Medical Legal and Ethics (MLE)
An exploration of the medical and legal underpinning of the medical practice in the United States, California, Placer County, and at Western Sierra Collegiate Academy. This includes major laws and court opinion at the federal, state, and local level. Also included is an exploration of the virtue ethic and ethical theories. This big idea lays the foundation for the medical program.
MLE-1 Describe the major US, state, and local laws dealing with medical policy.
MLE-1.A Describe the major U.S. Federal laws dealing with medical policy.
MLE-1.A.1 Explain the active Affordable Care Act provisions.
MLE-1.A.2 Explain Health Insurance Portability and Accountability Act and its effects.
MLE-1.A.3 Explain Emergency Medical Treatment and Active Labor Act and its effects.
MLE-1.A.4 Explain Healthcare Quality Improvement Act and its effects.
MLE-1.A.5 Explain Pure Food and Drug Act and its effects.
MLE-1.B Describe the major California state laws dealing with medical policy.
MLE-1.B.1 Confidentiality of Medical Information Act (Civil Code §§ 56.10 – 56.16)
MLE-1.B.2 Mandated Blood Testing and Confidentiality to Protect Public Health (Health and Safety Code §§ 120975-121020)
MLE-1.B.3 Identify the required vaccinations for students entering after Kindergarten and after entering after grade 7, these would be required of all secondary students.
MLE-1.C Describe the Placer County medical directives and personnel.
MLE-1.C.1 Identify the major healthcare personnel.
a. Identify the Certificated School Nurse responsible for the student’s school. Explain the responsibilities for the Certificated School Nurse.
b. Identify the Public Health Director and Public Health Officer for Placer County. Explain the responsibilities for the Public Health Director and Officer.
MLE-1.C.2 Identify the major Placer County Services
MLE-1.D Describe the five components of negligence and three types of negligence.
MLE-1.D.1 Explain duty to act, breach of duty, cause in fact, proximate cause, and monetizable damages.
MLE-1.D.2 Describe nonfeasance, malfeasance, misfeasance, comparative negligence, contributory negligence, vicarious liability, and gross negligence.
MLE-1.E Explain the various medical ranks and scopes of care in the hospital and pre-hospital settings.
MLE-1.E.1 Describe the scope of care for hospital providers.
a. Explain the scope of a physician.
b. Explain the scope of a physician’s assistant.
c. Explain the scope of a nurse.
d. Explain the scope of a pharmacist.
e. Explain the scope of a pharmacy technician.
f. Explain the scope of a licensed vocational nurse or certified nursing assistant.
g. Explain the scope of a certified medical assistant.
h. Explain the scope of a medical office assistant or medical insurance billing and coding technician.
MLE-1.E.2 Describe the scope the care for prehospital providers.
a. Explain the scope of a critical care paramedic or flight paramedic.
b. Explain the scope of a paramedic.
c. Explain the scope of an advanced emergency medical technician.
d. Explain the scope of an emergency medical technician.
MLE-1.E.3 Describe the scope the care for alternate healthcare providers.
a. Explain the scope of a chiropractor.
b. Explain the scope of an acupuncturist.
c. Explain the scope of a massage therapist.
MLE-2 Describe and utilize the major ethical principles that underline medical practice.
MLE-2.A Explain the principles of primum non nocere, autonomy, beneficence, and nonmaleficence along with their application.
MLE-2.A.1 Explain the difference between morals and ethics.
MLE-2.A.2 Using the standard of definition of morals and ethics, describe the difference between intrinsic and instrumental value.
MLE-2.B Explain the principles of the thirteen virtues and their application.
MLE-2.B.1 Describe Courage as a virtue, defined as the mental or moral strength to persevere and withstand danger and stress.
MLE-2.B.2 Describe Wisdom as a virtue, defined as the judicious application of knowledge.
MLE-2.B.3 Describe Temperance as a virtue, defined as orderliness and moderation in everything that is said and done.
MLE-2.B.4 Describe Commitment as a virtue, defined as the act of binding oneself (intellectually and emotionally) to a course of action or another person.
MLE-2.B.5 Describe Compassion as a virtue, defined as the deep awareness of and sympathy for another’s suffering.
a. Detachment, or lack of personalization of the patient’s needs, often translates in to mistakes that result in poor patient outcomes.
b. Empathy, or personalizing the emotions of others, can overwhelm a medical provider.
c. Medical providers must understand the detachment and empathy are both necessary for outstanding patient care.
MLE-2.B.6 Describe Conscientiousness as a virtue, defined as an individual who has the moral integrity and a s strict regard of doing what is considered the right thing to do.
MLE-2.B.7 Describe Discernment as a virtue, defined as the ability to make a good and reasoned decision without personal biases (or acknowledgement of bias), fears, and undue influence from others.
MLE-2.B.8 Describe Fairness as a virtue, defined as the requirement of each person to be objective, unbiased, dispassionate, impartial, non-narcissistic, and consistent with their principals of ethics.
MLE-2.B.9 Describe Fidelity as a virtue, defined as the virtue of faithfulness, being true to our commitments and obligations to others.
MLE-2.B.10 Describe Freedom as a virtue, defined as the quality of being free to make choices for oneself within the boundaries of law without compromising another’s Freedom.
MLE-2.B.11 Describe Honesty as a virtue, defined as confidence that a person will act with the right motives.
a. Veracity is devotion to and conformity with what it is intrinsically truthful or what is known at a given point in time.
b. Truth Telling is providing enough information so that a patient can make an informed decision with verifiable facts and not opinion.
MLE-2.B.12 Describe Integrity as a virtue, defined as a steadfast adherence to a strict moral or ethical code and commitment to not compromise this code even if the compromise will not be known.
MLE-2.B.13 Describe Kindness as a virtue, defined as the quality of being considerate and sympathetic to another’s needs, without being singularly a emotional / physical giver or taker. Explain how being kind many not be compassionate.
MLE-2.B.14 Describe Respect as a virtue, defined as to show special regard to someone or something. This involves understanding of their culture and personal needs and norms along with the accepted norms for interpersonal interaction.
MLE-2.B.15 Describe Hopefulness as a virtue, defined as involving looking forward to something with the confidence of success. This does not include counseling another to look forward to an unlikely outcome of success.
MLE-2.B.16 Describe Positive (Active) Tolerance as a virtue, defined as an implication that a person accepts differences in others and that one does not expect others to believe, think, speak, or act as he or she does.
MLE-2.B.17 Describe Negative (Passive) Tolerance as a virtue, defined as the expectation that one will reluctantly allow another’s beliefs so long as they do not intersect with their own.
MLE-2.B.18 Describe Cooperation as a virtue, defined as the process of working with others toward a common goal, where each person compromises key positions to build a consensus position.
MLE-2.C Explain the major ethical theories and their application.
MLE-2.C.1 Describe Normative Ethics and its application to medicine and society.
MLE-2.C.2 Describe Consequential Ethics and its application to medicine and society.
MLE-2.C.3 Describe Utilitarian Ethics and its application to medicine and society.
MLE-2.C.4 Describe Deontological Ethics and its application to medicine and society.
MLE-2.C.5 Describe Nonconsequential Ethics and its application to medicine and society.
MLE-2.C.6 Describe Ethical Relativism and its application to medicine and society.
MLE-2.C.7 Describe Situational Ethics and its application to medicine and society. Identify what additional information must be found to use situational ethics.
MLE-2.D Explain the implications to interpersonal interaction and medical decision making arising from the application of religious codes of conduct and cultural norms for common groups in California.
MLE-2.D.1 Describe the potential differences in patient interactions and decision making arising from the varieties of religious expression within a given religio-cultural grouping.
a. For each religio-cultural grouping practice identify the characteristics of orthodox practice.
b. For each religio-cultural grouping practice identify the characteristics of reformed practice.
c. For each religio-cultural grouping practice identify the characteristics of casual practice.
d. For each religio-cultural grouping practice identify the characteristics of spirituality.
e. For each religio-cultural grouping practice identify the characteristics of agnostic practice.
f. For each religio-cultural grouping practice identify the characteristics of atheistic practice.
MLE-2.D.2 Describe the history, principles, ethno-cultural practices, and morals of Judaism along with how they compare to other Abrahamic religions. Specifically to explain the implications to interpersonal interaction and medical decision making within this practice.
MLE-2.D.3 Describe the history, principles, ethno-cultural practices, and morals of Christianity along with how they compare to other Abrahamic religions. Specifically to explain the implications to interpersonal interaction and medical decision making within this practice.
a. Describe the history, principles, ethno-cultural practices, and morals of Roman Catholic practice.
b. Describe the history, principles, ethno-cultural practices, and morals of Eastern Orthodox practice.
c. Describe the history, principles, ethno-cultural practices, and morals of Protestant Christian practice
d. Describe the history, principles, ethno-cultural practices, and morals of the Church of Latter Day Saints.
e. Describe the history, principles, ethno-cultural practices, and morals of Jehovah’s Witness practice.
f. Describe the timeline over the past 2000 years of Christian schisms.
MLE-2.D.4 Describe the history, principles, ethno-cultural practices, and morals of Islam along with how they compare to other Abrahamic religions. Specifically to explain the implications to interpersonal interaction and medical decision making within this practice.
MLE-2.D.5 Describe the history, principles, ethno-cultural practices, and morals of Hinduism. Specifically to explain the implications to interpersonal interaction and medical decision making within this practice.
MLE-2.D.6 Describe the history, principals, ethno-cultural practices, and morals of Neopaganism along with differences between Hellenic/Roman, Norse, Wiccan, and Celtic. Specifically, to explain the implications to interpersonal interaction and medical decision making within this practice.
MLE-2.D.7 Describe the history, principles, ethno-cultural practices, and morals of Buddhism. Specifically, to explain the implications to interpersonal interaction and medical decision making within this practice.
a. Describe the history, principles, ethno-cultural practices, and morals of Falun Gong.
b. Describe the history, principles, ethno-cultural practices, and morals of Zen.
MLE-2.D.8 Describe the history, principles, ethno-cultural practices, and morals of Sikhism. Specifically to explain the implications to interpersonal interaction and medical decision making within this practice.
MLE-2.D.9 Describe the history, principles, ethno-cultural practices, and morals of Taoism. Specifically to explain the implications to interpersonal interaction and medical decision making within this practice.
MLE-2.D.10 Describe the history, principles, ethno-cultural practices, and morals of Zoroastrianism. Specifically to explain the implications to interpersonal interaction and medical decision making within this practice.
MLE-2.D.11 Describe the history, principles, ethno-cultural practices, and morals of First People’s indigenous practices. Specifically to explain the implications to interpersonal interaction and medical decision making within this practice.
MLE-2.D.12 Identify the various religio-cultural or ethic groups within your practice area and think about how you change your approach to an unique situation based on the patient being from a different religio-cultural group.
a. Explain what challenges would arise from mixed patient families and mixed power of attorney. How these challenges might be overcome.
b. Explain how gender is a key component in religio-cultural interactions.
MLE-3 Describe the major US, state, and local laws and policies dealing with education.
MLE-3.A Explain the Family Educational Rights and Privacy Act.
MLE-3.B Explain the Americans with Disabilities Act in regard to sport.
MLE-3.C Explain the applications of Title IX.
MLE-3.D Explain the application of the Equal Protection Clause of the Fourteenth Amendment.
MLE-3.E Explain Relevant Supreme Court Cases
MLE-3.E.1 Describe the applications of Tinker v. Des Moines, Board of Education v. Pico, Bethel v. Fraser, and Morse v. Frederick.
MLE-3.E.2 Describe the applications of Santa Fe I.S.D v. Doe, Vernonia School District 47 v. Acton, Brentwood Academy v. TSSAA (Parts I and II), New Jersey v. T.L.O., and Fitzgerald v. Barnstable School Committee.
MLE-3.F Explain the relevant California Education Code [33000-64100]
MLE-4 Describe the CIF bylaws and how they interact with secondary school sport.
MLE-4.A Describe the rules surrounding eligibility.
MLE-4.A.1 Explain the rules surrounding academic eligibility.
MLE-4.A.2 Explain the rules surrounding residential eligibility.
MLE-4.A.3 Explain the rules surrounding medical eligibility.
MLE-4.B Describe the rules surrounding player safety.
MLE-4.C Describe the rules surrounding penalties.
MLE-4.C.1 Explain how CIF determines penalties.
MLE-4.C.2 Explain how a school can contest a CIF sanction.
MLE-5 Explain consent and how to achieve consent for medical procedures.
MLE-5.A Describe informed expressed consent and in general who can or cannot give informed expressed consent.
MLE-5.A.1 Explain how a person is competent for consent.
a. Identify that under normal circumstances the patient must be an adult.
b. Identify that the person must be of sound mind.
MLE-5.A.2 Describe the amount of information that must be given to the patient to adequately inform them.
a. The patient must be given enough background knowledge to reasonably understand the concepts; therefore, all medical providers are medical educators.
b. The patient must be informed of the pathology of the medical condition.
c. The patient must be informed of the prognosis of the condition.
d. The patient must be informed of all reasonable treatment options and the relative risks and benefits of each.
MLE-5.A.3 Explain the voluntary nature of the decision.
a. Explain how the patient must make the decision on their own without coercion.
b. Explain how power dynamics can work in a variety of contexts and how the patient must be able to give consent independent of a coercive power.
c. Recognize intimate/close partner violence/abuse and how to achieve voluntary consent without the undue influence of the partner.
MLE-5.B Describe implied consent and in general when is consent implied.
MLE-5.B.1 Explain under what specific circumstances a patient would lose the ability to give expressed consent.
MLE-5.B.2 Explain what types of decisions an attending can make for a patient.
MLE-5.B.3 Describe how to resolve conflicts between two guardians over a person with implied consent.
MLE-5.B.4 Explain power of attorney in the medical context and under what circumstances is it durable. Describe anyone who would automatically receive medical power of attorney over a patient.
MLE-5.C Describe what constitutes decision making capacity.
MLE-5.C.1 Explain at which age decision making capacity engages under normal circumstances.
MLE-5.C.2 Describe the process to gauge the patient mental status.
a. Explain the process for gauging alertness and awareness (the patient must fall into one of the following categories: alert & aware, alert, verbal, painful, and unresponsive).
b. Explain the process for gauging orientation (the patient must be oriented to person, place, time, and event).
c. Explain how to generate a Glasgow Coma Score. Include an analysis of normal and compromised ranges.
d. Explain how to gauge logic ability. (patient must be able to understand the pathology, personalize the potential consequences, and be able to generate a logical plan)
MLE-5.D Describe under what circumstances a minor can have decision making capacity.
MLE-5.D.1 Explain that a patient of any age, with otherwise sound decision making capacity, can give expressed consent for their children.
MLE-5.D.2 Explain that a patient of any age, with otherwise sound decision making capacity, can give expressed consent for themselves if they are married.
MLE-5.D.3 Explain that a patient of any age, with otherwise sound decision making capacity, can give expressed consent for themselves if they are emancipated by the court.
MLE-5.D.4 Explain that a patient of reproductive age, with otherwise sound decision making capacity, can give expressed consent for themselves if they are choosing for a genitourinary/genitointestinal condition that would involve their reproductive organs or ability to utilize them.
MLE-5.D.5 Explain that a patient of reproductive age, with otherwise sound decision making capacity, can give expressed consent for themselves if they are choosing for a mental health condition.
MLE-5.D.6 Explain that if a patient has decision making capacity to give expressed consent they have the right to privacy about the information around that condition and decision even from a parent or guardian that would normally have a right to know in another situation.
MLE-5.E Explain how a patient can act against medical advice and refuse care.
MLE-5.E.1 Describe the process by which a patient can act against medical advice.
MLE-5.E.2 Describe the process by which a patient can seek a second opinion for a condition.
MLE-5.E.3 Describe the process by which a patient can refuse evaluation and care.
MLE-5.F Describe the burden of knowledge and how that interacts with medical practice.
MLE-5.F.1 Describe the burden of knowledge and when that burden creates a duty to act / duty to report.
MLE-5.F.2 Explain the concept of abandonment and how it intersects with the Good Samaritan Act.
MLE-6 Explain the relevant organizational law precepts to the healthcare industry.
MLE-6.A Explain the differences between common, administrative, and statutory law, including the sources of each.
MLE-6.B Explain the concepts of respondent superior and independent contractor
MLE-6.C Explain anti-trust laws and their application to healthcare.
MLE-6.D Explain the various types of organizations and their liabilities.
MLE-6.E Explain the jurisdictions of various courts and the concept of stare decisis.