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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.
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
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
Contents
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
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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.
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
Want to learn more about this product? Attend one Need help? Contact McGraw Hill Education’s Cus-
of our online webinars. To learn more about the webi- tomer Experience Group (CXG). Visit the CXG Web site
nars, please contact your McGraw Hill Learning Tech- at www.mhhe.com/support. Browse the FAQs (Fre-
nology Representative. To find your McGraw Hill quently Asked Questions) and product documentation
representative, go to www.mheducation.com and click and/or contact a CXG representative.
“Get Support,” select “Higher Ed,” and then click the
“GET STARTED” button under the “Find Your Sales
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Instructors
The Power of Connections
A complete course platform
Connect enables you to build deeper connections with your students through
cohesive digital content and tools, creating engaging learning experiences.
65%
We are committed to providing you with the right resources and tools to Less Time
support all your students along their personal learning journeys. Grading
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
• Confidentiality
End-of-Chapter
• Role fidelity
• 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?
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
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.
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?
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.)
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.
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.
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.
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
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
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?
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
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:
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:
VI I am loyal to my employer.
Copyright by American Association of Medical Assistants. All rights reserved. Used with permission.
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.
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.)
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
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.
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
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
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.
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.
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.
Self-
Actualization
A state of
self-fulfillment
Esteem
The need to develop a sense
of self-worth
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.
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.
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.
FIN
Format commode.
Impression en caractères très lisibles sur papier solide et durable.
Élégante reliure toile.
COLLECTION NELSON
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.
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.
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.
ÉDITION LUTETIA
ŒUVRES COMPLÈTES DE
MOLIÈRE
EN SIX VOLUMES ILLUSTRÉS
NELSON, ÉDITEURS
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