MD JURISPRUDENCE 2025/2026 QUESTIONS AND
SOLUTIONS GRADED A+
✔✔How are you supposed to legally amend a chart/record? - ✔✔To amend a
chart/record, you cross out the mistake with a single line, date, and initial it. Any
additions must be clearly marked as an addendum (you can doctor your patients but not
your charts!).
✔✔What is an advanced directive? Medical Power of Attorney? Are witnesses or a
notary needed? How can they be revoked? - ✔✔Advanced Directives are legal medical
"plans" that lay out the desire to receive/withdraw life-sustaining treatment. They include
both the out-of-hospital DNR and medical power of attorney (MPOA).
*The MPOA* is an individual who has been identified as having the ability to make
medical decisions for a patient when the patient is no longer able to make decisions for
themselves (temporarily or permanently).
Two witnesses are required to make an advanced directive, one of which must have no
vested interest (not a relative and not involved in the patient's medical care).
Advanced directives can be given verbally to a physician as long as they fulfill the
witness requirement and are subsequently documented.
Notary services are not required. Advanced directives (including DNR and MPOA) do
not expire, they last until they are revoked or supplanted.
Revoking is easy. All a patient has to do to revoke an AD is say never mind.
✔✔Can a delirious patient revoke an advanced directive? - ✔✔Yes.
Medical decision making capacity is needed to make an advanced directive but not to
revoke it.
A patient can always revoke an advance directive anytime an in any state.
✔✔Is an advanced directive legally binding? - ✔✔Note that an advanced directive does
*not legally bind a physician to action*; if there is disagreement, a physician can request
an ethics committee review.
Once an attending physician signs the patient's out-of-hospital DNR, it *is legally
binding.*
✔✔What can you do when no family member or MPOA is available? - ✔✔the attending
physician may decide along with an uninvolved physician to provide life-sustaining
treatment (the "two doc" consent).
, ✔✔When can a family overrule their loved one's choice to forgo aggressive medical
intervention? - ✔✔You've seen patient's families disagreeing with their medical
decisions, particularly when they choose to forgo aggressive medical interventions. In
order for a family to overrule their loved one, they must petition a court for and be
granted "temporary guardianship."
The medical code, particularly in Texas, is biased towards life-sustaining treatment.
✔✔What constitutes a life-sustaining treatment? Terminal condition? - ✔✔Life-
Sustaining treatment includes ventilation support, life-sustaining medications (e.g.
pressors), dialysis, artificial nutrition (tube feeds, TPN), and hydration (including IVF).
A terminal condition is an incurable condition that will result in death even with life-
sustaining treatment.
✔✔What is capacity v. competency? - ✔✔(A common error: physicians determine
capacity, not competency; competency is an analogous legal term that is determined
exclusively by judges, i.e. "competent to stand trial.")
✔✔Who can pronounce a patient dead? - ✔✔- MD, PA, NP, RN can all pronounce a
patient dead.
- A ventilated person is considered dead when there is "brain death," i.e. irreversible
cessation of brain function, evidenced by lack of brainstem reflexes, respiratory drive,
etc. Time of death is when brain death is determined.
✔✔What deaths do you have to report? When do you have to report it by? - ✔✔- Class
C misdemeanor for not complying with regulations for birth or death certificate (5 days
birth, 10 days death)
- Must report death from communicable diseases: AIDS, anthrax, plague, rabies, TB,
syphilis
- Must report unexpected/suspicious deaths to the medical examiner, which includes
things like: dying in prison, murder, dying within 24 hours of hospital admission, suicide,
found in a ditch, etc.
- Autopsy can be conducted under the order of the medical examiner, the Justice of the
Peace, or the consent of family.
✔✔What is the order of consent for organ donation? Who cannot participate in organ
procurement / transplantation? - ✔✔- The order of consent: written wishes of the patient
followed by family (spouse -> adult child -> parent -> adult sibling)
SOLUTIONS GRADED A+
✔✔How are you supposed to legally amend a chart/record? - ✔✔To amend a
chart/record, you cross out the mistake with a single line, date, and initial it. Any
additions must be clearly marked as an addendum (you can doctor your patients but not
your charts!).
✔✔What is an advanced directive? Medical Power of Attorney? Are witnesses or a
notary needed? How can they be revoked? - ✔✔Advanced Directives are legal medical
"plans" that lay out the desire to receive/withdraw life-sustaining treatment. They include
both the out-of-hospital DNR and medical power of attorney (MPOA).
*The MPOA* is an individual who has been identified as having the ability to make
medical decisions for a patient when the patient is no longer able to make decisions for
themselves (temporarily or permanently).
Two witnesses are required to make an advanced directive, one of which must have no
vested interest (not a relative and not involved in the patient's medical care).
Advanced directives can be given verbally to a physician as long as they fulfill the
witness requirement and are subsequently documented.
Notary services are not required. Advanced directives (including DNR and MPOA) do
not expire, they last until they are revoked or supplanted.
Revoking is easy. All a patient has to do to revoke an AD is say never mind.
✔✔Can a delirious patient revoke an advanced directive? - ✔✔Yes.
Medical decision making capacity is needed to make an advanced directive but not to
revoke it.
A patient can always revoke an advance directive anytime an in any state.
✔✔Is an advanced directive legally binding? - ✔✔Note that an advanced directive does
*not legally bind a physician to action*; if there is disagreement, a physician can request
an ethics committee review.
Once an attending physician signs the patient's out-of-hospital DNR, it *is legally
binding.*
✔✔What can you do when no family member or MPOA is available? - ✔✔the attending
physician may decide along with an uninvolved physician to provide life-sustaining
treatment (the "two doc" consent).
, ✔✔When can a family overrule their loved one's choice to forgo aggressive medical
intervention? - ✔✔You've seen patient's families disagreeing with their medical
decisions, particularly when they choose to forgo aggressive medical interventions. In
order for a family to overrule their loved one, they must petition a court for and be
granted "temporary guardianship."
The medical code, particularly in Texas, is biased towards life-sustaining treatment.
✔✔What constitutes a life-sustaining treatment? Terminal condition? - ✔✔Life-
Sustaining treatment includes ventilation support, life-sustaining medications (e.g.
pressors), dialysis, artificial nutrition (tube feeds, TPN), and hydration (including IVF).
A terminal condition is an incurable condition that will result in death even with life-
sustaining treatment.
✔✔What is capacity v. competency? - ✔✔(A common error: physicians determine
capacity, not competency; competency is an analogous legal term that is determined
exclusively by judges, i.e. "competent to stand trial.")
✔✔Who can pronounce a patient dead? - ✔✔- MD, PA, NP, RN can all pronounce a
patient dead.
- A ventilated person is considered dead when there is "brain death," i.e. irreversible
cessation of brain function, evidenced by lack of brainstem reflexes, respiratory drive,
etc. Time of death is when brain death is determined.
✔✔What deaths do you have to report? When do you have to report it by? - ✔✔- Class
C misdemeanor for not complying with regulations for birth or death certificate (5 days
birth, 10 days death)
- Must report death from communicable diseases: AIDS, anthrax, plague, rabies, TB,
syphilis
- Must report unexpected/suspicious deaths to the medical examiner, which includes
things like: dying in prison, murder, dying within 24 hours of hospital admission, suicide,
found in a ditch, etc.
- Autopsy can be conducted under the order of the medical examiner, the Justice of the
Peace, or the consent of family.
✔✔What is the order of consent for organ donation? Who cannot participate in organ
procurement / transplantation? - ✔✔- The order of consent: written wishes of the patient
followed by family (spouse -> adult child -> parent -> adult sibling)
