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How Bioethics Can Enrich Medical-Legal Collaborations

Published online by Cambridge University Press:  01 January 2021

Extract

Medical-legal partnerships (MLPs) — collaborative endeavors between health care clinicians and lawyers to more effectively address issues impacting health care — have proliferated over the past decade. The goal of this interdisciplinary approach is to improve the health outcomes and quality of life of patients and families, recognizing the many non-medical influences on health care and thus the value of an interdisciplinary team to enhance health. There are currently over 180 MLPs at over 200 hospitals and health centers in the United States, with increasing federal interest and potential legislative support of this model.

This article examines the unique, interrelated, and often similar (although at times conflicting) ethical issues that confront the clinical and legal partners involved in MLPs. We contend that the ethical precepts of the clinical and legal professions should be seen as opportunities, not barriers, to further the interdisciplinary nature of MLPs.

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Copyright © American Society of Law, Medicine and Ethics 2010

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References

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“Autonomy” seems an obvious value, but can be tricky as applied. How much capacity does a patient need to autonomously make a decision? What if one's wishes are not clearly known and the family cannot agree on a decision? Or what if the patient is an adolescent, on the cusp of legal adulthood? These are the sorts of cases that vex the treatment team and may result in an ethics consult (and certainly have been known to cause many a legal issue as well).Google Scholar
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At this point, the PCP may have an obligation to report child neglect pursuant to his state's mandatory child abuse and neglect reporting statute. Generally, mandatory reporters (those defined by statute) are required to report abuse, neglect, injuries detected that are inconsistent or at variance with explanations provided, and children who are placed in imminent risk of harm. Many state reporting schemes require that a parent, guardian, or someone responsible for the care and protection of the child cause the abuse, neglect or imminent risk of harm. As a result, the mere fact that a minor is engaged in potentially illegal conduct (e.g., statutory rape) may not implicate child welfare reporting laws in many states because the conduct complained of does not emanate from parental malfeasance or parental nonfeasance.Google Scholar
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There are valid differences of opinion amongst those involved in MLPs about whether the “training” in interdisciplinary collaborations should be during the professional school training or when the professionals are in practice. The authors believe that it is important to have it during the professional school training so that it affects and influences the training and socialization of the professionals.Google Scholar
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We do recognize the “not another commission” argument against this recommendation, but stress that this proposed commission would be formed with the specific goal to address the sorts of non-profit multidisciplinary practices that MLPs represent, and that are of growing use.Google Scholar
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