerning profes-
sional etiquette that staff members are expected to follow. Policy manu-
als written especially for the facility can serve as permanent records and
as guidelines for employees in these matters.
By the same token, health care practitioners are expected to know
protocol protocol, standard rules of etiquette applicable specifically to their place
A code prescribing correct behavior in a of employment. For example, when another physician telephones, does
specific situation, such as a situation
arising in a medical office.
the receptionist put the call through without delay? What is the protocol
in the diagnostic testing office when the technicians get behind because
of a late patient or a repair to an X-ray machine?
Within the health care environment, all health care practitioners are,
of course, expected to treat patients with the same respect and courtesy
afforded others in the course of day-to-day living. Politeness and appro-
priate attire are mandatory.

1.3 Qualities of Successful Health


Care Practitioners
Successful health care practitioners have a knowledge of techniques and
principles that includes an understanding of legal and ethical issues.
They must also acquire a working knowledge of and tolerance for human
nature and individual characteristics, since daily contact with a wide
variety of individuals with a host of problems and concerns is a signifi-
cant part of the work. Courtesy, compassion, and common sense are
often cited as the “three Cs” most vital to the professional success of
health care practitioners.

COURTESY
courtesy The simplest definition of courtesy is the practice of good manners. Most
The practice of good manners. of us know how to practice good manners, but sometimes circumstances
make us forget. Maybe we’re having a rotten day—we overslept and
dressed in a hurry but were still late to work; the car didn’t start so we
had to walk, making us even more late; we were rebuked at work for
coming in late … and on and on. Perhaps we’re burned out, stressed
out, or simply too busy to think. Regardless of a health care practitioner’s
personal situation, however, patients have the right to expect courtesy
and respect, including self-introduction. (“Hi, I’m Maggie, and I’ll be
taking care of you” is one nursing assistant’s way of introducing herself
to new patients in the skilled nursing care facility where she works.)

14 Chapter 1 | Introduction to Law and Ethics


Think back to experiences you have had with health care practitioners.
Did the receptionist in a medical office greet you pleasantly, or did he
or she make you feel as though you were an unwelcome intruder? Did
the laboratory technician or phlebotomist who drew your blood for test-
ing put you at ease or make you more anxious than you already were?
If you were hospitalized, did health care practitioners carefully explain
procedures and treatments before performing them, or were you left
wondering what was happening to you? Chances are that you know from
your own experiences how important common courtesy can be to a
patient.

COMPASSION
Compassion is empathy—the identification with and understanding of compassion
another’s situation, feelings, and motives. In other words, compassion is The identification with and understand-
ing of another’s situation, feelings, and
temporarily putting oneself in another’s shoes. It should not be confused motives.
with sympathy, which is feeling sorry for another person’s plight—typi-
cally a less deeply felt emotion than compassion. While “I know how
you feel” is not usually the best phrase to utter to a patient (it too often
earns the retort, “No, you don’t”), compassion means that you are sin-
cerely attempting to know how the patient feels.

COMMON SENSE
Common sense is simply sound practical judgment. It is somewhat dif- common sense
ficult to define because it can have different meanings for different peo- Sound practical judgment.

ple, but it generally means that you can see which solution or action
makes good sense in a given situation. For example, if you were a nurs-
ing assistant and a gasping, panicked patient told you he was having
trouble breathing, common sense would tell you to immediately seek
help. You wouldn’t simply enter the patient’s complaint in his medical
chart and wait for a physician or a nurse to see the notation. Likewise,
if a patient spilled something on the floor, common sense would tell you
to wipe it up (even if you were not a member of the housekeeping staff)
before someone stepped in it and possibly slipped and fell. While it’s
not always immediately obvious that someone has common sense, it
usually doesn’t take long to recognize its absence in an individual.
Additional capabilities that are helpful to those who choose to work
in the health care field include those that are listed in the following
sections “People Skills” and “Technical Skills.”

PEOPLE SKILLS
People skills are those traits and capabilities that allow you to get along
well with others and to relate well to patients or clients in a health care
setting. They include such attributes as the following:
• A relaxed attitude when meeting new people
• An understanding of and empathy for others
• Good communication skills, including writing, speaking, and listening
• Patience in dealing with others and the ability to work as a member
of a health care team
• Tact, or sensitivity when dealing with others or with difficult issues
Chapter 1
• The ability to impart information clearly and accurately
• The ability to keep information confidential
• The ability to leave private concerns at home
• Trustworthiness and a sense of responsibility

TECHNICAL SKILLS
Technical skills include those abilities you have acquired in your course
of study, including but not limited to the following:
• Computer literacy
• Proficiency in English, science, and mathematics
• A willingness to learn new skills and techniques
• An aptitude for working with the hands
• Ability to document well
• Ability to think critically

CRITICAL THINKING SKILLS


When faced with a problem, most of us worry a lot before we finally
begin working through the problem effectively, which means using fewer
emotions and more rational thinking skills. As a health care practitioner,
you will be expected to approach a problem at work in a manner that
lets you act as ethically, legally, and helpfully as possible. Sometimes
solutions to problems must also be found as quickly as possible, but
solutions must always be within the scope of your training, licensure,
critical thinking and capabilities. This problem-solving process is called critical thinking.
The ability to think analytically, using Here is a five-step aid for approaching a problem using critical thinking:
fewer emotions and more rationality.
1. Identify and clarify the problem. It’s impossible to solve a problem
unless you know the exact nature of the problem. For example,
imagine that patients in a medical office have frequently complained
that the wait to see physicians is too long, and several have protested
loudly and angrily that their time “is valuable too.” Rhea is the wait-
ing room receptionist and the person who faces angry patients first,
so she would like to solve this problem as quickly as possible. Rhea
has recognized that a problem exists, of course, but her apologies to
patients have been temporary fixes, and the situation continues.
2. Gather information. In the previous situation, Rhea begins to gather
information. She first checks to see exactly why patients have been
kept waiting and considers the following questions: Are all the phy-
sicians simply oversleeping and beginning the day behind schedule?
(Not likely, but an easy solution if this were the case would be to
buy the physicians new alarm clocks.) Are the physicians often
delayed in surgery or because of hospital rounds? Is the clinic under-
staffed? How long, on average, has each patient who has complained
been waiting beyond the appointment time?
3. Evaluate the evidence. Rhea evaluates the answers she has gathered
to the earlier questions and determines that too many patients are,
indeed, waiting too long beyond appointment times to see their phy-
sicians. The next step in the critical thinking process is to consider
all possible ways to solve the problem.

16 Chapter 1 | Introduction to Law and Ethics


4. Consider alternatives and implications. Rhea has determined that
the evidence supports the fact that a problem exists and begins to
formulate alternatives by asking herself these questions: Could the
waiting room be better supplied with current reading material or
perhaps television sets and a children’s corner, so that patients both
with and without children are less likely to complain about waiting?
Is the waiting room cheery and comfortable, so waiting does not
seem interminable? What solution would best serve the goals of phy-
sicians, other medical office personnel, and patients? Should Rhea
look more closely at how patients are scheduled and discuss possible
changes with the office manager or supervisor? Rhea must consider
costs of, objections to, and all others’ opinions of each alternative
she considers.
5. Choose and implement the best alternative. Rhea selects an alterna-
tive and implements it. As a medical office receptionist, she cannot
act alone, but she has brought the problem to the attention of those
who can help, and her suggestions have been heard. As a result of
Rhea’s research, acceptable solutions to patients’ complaints that
they are forced to wait too long to see physicians might include the
following:
• While there is a sign-in sheet at the front desk, the sheet does
not ask patients what time they arrived or their appointment
time. A new sign-in sheet should be created that provides patient
arrival and appointment times so that Rhea or other front office
staff can monitor wait time issues. This should be done before
Rhea makes any recommendations about changing appointment
times.
• Additional personnel are hired to see patients.
• The waiting room is stocked with current news publications, tele-
vision sets, and/or a child play center for patient comfort while
waiting.
Critical thinking is not easy, but, like any skill, it improves with
practice.

Check Your Progress

8. Describe how each of the following characteristics relates to law and ethics in the health
care professions:
The ability to be a good communicator and listener
The ability to keep information confidential
The ability to impart information clearly and accurately
The ability to think critically
9. List and discuss each of the steps helpful to developing critical thinking skills.
10. Explain how you, as a health care practitioner, would use the critical thinking steps listed
previously to reach a solution to the following problem: A patient holds the cultural belief
that evil spirits can cause illness. The patient wants to have his liver surgically removed
because he believes the organ has been cursed.

Chapter 1
DETERMINING IF A DECISION IS ETHICAL
While considering the legality of a certain act, health care practitioners
must also consider ethical implications. According to many ethics experts,
the following questions can help you determine if an act you have
decided on via critical thinking skills is ethical:
• If you perform this act, have you followed relevant laws and kept
within your employing organization’s policy?
• Will this act promote a win–win situation for as many of the involved
individuals as possible?
• How would you feel if this act were to be publicized in the newspa-
pers or other media?
• Would you want your family members to know?
• If you perform this act, can you look at yourself in a mirror?
The health care practitioner who demonstrates these qualities and skills,
coupled with a working knowledge of law and ethics, is most likely to
find success and job satisfaction in a chosen profession.

18 Chapter 1 | Introduction to Law and Ethics


Chapter Summary

Learning Outcome Summary

LO 1.1 Explain why Why study law and ethics?


knowledge of law and
ethics is important to • Health care practitioners who function at the highest possible levels have a working
knowledge of law and ethics.
health care practitioners.
• Knowing the law relevant to your profession can help you avoid legal entanglements that
threaten your ability to earn a living. Court cases illustrate how health care practitioners,
health care facilities, and drug and medical device manufacturers can be held accountable
in a court of law.
• A knowledge of law and ethics will also help familiarize you with the following areas:
• The rights, responsibilities, and concerns of health care consumers
• The legal and ethical issues facing society, patients, and health care practitioners as
the world changes
• The impact of rising costs on the laws and ethics of health care delivery

LO 1.2 Define law, ethics, What are the basic aspects of law and ethics, and how do they compare?
and moral values as used
in health care by health • Laws are considered the minimum standard necessary to keep society functioning. Many
laws govern the health care professions, including criminal and civil statutes and medical
care practitioners.
practice acts.
• Ethics are principles and standards that govern behavior. Most health care professions
have a code of ethics members are expected to follow.
• Bioethics is the discipline dealing with the ethical implications of biological research
methods and results, especially in medicine.
• Moral values define one’s personal concept of right and wrong.
• Etiquette refers to manners and courtesy.
• Protocol is a code prescribing correct behavior in a specific situation, such as in a medical
office.

LO 1.3 Discuss the What characteristics and skills will most likely help a health care practitioner achieve
characteristics and skills success?
most likely to lead to a
successful career in one of • People skills, such as listening to others and communicating well, are an asset to health
care practitioners.
the health care professions.
• Technical skills, including a basic knowledge of computers, and a foundation in science
and math are necessary to achieve an education in the health care sciences.
• Critical thinking skills are required for you to correctly assess a situation and provide the
proper response. Solving problems through critical thinking involves:
1. Identifying and clarifying the problem
2. Gathering information
3. Evaluating the evidence
4. Considering alternatives and implications
5. Choosing and implementing the best alternative
What questions can help you determine if a decision is ethical?
1. If you perform this act, have you followed relevant laws and kept within your
employing organization’s policy?
2. Will this act promote a win–win situation for as many of the involved individuals as
possible?
3. How would you feel if this act were to be publicized in the newspapers or other
media?
4. Would you want your family members to know?
5. If you perform this act, can you look at yourself in a mirror?

Chapter 1
Chapter 1 Review
Applying Knowledge
LO 1.1
1. List three areas where health care practitioners can gain insight through studying law and ethics.
2. Define summary judgment.

LO 1.2
3. Define bioethics.
4. Define law.
5. Define ethics.
6. How is unethical behavior punished?
7. Define etiquette.
8. How are violations of etiquette handled?
9. What is the purpose of a professional code of ethics?
10. Name five bioethical issues of concern in today’s society.
11. What duties might a medical ethicist perform?
12. Decisions made by judges in the various courts and used as a guide for future decisions are called what?
13. Written codes of ethics for health care practitioners
a. Evolved primarily to serve as moral guidelines for those who provided care to the sick
b. Are legally binding
c. Did not exist in ancient times
d. None of these
14. Which Greek physician is known as the Founder of Medicine?
a. Hippocrates
b. Percival
c. Hammurabi
d. Socrates
15. Name the pledge for physicians that remains influential today.
a. Code of Hammurabi
b. Babylonian Ethics Code
c. Hippocratic oath
d. None of these
16. What ethics code superseded earlier codes to become the definitive guide for a physician’s professional
conduct?
a. Code of Hammurabi
b. Percival’s Medical Ethics
c. Hippocratic oath
d. Babylonian Ethics Code

20 Chapter 1 | Introduction to Law and Ethics


17. Unethical behavior is always
a. Illegal
b. Punishable by legal means
c. Unacceptable
d. None of these
18. Unlawful acts are always
a. Unacceptable
b. Unethical
c. Punishable by legal means
d. All of these
19. Violation of a professional organization’s formalized code of ethics
a. Always leads to prosecution in a court of law
b. Is ignored if one’s membership dues in the organization are paid
c. Can lead to expulsion from the organization
d. None of these
20. Law is
a. The minimum standard necessary to keep society functioning smoothly
b. Ignored if transgressions are ethical, rather than legal
c. Seldom enforced by controlling authorities
d. None of these
21. Conviction of a crime
a. Cannot result in loss of license unless ethical violations also exist
b. Is always punishable by imprisonment
c. Always results in expulsion from a professional organization
d. Can result in loss of license
22. The basis for ethical conduct includes
a. Morals c. Family
b. Culture d. All of these
23. What is bioethics concerned with?
a. Health care law
b. Etiquette in medical facilities
c. The ethical implications of biological research methods and results
d. None of these

LO 1.3
24. Critical thinking skills include
a. Assessing the ethics of a situation
b. First clearly defining a problem
c. Determining the legal implications of a situation
d. None of these
Chapter 1
25. A medical assistant greets a patient and states “I am Jonathan and I will be your medical assistant today.”
This is an example of
a. Empathy c. Common sense
b. Trustworthiness d. Courtesy

Ethics Issues Introduction to End-of-Chapter Ethics Discussions

Learning Outcomes for the Ethics Issues Feature at the End of Each Chapter
After studying the material in each chapter’s Ethics Issues feature, you should be able to:
1. Discuss current ethical issues of concern to health care practitioners.
2. Compare ethical guidelines to the law as discussed in each chapter of the text.
3. Practice critical thinking skills as you consider medical, legal, and ethical issues for each situation presented.
4. Relate the ethical issues presented in the text to the health care profession you intend to practice.
Health care practitioners are bound by state and federal laws, but they are also bound by certain ethical
standards—both personal standards and those set forth by professional codes of ethics and ethical guidelines and
by bioethicists. Many professional organizations for health care practitioners employ an ethics consultant who
is available to speak with organization members who need help with an ethical dilemma. “We serve as a third
party who can stand outside a situation and facilitate communication,” says Dr. Carmen Paradis, an ethics con-
sultant with the Cleveland Clinic’s Department of Bioethics. At the Cleveland Clinic, ethics consultations are
available to health care practitioners, patients, family members, and others involved with patient decisions.
Medical facility ethics committees can also serve as consultants. In larger health care facilities, such commit-
tees usually deal with institutional matters, but in smaller communities where ethics consultants may not be
available, members of an ethics committee may also function as ethics consultants.
Keep in mind as you read the Ethics Issues feature for each chapter that ethical guidelines are not law but
deal solely with ethical conduct for health care practitioners. Most guidelines published for professional health
care practitioner organizations emphasize this difference. For example, as stated in Guidelines for Ethical Conduct
for the Physician Assistant Profession:
Physician Assistants are expected to behave both legally and morally. They should know and understand
the laws governing their practice. Likewise, they should understand the ethical responsibilities of being
a health care professional. Legal requirements and ethical expectations will not always be in agreement.
Generally speaking, the law describes minimum standards of acceptable behavior, and ethical principles
delineate the highest moral standards of behavior.
Source: www.aapa.org/wp-content/uploads/2017/02/16-EthicalConduct.pdf, ©American Academy of PAs.

The ethical guidelines for various health care professions have several points in common, but first and foremost
is that health care practitioners are obligated to provide the best care possible for every patient and to protect
the safety, privacy, and welfare of every patient.
State and federal laws may differ somewhat from an ethical principle. For example, a state’s law may not
require physicians to routinely inquire about physical, sexual, and psychological abuse as part of a patient’s
medical history, but the physician may feel an ethical duty to patients to do so.
Furthermore, the fact that a health care practitioner who has been charged with illegal conduct is acquitted
or exonerated does not necessarily mean that the health care practitioner acted ethically.
The term ethical as used here refers to matters involving the following:
1. Moral principles or practices
2. Matters of social policy involving issues of morality in the practice of medicine
The term unethical refers to professional conduct that fails to conform to these moral standards or policies.
The ethical issues raised are from the real-life experiences of a variety of health care practitioners and are
recounted throughout the text to raise awareness of the ethical dilemmas many practitioners face daily and to
stimulate discussion.

22 Chapter 1 | Introduction to Law and Ethics


Ethics Issues Introduction to Law and Ethics

Use your critical thinking skills to answer the questions that follow each ethics issue.

Ethics Issue 1:
A physician assistant (PA) in a medical practice with several physicians contacts his professional association, the
American Academy of Physician Assistants (AAPA), to report that one of his employing physicians often recom-
mends chiropractic treatment for patients with persistent back pain issues that have resisted medical solutions.
The PA knows it is legal to refer a patient for chiropractic treatments, but he adamantly opposes the practice,
considering it “bogus medicine.” The physician declines to discuss the matter.

Discussion Questions
26. In your opinion, how might the situation be resolved?
27. Is it ethical for the PA to continue working for the physician when their opinions differ so widely on this issue?

Ethics Issue 2:
A registered nurse calls her professional organization’s ethics consultant to ask for resources she can present to
her employing medical clinic to support her intention to quit working with a physician she feels is providing
sloppy and possibly dangerous care.

Discussion Questions
28. What is the most important principle for the nurse to consider here?
29. In your opinion, are there legal issues inherent in this situation, as well as ethical issues? Explain your
answer.

Ethics Issue 3:
A PA has been helping treat a patient awaiting a heart transplant. The patient is depressed and says he no
longer wants to live. The PA is doubtful that the patient will cooperate in the demanding regimen required for
post-transplantation patients.

Discussion Question
30. Is it ethical for the PA to discuss the patient’s depression with the patient’s family? Should the PA find out
if the patient has been treated for depression before the heart issues?

Ethics Issue 4:
Family members of a certified medical assistant employed by a medical clinic in a small community often ask
the CMA (AAMA) for medical advice. Two of her family members have asked her to bring antibiotic samples
home for them.

Discussion Question
31. In your opinion, would it be ethical or legal for the CMA (AAMA) to give medical advice to her own family
members? To bring drug samples home for them? Explain your answers.

Ethics Issue 5:
A radiology technician practicing in a small community is interested in dating a person he has seen as a patient.

Discussion Question
32. In your opinion, would it be ethical for the radiology technician to date one of his patients? Would it be
ethical for him to date a coworker? Explain your answers.

Chapter 1
Case Studies
LO 1.2
Use your critical thinking skills to answer the questions that follow each case study. Indicate whether each sit-
uation is a question of law, ethics, protocol, or etiquette.
You are employed as an assistant in an ophthalmologist’s office. Your neighbor asks you to find out for him
how much another patient was charged for an eye examination at the eye clinic that employs you. Your neighbor
also asks you how much the patient was charged for his prescription eyeglasses (the eye clinic also sells lenses
and frames).
33. Can you answer either of your neighbor’s questions? Explain your answer.
A physician employs you as a medical assistant. Another physician comes into the medical office where you
work and asks to speak with your physician/employer.
34. Should you seat the physician in the waiting room, or show her to your employer’s private office? Why?
You are employed as a licensed practical nurse (LPN) in a small town. (In California and Texas, the term for this
profession is licensed vocational nurse, abbreviated as LVN.) A woman visits the clinic where you work, complain-
ing of a rash on her body. She says she recently came in contact with a child who had the same symptoms, and
she asks, “What did this child see the doctor for, and what was the diagnosis?” She explains that she needs to
know so that she can be immunized, if necessary. You explain that you cannot give out this information, but
another LPN overhears, pulls the child’s chart, and gives the woman the information she requested.
35. Did both LPNs in this scenario act ethically and responsibly? Explain your answer.

LO 1.3
A physician admitted an older patient to the hospital, where she was treated for an irregular heartbeat and chest
pain. The patient was competent to make her own decisions about a course of treatment, but her daughter
repeatedly second-guessed the physician’s recommendations with medical information she had obtained from
the internet.
36. In your opinion, what responsibilities, if any, does a physician or other health care practitioner have toward
family members or other third parties who interfere with a patient’s medical care?
37. What might the physician in this situation have said to the patient’s daughter to help resolve the situation?

Internet Activities
LO 1.1 and LO 1.2
Complete the activities and answer the questions that follow.
38. Use a search engine to conduct a search for Web sites on the internet concerned with bioethics. Name
two of those sites you think are reliable sources of information. Explain your choices. How does each site
define the term bioethics?
39. Locate the Web site for the organization that represents the health care profession you intend to practice.
Does the site provide guidance on ethics? If so, how? Does the site link to other sites concerning ethics?
If so, list three ethics links, and then explore these links.
40. Visit this Web site sponsored by the National Institutes of Health: https://oir.nih.gov/sourcebook/ethical
-conduct/responsible-conduct-research-training/annual-review-ethics-case-studies. Pick a case study from
the list and review it. Do you agree or disagree with the conclusions reached about the issue? Explain
your answer.

24 Chapter 1 | Introduction to Law and Ethics


2
iQoncept/Shutterstock

Making Ethical
Decisions
Key Terms
autonomy
beneficence
LEARNING OUTCOMES categorical imperative
confidentiality
After studying this chapter, you should be able to: deontological or duty-
oriented theory
LO 2.1 Describe and compare need and value fidelity
development theories. health disparity
health equity
justice
LO 2.2 Identify the major principles of contemporary needs-based motivation
consequence-oriented, duty-oriented, and virtue nonmaleficence
ethics reasoning. principle of utility
social determinants of
health
LO 2.3 Define the basic principles of health care ethics. teleological or
consequence-oriented
theory
utilitarianism
veracity
virtue ethics


FROM THE PERSPECTIVE OF. . .
TOM AND BILL ARE RADIOLOGY TECHNICIANS at a 300-bed hospital
in a large metropolitan area. Tom has been employed by the hospital for
10 years, and Bill is a recent graduate from radiology technician school and
has been on the job for 4 months. Their supervisor, Anna, has been with
the hospital for 20 years, moving up the ranks from radiology technician to
manager of the department. Because they are short staffed, Anna has been
helping the staff complete the required X-rays throughout the day.
One afternoon, Bill notices that Anna is late coming back from lunch.
He doesn’t give it a second thought because Anna is the boss and often has
lunch meetings. However, while working with her that afternoon, Bill real-
izes that he smells alcohol on Anna’s breath. He decides not to say anything.
Several days later, Bill once again smells alcohol when around Anna.
Bill decides to talk with Tom about the problem. Tom confirms that
he has noticed the problem also. Tom advises Bill not to say anything
and offers three pieces of advice. First, Anna’s behavior is not Bill’s prob-
lem. Second, Anna is a supervisor, and it is difficult to understand the
pressure she is under. For his final piece of advice, Tom reminds Bill that
the last person hired is often the first person fired.
From Bill’s perspective, he has seen a clear violation of hospital policy
on the part of his supervisor.
From Tom’s perspective, he has already decided he doesn’t want to
get involved in what could be a messy situation. The department is
already short staffed, and if Anna were fired, that would mean he would
have to work even harder until a new manager was found.
From Anna’s perspective, she may not realize that she has a problem
with alcohol. Even if she does realize that she has a problem, she may
believe that the problem is not serious or she would never be fired
because she has been with the hospital for so long.

Ethical decision making requires you to tap into your values, morals,
and sense of fair play, so that you can be comfortable with the decisions
you implement and so that your decisions do not harm others. Study
the following theories for further understanding of your own deci-
sion-making process.

2.1 Value Development Theories


In Chapter 1, the differences between law, ethics, and etiquette were
briefly discussed. Ethics was defined as standards of behavior developed
as a result of one’s concept of right and wrong. One’s personal concept
of right and wrong, called moral values, is formed through the influence
of the family, culture, and society. Because each individual experiences
different family, cultural, and societal influences, like Tom and Bill in the
opening scenario, individuals may see the same situation yet determine
different methods to handle the problem.
Psychologists, philosophers, and social scientists all study human behav-
ior. Many subscribe to the idea that human behavior is a reflection of our
attention to our needs or to our values. A classic work by Abraham Maslow,
Motivation and Personality, first published in 1954, identified a hierarchy

26 Chapter 2 | Making Ethical Decisions


of needs that motivates our actions (see Figure 2-1). According to Maslow’s
theory, there are five stages of need that influence our behavior. We must
satisfy each need in order, and the resulting progression is called a hierar-
chy. Maslow defined needs 1 to 3 as deficiency, or D-needs. Needs 4 and
5 are growth needs, also known as being, or B-needs.
1. The need for basic life—food and shelter
2. The need for a safe and secure environment
3. The need to belong and to be loved
4. The need for esteem, where status, responsibility, and recognition are
important
5. The need for self-actualization, for personal growth and fulfillment
Originally, Maslow believed that the needs followed a strict order, but
in his later years, he allowed for the possibility that some people may
not require meeting all the D-needs before moving on to the B-needs.

FIGURE 2-1 Maslow’s Hierarchy of Needs Pyramid

Self-
Actualization
A state of
self-fulfillment

Esteem
The need to develop a sense
of self-worth

Love and Belongingness


The need to obtain and give affection

Safety Needs
The need for a safe and secure environment

Physiological Needs
The primary drives: needs for water, food, sleep, and sex

(bottom left): BananaStock/age fotostock; (bottom right): BrandX/Stockbyte/Getty Images; (top right): Monzenmachi/iStock/
Getty Images; (top left): Michaeljung/iStock/Getty Images


Maslow’s theory may help us understand what motivates people, but
it does not always help us determine how we developed the values that
guide us in ethical decision making.
needs-based motivation Many psychologists believe that individuals move from needs-based
The theory that human behavior is motivation to a personal value system that develops from childhood.
based on specific human needs that
must often be met in a specific order.
When we are born, we have no values. The value system we develop as
Abraham Maslow is the best-known we grow and mature is dependent on the cultural framework in which
psychologist for this theory. we live. If one grows up in an Asian culture, for example, honoring
ancestors and tradition may emerge as prominent values; growing up in
a Western culture, such as in the United States, may encourage one to
place more value on individualism.
A variety of theories exist about how we develop values. Most focus on
our stages of development from childhood to adulthood. One of the most
famous researchers in this area is Jean Piaget (see Figure 2-2). By observ-
ing children at play, Piaget described four levels of moral development.

FIGURE 2-2 J ean Piaget’s Stages of Development


from Childhood to Adulthood

The first stage occurs from birth to age 2 and is called the sensorimotor stage, during which the child is totally
1 self-centered. Children at this stage of development explore the world with their five senses, and cannot yet see
from another’s point of view.

As infants grow, they develop an awareness of things and people even if not in their direct sight, leading to the
second stage, called the preoperational or egocentric stage, which extends from ages 2 to 7. During this time
2 period, children view the word from their own perspective. For example, when playing a game, the child is not
particularly concerned with rules of play; the focus is on fun, not rules.

The third stage of Piaget’s theory is called the concrete operational stage, extending from ages 7 to 12. In this
3 stage, children tend to see things as either right or wrong, and to see adults as powerful and controlling.

Finally, during the formal operational stage, children develop abstract thought and begin to understand that
there may be different degrees of wrongdoing. For example, children in earlier stages of development, when
asked why telling a lie is wrong, may simply reply “because it’s bad” whereas children in the formal operational
4 stage can explain “because a lie isn’t true.” During this stage and through adulthood, intentions, such as lying
(I intend to deceive you) and stealing (I intend to take that object) are central to decisions made.

28 Chapter 2 | Making Ethical Decisions


Exploring the Variety of Random
Documents with Different Content
gens tenaient pour impossible de voir supprimer ces choses-là. Et
l'on s'est étonné après coup qu'elles aient pu durer si longtemps!
Pensez-vous qu'à présent, si les fermiers généraux de notre centre,
par exemple, venaient à disparaître, nous ne pourrions plus vivre?
Ça nous serait au contraire un grand soulagement de n'avoir plus ces
ventrus à nourrir sans rien faire…
—Bien dit! fit le carrier en se levant pour aller rejoindre un client
qui lui faisait signe.
—Bravo! père Tiennon. Vive la Sociale! s'exclamèrent trois jeunes
gens qui m'avaient entendu.
Et ils offrirent le café. Mais je me sentais un peu étourdi par le
bruit de la salle, par la chaleur et la fumée. Je regardai la pendule.
—Non, mes amis, non; il est temps que j'aille panser mes vaches.
Daumier intervint:
—Allons, buvons le café avec ces jeunes gas, vieux socio.
—Merci! La tête me fait un peu mal; je dirais sans doute des
«âneries». C'est toujours ce qui arrive quand on reste au café
longtemps. Au revoir!
Et leur ayant serré la main à tous je partis, laissant le père
Daumier qui prit sa «cuite». C'est la seule fois de ma vie qu'il
m'arriva de tant causer politique.

Les élections furent vite oubliées, et les discussions et les rêves


auxquels elles avaient donné lieu, en présence du grand désastre
qu'on eut à subir cette année-là… Tout le printemps, tout l'été sans
pluie; un soleil constant qui brûlait les plantes jusqu'en leurs racines;
une récolte de foin dérisoire; une récolte de céréales médiocre; les
pâtures desséchées; les mares vidées; les animaux se vendant pour
rien:—quelle misère! Je fus obligé d'aller au bois râteler des feuilles
sèches dont j'amassai une provision pour la litière, et d'acheter des
fourrages du Midi qu'un négociant faisait venir à Saint-Aubin par
wagons. Je compris, cette année-là, que le chemin de fer pouvait
tout de même rendre des services aux paysans!
LVII

Au cours de ces grandes chaleurs de 1893, la mort—qu'il avait


tant souhaitée—délivra enfin mon pauvre martyr de frère…
En novembre de cette même année, ma vieille servante entra au
service d'un curé, espérant y être plus tranquille que chez nous.
J'en engageai une autre, une grande bringue, bêbête et
méchante, qui ronchonnait à tout propos et bousculait ma sœur à la
moindre frasque. Plus tard, je découvris qu'elle prélevait la dîme sur
la vente de mes denrées au marché de Saint-Hilaire, et qu'elle buvait
à mes dépens des tasses de café, des bols de vin sucré. Je la
conservai quand même, préférant tout supporter que de changer
encore, et sachant que je n'arriverais jamais à trouver la ménagère
idéale.

Nous fûmes pris par la grippe, la Marinette et moi, au cours de


l'hiver tardif et rude de 1895;—Madeleine, la femme de Charles, dut
venir de Puy-Brot pour nous soigner. Cette maladie emporta la
malheureuse innocente, d'ailleurs très affaiblie depuis un certain
temps. Et, pour moi aussi, je crus que ç'allait être la fin, tellement je
me sentais sans force, miné par la fièvre, épuisé par une toux
caverneuse qui m'arrachait l'estomac. Je guéris pourtant,
péniblement à vrai dire, après être resté traînard et courbaturé
pendant plusieurs mois,—et ne retrouvant plus qu'une petite part de
la vigueur que j'avais conservée jusque-là.
Alors j'aspirai au jour où, mon bail fini, je pourrais retourner avec
mes enfants.

Durant cette période, mes idées tournèrent souvent au lugubre.


Je me voyais rester là tout seul, comme un vieil arbre oublié dans un
taillis au milieu de la poussée des jeunes. Un à un, ceux que j'avais
connus s'en étaient tous allés… Morte, ma grand'mère en châle brun
et chapeau bourbonnais.—Mort, l'oncle Toinot qui avait servi sous le
grand empereur et tué un Russe.—Morts, mon père et ma mère,—lui
bon et faible, elle souvent dure et mauvaise d'avoir été trop
malheureuse.—Morts, le père et la mère Giraud, mes beaux-parents,
et leur fils, le soldat d'Afrique, et leur gendre, le verrier, qui parlait
toujours de tirer le pissenlit par la racine…—Morts, mes deux frères
et mes deux sœurs.—Morte, la Victoire, bonne compagne de ma vie,
dont les défauts ne m'apparaissaient à la fin que très peu sensibles,
comme devaient lui apparaître les miens, sous l'effet de
l'accoutumance.—Morte, ma petite Clémentine, douce et mutine.—
Morte, ma nièce Berthe, délicate fleur de Paris, des suites d'une
couche pénible.—Morts, Fauconnet père et fils, Boutry, Gorlier,
Parent, Lavallée, Noris.—Morts, tous ceux qui avaient joué un rôle
dans ma vie, y compris Thérèse, ma première amoureuse. Je les
revoyais souvent; ils défilaient de compagnie dans mes rêves de la
nuit, dans mes souvenirs de la journée. La nuit, ils revivaient pour
moi; mais le jour, il me semblait à de certains moments marcher
entre une rangée de spectres…
Et pourtant, pas plus qu'autrefois, l'idée de la mort ne m'effrayait
pour moi-même. Ah! mes premières émotions funèbres à la Billette,
lors du décès de ma grand'mère! Mon serrement de cœur à l'entrée
de la grande boîte longue où on devait la mettre, et ma tristesse
poignante, sincère, en entendant tomber les pelletées de terre sur le
cercueil descendu dans la fosse! J'avais trop vu de scènes
semblables depuis; et mon cœur à présent restait dur et fermé. A
chaque nouveau convoi s'accroissait mon indifférence. Et pourtant
mon tour approchait d'être couché dans une caisse semblable qu'on
descendrait aussi, avec des câbles, au fond d'un trou béant—et sur
laquelle on jetterait par pelletées le gros tas de terre resté au bord,
comme la barrière infinie qui sépare la mort de la vie! Mais cette
pensée même ne me faisait pas ému…

Je m'intéressais d'ailleurs à toutes les floraisons d'énergie


épanouies derrière moi. Mes fils étaient les hommes sérieux, les
hommes vieillissants de l'heure actuelle. Mes petits-fils
représentaient l'avenir; ils avaient l'air de croire que ça ne finirait
jamais… Pourtant, l'enfance, derrière eux, gazouillait, croissait…
LVIII

Il y a cinq ans déjà que je suis revenu avec mes enfants. Ils ne
me sont pas mauvais. Rosalie même a pour moi des tendresses qui
m'étonnent. Madeleine est toute dévouée, toute aimante et laisse
gouverner sa belle-sœur. L'harmonie règne dans la maisonnée et j'en
suis bien aise. Mais une séparation prochaine n'en est pas moins
imminente; ils vont être trop nombreux pour rester ensemble.
C'est qu'il y a un troisième ménage. Mon filleul, le fils de Jean et
de Rosalie, rentré du régiment depuis trois ans, s'est marié à la
Saint-Martin dernière. J'ai une petite-bru; j'aurai bientôt, je pense,
un arrière-petit-fils. Et Charles a deux filles qui sont d'âge à se
marier aussi. Il devient urgent que mes deux garçons aient chacun
leur ferme. Duverdon, qui tient à eux, a promis d'ailleurs de placer le
sortant dans un autre de ses domaines.

Moi, je suis le vieux!


Je rends des petits services aux uns et aux autres. Les brus me
disent:
—Mon père, si ça ne vous ennuyait pas, vous devriez bien…
Et, pour les contenter, je casse du bois pour la cuisine, je donne
à manger aux lapins, je surveille les oies.
En été, les jours de presse, mes garçons aussi me demandent
souvent de faire une chose ou l'autre. Et je conduis aux champs les
vaches ou les moutons, je garde même les cochons tout comme il y
a soixante-dix ans. Je finis par où j'ai commencé:—la vieillesse et
l'enfance ont des analogies…
Quand on fait les foins, je fane encore et je ratèle. Et lorsqu'on
charge, je prêche la prudence et les charrois moins gros; je donne
des conseils qu'on ne suit pas toujours. Les jeunes veulent oser,
risquer le tout pour le tout, faire les malins… Mais funeste à la
témérité est l'expérience que l'âge donne. Et je suis le vieux!
Mes forces, de plus en plus, vont déclinant; j'ai les membres
raidis; on dirait que le sang n'y circule pas. L'hiver, Rosalie met
chaque soir dans mon lit une brique chaude enveloppée d'un chiffon,
—faute de quoi je ne pourrais ni me réchauffer, ni dormir. Je me
courbe en arc de cercle; je regarde la pointe de mes sabots; le sol,
que j'ai tant remué, me fascine à présent, semble se hausser vers
moi avec un air de me dire qu'il aura bientôt son tour. Je vois gros et
je tremble un peu; j'ai du mal à me raser sans entailles; il m'arrive,
quand je vais à la messe, de ne plus reconnaître des personnes que
je connais très bien.—Jusqu'à mon petit Francis que je ne remettais
pas lorsqu'il est venu me voir au retour du service!—Je suis dur
d'oreilles en tout temps et très sourd par périodes durant l'hiver.
Lorsqu'on s'adresse à moi, il m'arrive de mal comprendre, de
répondre de travers, ce qui fait rire tout le monde à mes dépens.
Quand j'ai mangé, si je reste assis, je m'endors—et la nuit, au
contraire, les longues insomnies sont fréquentes. J'ai des absences
de mémoire impossibles; je conserve très bien le souvenir des
épisodes saillants de ma jeunesse, et les choses de la veille
m'échappent. Ma pensée, j'imagine, est à ce point fatiguée des
événements qui l'ont préoccupée pendant trois quarts de siècle
qu'elle n'a plus la force de se porter sur des sujets neufs. Le résultat
est que j'aime trop parler de ces choses d'autrefois qui n'intéressent
plus personne, et que j'ai sur les nouvelles des naïvetés qui font rire.
Cela me rend un peu ridicule. Sur la physionomie de mes petits-
enfants, je lis souvent cette phrase du langage d'aujourd'hui:
—Ce qu'il est «rasant» tout de même, le vieux…
Oui, je suis le vieux! Il faut bien que je le reconnaisse de bonne
grâce. Mes organes ont fait leur temps; ils aspirent au grand repos!
Et puis, vraiment, on voit des choses trop étonnantes. Dans ma
jeunesse, tout le beau monde allait à cheval parce que les voitures
ne pouvaient circuler dans les mauvais chemins. A présent, il circule
des voitures qui n'ont pas besoin de chevaux… Dans un de nos
champs qui borde la grand'route, j'ai gardé les cochons cet été.
Souvent il m'arrivait d'entendre dans le lointain un bruit criard,
disgracieux, très vite rapproché:—l'automobile passait avec ses
voyageurs accoutrés en sauvages, enlunettés comme des casseurs
de pierres, laissant derrière elle un nuage de poussière et de fumée,
une mauvaise odeur de pétrole…
Un jour, la petite servante d'un domaine voisin conduisait son
troupeau de vaches dans une pâture dont les claies donnaient sur la
route. Et voilà que survint à grand train, du côté de Bourbon, l'une
de ces voitures devant laquelle se prirent à courir les bêtes. Le
conducteur ayant donné de la trompe les effraya davantage. Deux
s'engagèrent dans un chemin latéral à gauche; deux autres,
franchissant la bouchure, pénétrèrent dans un champ d'avoine,
cependant que les trois dernières continuaient leur course folle. Je
rejoignis sur la route la pauvre gamine éplorée, qui me dit les
apercevoir encore à l'extrémité d'une longue côte, à deux kilomètres
au moins, fuyant toujours dans les mêmes conditions. Vite je
l'envoyai prévenir ses maîtres. Un homme partit à la recherche des
trois vaches coureuses—qui revint longtemps après, n'en ramenant
que deux. L'autre était crevée de fatigue au bord d'un fossé; il avait
dû aller quérir un boucher d'Ygrande pour la faire enlever.
Il me souvient d'avoir dit, en racontant la chose chez nous:
—Ah! on avait bien tort de se plaindre du chemin de fer; le
chemin de fer a sa route à lui et il ne passe qu'à de certaines
heures; avec de la prudence, on peut l'éviter. Mais ces automobiles
sont de vrais instruments du diable qui envahissent nos routes, nous
inquiètent et nous font du mal.
Je dis cela, mais non sans penser, après coup, que je n'avais pas
à me mettre en peine de ces choses… Homme d'une autre époque,
aïeul à tête branlante, ce n'était pas à moi d'avoir une opinion. Les
jeunes s'habitueront au passage de ces véhicules nouveaux, mais ils
en voudront plus encore aux riches de causer ainsi, par inconscience
ou plaisir, du désagrément tous les jours, des accidents quelquefois.
Au reste, les animaux eux-mêmes s'habitueront…

Moi, que m'importe! Je ne demande qu'une chose, c'est de rester


jusqu'au bout à peu près valide. Tant que je rendrai des services à
mes enfants, ils me supporteront aisément. Ils me seront encore
humains, je n'en doute pas, si j'en arrive à n'être bon à rien. Mais
j'appréhende de devenir paralytique ou aveugle, ou de tomber dans
l'inconscience, ou encore de souffrir longtemps de quelque maladie
de langueur. Cette idée me causerait trop de peine de savoir que je
suis un vieil objet encombrant qu'on voudrait bien voir disparaître…
Que la mort survienne, elle ne m'effraie pas! Je songe à elle sans
amertume et sans crainte. La mort! la mort! mais non l'horrible
déchéance venant troubler le labeur des jeunes, des bien portants,
la vie ordinaire d'une maisonnée. Qu'elle me frappe à l'œuvre
encore, afin qu'on puisse dire:
—Le père Tiennon a cassé sa pipe; il était bien vieux, bien usé,
mais point à charge. Jusqu'au bout il a travaillé.
Mais je redoute comme oraison funèbre ceci:
—Le père Bertin est mort. Pauvre vieux! C'est un grand débarras
pour lui et un grand bonheur pour sa famille.
De la vie, je n'ai plus rien à espérer, mais j'ai encore à craindre.
Que cette calamité dernière me soit évitée: c'est là mon unique
souhait!
Ygrande (Allier), 1901-1902.

FIN

IMPRIMERIE NELSON, ÉDIMBOURG, ÉCOSSE


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LISTE ALPHABÉTIQUE

ABOUT, EDMOND.
Le Nez d'un Notaire.
Les Mariages de Paris.
ABRANTÈS, MADAME D'.
Mémoires (2 vol.).
ACHARD, AMÉDÉE.
Belle-Rose.
Récits d'un Soldat.
ACKER, PAUL.
Le Désir de vivre.
ADAM, PAUL.
Stéphanie.
AICARD, JEAN.
L'Illustre Maurin.
Maurin des Maures.
Notre-Dame-d'Amour.
ANGELL, NORMAN.
La Grande Illusion.
AUGIER, ÉMILE.
Le Gendre de M. Poirier et autres Comédies.
AVENEL, LE Vte G. D'.
Les Français de mon temps.
BALZAC, HONORÉ DE.
Eugénie Grandet.
La Peau de Chagrin, Le Curé de Tours, etc.
Les Chouans.
BARDOUX, A.
La Comtesse Pauline de Beaumont.
BARRÈS, MAURICE.
Colette Baudoche.
Le Roman de l'Énergie Nationale:
* Les Déracinés.
** L'Appel au Soldat.
*** Leurs Figures.
BASHKIRTSEFF, MARIE.
Journal.
BAZIN, RENÉ.
De toute son Âme.
Le Guide de l'Empereur.
Madame Corentine.
BENTLEY, E. C.
L'Affaire Manderson.
BERTRAND, LOUIS.
L'Invasion.
BORDEAUX, HENRY.
La Croisée des Chemins.
La Robe de Laine.
L'Écran brisé.
Les Roquevillard.
Les Derniers Jours du Fort de Vaux.
Les Captifs délivrés.
BOURGET, PAUL.
Le Disciple.
Voyageuses.
BOYLESVE, RENÉ.
L'Enfant à la Balustrade.
BRADA.
Retour du Flot.
BRUNETIÈRE, FERDINAND
Honoré de Balzac.
BUCHAN, JOHN.
Le Prophète au Manteau Vert.
CAMPAN, MADAME.
Mémoires sur la Vie de Marie-Antoinette.
CARO, MADAME E.
Amour de Jeune Fille.
CHATEAUBRIAND.
Mémoires d'Outre-tombe.
CHERBULIEZ, VICTOR.
L'Aventure de Ladislas Bolski.
Le Comte Kostia.
Miss Rovel.
CHILDERS, ERSKINE.
L'Énigme des Sables.
CLARETIE, JULES.
Noris.
Le Petit Jacques.
Les Huit Jours du Petit Marquis.
CONSCIENCE, HENRI.
Le Gentilhomme pauvre.
COULEVAIN, PIERRE DE.
Ève Victorieuse.
CROCKETT, S. R.
La Capote lilas.
DAUDET, ALPHONSE.
Contes du Lundi.
Lettres de mon Moulin.
Numa Roumestan.
DICKENS, CHARLES.
Aventures de Monsieur Pickwick (3 vol.).
DUMAS, ALEXANDRE.
La Tulipe noire.
Les Trois Mousquetaires (2 vol.).
Vingt Ans après (2 vol.).
Le Vicomte de Bragelonne (5 vol.).
DUMAS FILS, ALEX.
La Dame aux Camélias.
FABRE, FERDINAND.
Monsieur Jean.
FEUILLET, OCTAVE.
Histoire de Sibylle.
Un Mariage dans le Monde.
FLAUBERT, GUSTAVE.
L'Éducation sentimentale.
Trois Contes.
FRANCE, ANATOLE.
Jocaste et Le Chat maigre.
Pierre Nozière.
St FRANÇOIS DE SALES.
Introduction à la Vie dévote
FRAPIÉ, LÉON.
L'Écolière.
FROMENTIN, EUGÈNE.
Dominique.
Les Maîtres d'Autrefois.
GAUTIER, THÉOPHILE.
Le Capitaine Fracasse (2 vol.).
Le Roman de la Momie.
Un Trio de Romans.
GONCOURT, EDMOND DE.
Les Frères Zemganno.
GRÉVILLE, HENRY.
Suzanne Normis.
GYP.
Bijou.
Le Mariage de Chiffon.
HANOTAUX, GABRIEL.
La France en 1614.
HAY, IAN.
Les Premiers Cent Mille.
JEAN DE LA BRÈTE.
Mon Oncle et mon Curé.
KARR, ALPHONSE.
Voyage autour de mon Jardin.
KIPLING, RUDYARD.
Simples Contes des Collines.
LABICHE, EUGÈNE.
Le Voyage de M. Perrichon, etc.
LA BRUYÈRE, JEAN DE.
Caractères.
LAMARTINE.
Geneviève.
LANG, ANDREW.
La Pucelle de France.
LE BRAZ, ANATOLE.
Pâques d'Islande.
LEMAÎTRE, JULES.
Les Rois.
LE ROY, EUGÈNE.
Jacquou le Croquant.
É
LÉVY, ARTHUR.
Napoléon Intime.
Napoléon et la Paix.
LOTI, PIERRE.
Figures et Choses qui passaient.
Jérusalem.
LYTTON, BULWER.
Les Derniers Jours de Pompéi.
MAETERLINCK, MAURICE.
Morceaux choisis.
MASON, A. E. W.
L'Eau vive.
MÉREJKOWSKY.
Le Roman de Léonard de Vinci.
MÉRIMÉE, PROSPER.
Chronique du Règne de Charles IX.
MERRIMAN, H. SETON.
La Simiacine.
Les Vautours.
MICHELET, JULES.
La Convention.
Du 18 Brumaire à Waterloo.
MIGNET.
La Révolution Française. (2 vol.)
NOLHAC, PIERRE DE.
Marie-Antoinette Dauphine.
La Reine Marie-Antoinette.
NOLLY, ÉMILE.
Hiên le Maboul.
ORCZY, LA BARONNE.
Le Mouron Rouge.
PÉLADAN.
Les Amants de Pise.
POE, EDGAR ALLAN (trad. BAUDELAIRE).
Histoires Extraordinaires.
Nouvelles Histoires Extraordinaires.
RENAN, ERNEST.
Souvenirs d'Enfance et de Jeunesse.
Vie de Jésus.
ROD, EDOUARD.
L'Ombre s'étend sur la Montagne.
SAINT-PIERRE, B. DE.
Paul et Virginie.
SAINT-SIMON.
La Cour de Louis XIV.
SAND, GEORGE.
Jeanne.
Mauprat.
SANDEAU, JULES.
Mademoiselle de La Seiglière.
SARCEY, FRANCISQUE.
Le Siège de Paris.
SCHULTZ, JEANNE.
Jean de Kerdren.
La Main de Ste-Modestine.
SCOTT, SIR WALTER.
Ivanhoe.
SÉGUR, Cte PH. DE.
Mémoires d'un Aide de Camp de Napoléon: De 1800 à
1812.
La Campagne de Russie.
Du Rhin à Fontainebleau.
SÉGUR, LE MARQUIS DE.
Julie de Lespinasse.
SIENKIEWICZ, HENRYK.
Quo Vadis?
SOUVESTRE, ÉMILE.
Un Philosophe sous les toits.
STENDHAL.
La Chartreuse de Parme.
THEURIET, ANDRÉ.
La Chanoinesse.
TILLIER, CLAUDE.
Mon Oncle Benjamin.
TINAYRE, MARCELLE.
Hellé.
L'Ombre de l'Amour.
TINSEAU, LÉON DE.
Un Nid dans les Ruines.
TOLSTOÏ, LÉON.
Anna Karénine (2 vol.).
Hadji Mourad.
Le Faux Coupon.
Le Père Serge.
TOURGUÉNEFF, IVAN.
Fumée.
Une Nichée de Gentilshommes.
VANDAL, LE COMTE A.
L'Avènement de Bonaparte (2 vol.).
VIGNY, ALFRED DE.
Cinq-Mars.
Servitude et Grandeur Militaires.
Poésies.
Stello.
Chatterton, etc.
Journal d'un Poète.
VOGÜÉ, LE Vte E.-M. DE.
Jean d'Agrève.
Le Maître de la Mer.
Les Morts qui parlent.
Nouvelles Orientales.
WENDELL, BARRETT.
La France d'Aujourd'hui.
YVER, COLETTE.
Comment s'en vont les Reines.
ZOLA, ÉMILE.
Le Rêve.
ANTHOLOGIE DES POÈTES LYRIQUES FRANÇAIS.
É
L'IMITATION DE JÉSUS-CHRIST.

Les Classiques français

ÉDITION LUTETIA
DESCARTES.—Discours de la Méthode, Méditations
métaphysiques, Traité des Passions. Introduction par Émile
Faguet (de l'Académie française).
NODIER.—Jean Sbogar et autres Nouvelles. Introduction par
Émile Faguet.
P.-L. COURIER.—Lettres et Pamphlets. Introduction par Émile
Faguet.
MONTESQUIEU.—Lettres Persanes, Grandeur et Décadence
des Romains. Introduction par Émile Faguet.
ANDRÉ CHÉNIER.—Poésies. Introduction par Émile Faguet.
LESAGE.—Gil Blas. Introduction par Émile Faguet. (Deux volumes.)
BEAUMARCHAIS.—Théâtre choisi. Introduction par Émile Faguet.

Le Barbier de Séville, Le Mariage de Figaro, La Mère coupable, Mélanges,


Vers et Chansons.

AMYOT.—Les Vies des Hommes illustres de Plutarque.


Introduction par Émile Faguet.

Tome Ier. Vies parallèles de Theseus et Romulus, Lycurgus et Numa


Pompilius, Solon et Publicola. Glossaire.
Tome II. Vies parallèles de Themistocles et Furius Camillus, Pericles et
Fabius Maximus, Alcibiades et Coriolanus. Glossaire.

RACINE.—Théâtre. Introduction par Émile Faguet. (Deux volumes.)


Tome Ier. La Thébaïde, Alexandre le Grand, Andromaque, Les Plaideurs,
Britannicus, Bérénice.
Tome II. Bajazet, Mithridate, Iphigénie en Aulide, Phèdre, Esther, Athalie.

CORNEILLE.—Théâtre choisi. Introduction par Émile Faguet. (Deux


volumes.)

Tome Ier. La Galerie du Palais, La Place Royale, L'Illusion, Le Cid, Horace,


Cinna.
Tome II. Polyeucte, Pompée, Le Menteur, Rodogune, Don Sanche d'Aragon,
Nicomède.

LA FONTAINE.—Fables et Épîtres. Introduction par Émile Faguet.


MADAME DE LA FAYETTE.—La Princesse de Clèves.
Introduction par l'Abbé J. Calvet.
CHATEAUBRIAND.—Atala, René, Le dernier Abencérage.
Introduction par Émile Faguet.
PERRAULT, etc.—Choix de Contes de Fées. Introduction par
Madame Félix-Faure Goyau.
MADAME DE STAËL.—Corinne, ou l'Italie. Introduction par Émile
Faguet. (Deux volumes.)
ROUSSEAU.—Émile, ou de l'Éducation. Introduction par émile
Faguet. (Deux volumes.)
PASCAL.—Pensées. Introduction par Émile Faguet.
MONTAIGNE.—Essais. Introduction par Émile Faguet. (Trois
volumes.)
ALFRED DE MUSSET.—Poésies. Introduction par Émile Faguet.
MADAME DE SÉVIGNÉ.—Lettres choisies. Introduction par Émile
Faguet.
ŒUVRES COMPLÈTES
DE

VICTOR HUGO
1-4. Les Misérables. Tomes I-IV.
5. Les Contemplations.
6. Napoléon-le-Petit.
7. Ruy Blas, Les Burgraves.
8. Han d'Islande.
9, 10. Le Rhin. Tomes I, II.
11-13. La Légende des Siècles. Tomes I-III.
14. Marie Tudor. La Esmeralda, Angelo.
15. Les Feuilles d'Automne, Les Chants du Crépuscule.
16, 17. Notre-Dame de Paris. Tomes I, II.
18. Dieu, La Fin de Satan.
19. Le Roi s'amuse, Lucrèce Borgia.
20. Histoire d'un Crime.
21. L'Art d'être Grand-Père.
22. Burg-Jargal, Le Dernier Jour d'un Condamné, Claude
Gueux.
23. Les Châtiments.
24. France et Belgique, Alpes et Pyrénées.
25, 26. L'Homme qui Rit. Tomes I, II.
27. Les Voix intérieures, Les Rayons et les Ombres.
28. Théâtre en Liberté, Amy Robsart.
29. Actes et Paroles, I. Avant l'Exil.
30. Les Quatre Vents de l'Esprit.
31. Actes et Paroles, II. Pendant l'Exil.
32. Lettres à la Fiancée.
33, 34. Actes et Paroles, III. Depuis l'Exil.
35. Les Chansons des Rues et des Bois.
36. Cromwell.
37. Le Pape, La Pitié suprême, Religions et Religion, L'Âne.
38. Quatrevingt-Treize.
39, 40. Toute la Lyre. Tomes I, II.
41. Torquemada, Les Jumeaux.
42. William Shakespeare.
43. Odes et Ballades, Les Orientales.
44. Littérature et Philosophie mêlées, Paris.
45, 46. Les Travailleurs de la Mer. Tomes I, II.
47. L'Année terrible, Les Années funestes.
48. Choses vues (les deux séries).
49. Hernani, Marion de Lorme.
50, 51. Victor Hugo raconté par un témoin de sa vie. Tomes I, II.

LES CLASSIQUES FRANÇAIS

ÉDITION LUTETIA

ŒUVRES COMPLÈTES DE
MOLIÈRE
EN SIX VOLUMES ILLUSTRÉS

Avec une Notice sur Molière et une introduction à chaque


pièce par ÉMILE FAGUET, de l'Académie française

Tome Ier: Notice sur Molière, La Jalousie du Barbouillé, Le Médecin


volant, L'Étourdi, Le Dépit amoureux, Les Précieuses ridicules,
Sganarelle, Don Garcie de Navarre.
Tome II: L'École des Maris, Les Fâcheux, L'École des Femmes, La
Critique de l'École des Femmes, L'Impromptu de Versailles, Le
Mariage forcé, Les Plaisirs de l'Île enchantée, La Princesse
d'Élide.
Tome III: Le Tartuffe, Don Juan, L'Amour médecin, Le Misanthrope,
Le Médecin malgré lui.
Tome IV: Mélicerte, Pastorale comique, Le Sicilien, Amphitryon,
George Dandin, L'Avare, Relation de la Fête de Versailles.
Tome V: Monsieur de Pourceaugnac, Les Amants magnifiques, Le
Bourgeois Gentilhomme, Psyché.
Tome VI: Les Fourberies de Scapin, La Comtesse d'Escarbagnas,
Les Femmes savantes, Le Malade imaginaire, Poésies diverses, La
Gloire du Dôme du Val-de-Grâce.

NELSON, ÉDITEURS

25, rue Denfert-Rochereau, Paris


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