Medical Treatment and the Physician’s Legal Duties

  • Marshall B. Kapp


In the course of obtaining medical care, the older patient enters into a relationship with one or more physicians, professional staff working under the physician’s control, and frequently health care entities through which or in which the health care is delivered. These relationships may be described as both contractual (i.e., based on a mutual exchange of promises) and fiduciary (i.e., based on the necessary trust that accompanies the patient’s reliance on the more knowledgeable and powerful health care provider). Under either of these characterizations, the relationships that are formed entail a variety of legal obligations on the part of the physician. These duties are enforceable, and their violation may lead to adverse legal and financial consequences for the physician.


Nursing Home Advance Directive Protective Service Court Order Social Service Agency 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Kapp MB. The malpractice crisis: relevance for geriatrics. J Am Geriatr Soc. 1989; 37: 364–368.PubMedGoogle Scholar
  2. 2.
    Kapp MB, Lo B. Legal perceptions and medical decisionmaking. Milbank Q. 1986; 64 (suppl 2): 162–202.Google Scholar
  3. 3.
    Kapp MB. Defensive medicine in geriatric practice. In: Homburger F, ed. The Rational Use of Advanced Medical Technology with the Elderly. New York: Springer; 1994: 67–74.Google Scholar
  4. 4.
    Sager M, Voeks S, Drinka P, et al. Do the elderly sue physicians? Arch Intern Med. 1990; 150: 1091–1093.PubMedCrossRefGoogle Scholar
  5. 5.
    US General Accounting Office. Medical Malpractice: Medi-care/Medicaid Beneficiaries Account for a Relatively Small Percentage of Malpractice Losses. Washington, DC: US Government Printing Office; 1993.Google Scholar
  6. 6.
    Burstin H, Johnson W, Lipsitz, et al. Do the poor sue more? JAMA. 1993; 20: 775–795.Google Scholar
  7. 7.
    Weiler P, Hiatt H, Newhouse J, et al. A Measure of Malpractice: Medical Injury, Malpractice Litigation, and Patient Compensation. Cambridge, MA: Harvard University Press; 1993.Google Scholar
  8. 8.
    Kapp MB. Our hands are tied: legally induced moral tensions in health care delivery. J Gen Intern Med. 1991; 6: 345–348.PubMedCrossRefGoogle Scholar
  9. 9.
    Making Health Care Decisions: The Ethical and Legal Implications of Informed Consent in the Patient-Practitioner Relationship. Washington, DC: President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research; 1982.Google Scholar
  10. 10.
    Keeler EB, Solomon DH, Beck JC, et al. Effect of patient age on duration of medical encounters on physicians. Med Care. 1982; 20: 1101–1108.PubMedCrossRefGoogle Scholar
  11. 11.
    Levinson SA, ed. Medical Direction in Long-Term Care. 2nd ed. Owings Mills, MD: National Health Publishing; 1993.Google Scholar
  12. 12.
    Faden RR, Beauchamp TL. A History and Theory of Informed Consent. New York: Oxford University Press; 1986.Google Scholar
  13. 13.
    Marsh FH. Informed consent and the elderly patient. Clin Geriatr Med. 1986; 2: 501–510.PubMedGoogle Scholar
  14. 14.
    Rozovsky FA. Consent to Treatment: A Practical Guide. 2nd ed. Boston, MA: Little, Brown; 1990.Google Scholar
  15. 15.
    Miller L. Informed consent. JAMA. 1980; 244: 2100–2103, 2347–2350, 2556–2558, 2661–2662.Google Scholar
  16. 16.
    Kapp MB. Evaluating decision making capacity in the elderly: a review of recent literature. J Elder Abuse Neglect. 1990; 2: 15–29.CrossRefGoogle Scholar
  17. 17.
    Kapp MB. Assessment of competence. In: Carstensen L, Dornbrand L, Edelstein BA, eds. Practical Handbook of Clinical Gerontology. Newbury Park, CA: Sage Publications; 1996.Google Scholar
  18. 18.
    Larson EB, Lo B, Williams ME. Evaluation and care of elderly patients with dementia. J Gen Intern Med. 1986; 1: 116–126.PubMedCrossRefGoogle Scholar
  19. 19.
    Dubler NN. Coercive placement of elders: protection of choice? Generations. 1987; 11: 6–9.Google Scholar
  20. 20.
    Blank K. Depressive illness in the elderly: legal and ethical issues. In: Rosner R, Schwartz HI, eds. Geriatric Psychiatry and the Law. New York: Plenum; 1987: chap. 11.Google Scholar
  21. 21.
    Multi-Society Task Force on PVS. Medical aspects of the persistent vegetative state. Parts One and Two. N Engl J Med. 1994; 330: 1499–1508, 1572–1579.Google Scholar
  22. 22.
    Munetz M, Lidz C, Meisel A. Informed consent and incompetent medical patients. J Fam Pract. 1985; 20: 273–279.PubMedGoogle Scholar
  23. 23.
    Goldstein RL. Non compos mentis: the psychiatrist’s role in guardianship and conservatorship proceedings involving the elderly. In: Rosner R, Schwartz HI, eds. Geriatric Psychiatry and the Law. New York: Plenum; 1987: chap. 16.Google Scholar
  24. 24.
    Strain JJ, Fulop G. Screening devices for cognitive capacity. Ann Intern Med. 1987; 107: 583–585.PubMedGoogle Scholar
  25. 25.
    Meisel A, Roth L, Lidz C. Toward a model of the legal doctrine of informed consent. Am J Psychiatry. 1977; 134: 285–289.PubMedGoogle Scholar
  26. 26.
    Grisso T, Appelbaum PS. Mentally ill and nonmentally ill patients’ abilities to understand informed consent disclosures for medication. Law Human Behav. 1991; 15: 377–388.CrossRefGoogle Scholar
  27. 27.
    Roth L, Meisel A, Lidz C. Tests of competency to consent to treatment. Am J Psychiatry. 1977: 134: 279–284.PubMedGoogle Scholar
  28. 28.
    Culver C. The clinical determination of competence. In: Kapp MB, Pies H, Doudera AE, eds. Legal and Ethical Aspects of Health Care for the Elderly. Ann Arbor, MI: Health Administration Press; 1985: chap. 24.Google Scholar
  29. 29.
    Harris S. Protecting the rights of questionably competent long-term care facility residents. In: Kapp MB, Pies H, Doudera AE, eds. Legal and Ethical Aspects of Health Care for the Elderly. Ann Arbor, MI: Health Administration Press; 1985: chap. 17.Google Scholar
  30. 30.
    Heikoff LE. Practical management of the demented elderly. West J Med. 1986; 145: 397–399.PubMedGoogle Scholar
  31. 31.
    Caplan A. Let wisdom find a way. Generations. 1985; 10: 10–14.Google Scholar
  32. 32.
    Sachs GA, Rhymes J, Cassel CK. Biomedical and behavioral research in nursing homes: guidelines for ethical investigations. J Am Geriatr Soc. 1993; 41: 771–777.PubMedGoogle Scholar
  33. 33.
    Sachs GA, Cassel CK. Biomedical research involving older human subjects. Law Med Health Care. 1990; 18: 234–243.PubMedGoogle Scholar
  34. 34.
    Levine RJ. Ethics and Regulation of Clinical Research. 2nd ed. Baltimore: Urban & Schwarzenberg; 1986.Google Scholar
  35. 35.
    Ratzan RM. Being old makes you different: the ethics of research with elderly subjects. Hastings Cent Rep. 1980; 10: 32–42.PubMedGoogle Scholar
  36. 36.
    Annas GJ, Glantz LH. Rules for research in nursing homes. N Engl J Med. 1986; 315: 1157–1158.PubMedCrossRefGoogle Scholar
  37. 37.
    American College of Physicians. Cognitively impaired subjects. Ann Intern Med. 1989; 111: 843–848.Google Scholar
  38. 38.
    Warren JW, Sobal J, Tenney JH, et al. Informed consent by proxy: an issue in research with elderly patients. N Engl J Med. 1986; 315: 1124–1128.PubMedCrossRefGoogle Scholar
  39. 39.
    Melnick VL, Dubler NN, Weisbard A, et al. Clinical research in senile dementia of the Alzheimer’s type: suggested guidelines addressing the ethical and legal issues. J Am Geriatr Soc. 1984; 32: 531–536.PubMedGoogle Scholar
  40. 40.
    Dubler NN. Legal judgments and informed consent in geriatric research./Am Geriatr Soc. 1987; 35: 545–549.Google Scholar
  41. 41.
    Kapp MB. Proxy decision making in Alzheimer’s disease research: durable powers of attorney, guardianship, and other alternatives. Alzheimer’s Dis Assoc Disord. 1994; 8 (suppl 4): 28–37.CrossRefGoogle Scholar
  42. 42.
    Dickens BM. Substitute consent to participation of persons with Alzheimer’s disease in medical research: legal issues. In: Berg J, Karlinsky H, Lowy F, eds. Alzheimer’s Disease Research: Ethical and Legal Issues. Toronto: Carswell Publishers; 1991: 60–75.Google Scholar
  43. 43.
    Cassel CK. Ethical issues in the conduct of research in long term care. Gerontologist. 1988; 28 (suppl): 90–96.PubMedCrossRefGoogle Scholar
  44. 44.
    Cantor NL. Advance Directives and the Pursuit of Death with Dignity. Bloomington, IN: Indiana University Press; 1993.Google Scholar
  45. 45.
    Kapp MB, ed. Patient Self-Determination in Long-Term Care. New York: Springer; 1994.Google Scholar
  46. 46.
    Areen J. Advance directives under state law and judicial decisions. Law Med Health Care. 1991; 19: 91–100.PubMedGoogle Scholar
  47. 47.
    Menikoff JA, Sachs GA, Siegler M. Beyond advance directives: health care surrogate laws. N Engl J Med. 1992; 327: 1165–1169.PubMedCrossRefGoogle Scholar
  48. 48.
    In re Storar, 52 NY2d 363, 420 NE2d 64 (1981).Google Scholar
  49. 49.
    US House of Representatives, Subcommittee on Health and Long-term Care of the Select Committee on Aging. Abuses in Guardianship of the Elderly and Infirm: A National Disgrace. 100th Congress, 1st Session; 1987. Committee Publication 100–641.Google Scholar
  50. 50.
    Applebaum PS. Limitations on guardianship of the mentally disabled. Hosp Community Psychiatry. 1982; 33: 183–184.Google Scholar
  51. 51.
    American Medical Association Judicial Council. Guidelines for ethics committees in health care institutions. JAMA. 1985; 253: 2698–2699.CrossRefGoogle Scholar
  52. 52.
    Brown BA, Miles SH, Aroskar MA. The prevalence and design of ethics committees in nursing homes. J Am Geriatr Soc. 1987; 35: 1028–1033.PubMedGoogle Scholar
  53. 53.
    Fost N, Cranford RE. Hospital ethics committees: administrative aspects. JAMA. 1985; 253: 2687–2692.PubMedCrossRefGoogle Scholar
  54. 54.
    Wood JS. Nursing home care. Clin Geriatr Med. 1986; 2: 601–615.PubMedGoogle Scholar
  55. 55.
    Kapp MB. Legal and ethical aspects of resuscitation: an annotated bibliography of recent literature. Resuscitation. 1987; 15: 289–297.PubMedCrossRefGoogle Scholar
  56. 56.
    US Congress, Office of Technology Assessment. Life- Sustaining Technologies and the Elderly. 100th Congress, 1st Session; 1987. Publication OTA-BA-306.Google Scholar
  57. 57.
    Miles SH, Ryden M. Limited-treatment policies in long-term care facilities. J Am Geriatr Soc. 1985; 33: 707–711.PubMedGoogle Scholar
  58. 58.
    Stephens R. Do not resuscitate orders: ensuring the patient’s participation. JAMA. 1986; 255: 240–241.PubMedCrossRefGoogle Scholar
  59. 59.
    Kapp MB. Futile medical treatment: a review of the ethical arguments and legal holdings. J Gen Intern Med. 1994; 9: 170–177.PubMedCrossRefGoogle Scholar
  60. 60.
    Miles SH. Advanced directives to limit treatment: the need for portability. J Am Geriatr Soc. 1987; 35: 74–76.PubMedGoogle Scholar
  61. 61.
    Farber N, Weiner J, Boyer G, et al. Cardiopulmonary resuscitation: values and decisions—a comparison of health care professionals. Med Care. 1985; 23: 1391–1398.PubMedCrossRefGoogle Scholar
  62. 62.
    Rango N. The nursing home resident with dementia: clinical care, ethics, and policy implications. Ann Intern Med. 1985; 102: 835–841.PubMedGoogle Scholar
  63. 63.
    Kapp MB. Adult protective services: convincing the patient to consent. Law Med Health Care. 1983; 11: 163–167.PubMedGoogle Scholar
  64. 64.
    American Medical Association Council on Scientific Affairs. Elder abuse and neglect. JAMA. 1987; 257: 966–971.CrossRefGoogle Scholar
  65. 65.
    Kantor JE. Ethical considerations in geriatric forensic psychiatry. In: Rosner R, Schwartz HI, eds. Geriatric Psychiatry and the Law. New York: Plenum; 1987: chap. 19.Google Scholar
  66. 66.
    Quinn MJ, Tomita SK. Elder Abuse and Neglect: Causes, Diagnosis, and Intervention Strategies. New York: Springer; 1986.Google Scholar

Copyright information

© Springer Science+Business Media New York 1997

Authors and Affiliations

  • Marshall B. Kapp

There are no affiliations available

Personalised recommendations