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Step 3 > Ethics > Flashcards

Ethics Flashcards

1
Q

If an adult patient who is mentally intact desires to refuse a treatment or test, what is the next step in management?

A

Discuss the reasons before honoring his/her wishes

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2
Q

Who determines Capacity?

A

Doctors

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3
Q

Who determines Competence?

A

Courts/Judges

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4
Q

Is capacity sufficient to make a medical decision?

A

Yes

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5
Q

When is a Psych consult indicated for ethical matters?

A

If the patient’s capacity to understand is not clear

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6
Q

When should a psych consult NOT be done?

A

When pt competence/Capcity is Clearly present

When pt is comatose/clearly does not hv capacity

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7
Q

Which minors can be considered Emancipated?

A

Those who :
Live independent of their parents and are self-supported
Married
In Military

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8
Q

When is a minor considered partially emancipated?

A

In terms of sexual/reproductive related issues and substance abuse –> these minors can mk decisions w/o parental notification/consent

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9
Q

What condition is an exception to Partial Emancipation and requires parental consent/knowledge ?

A

Abortion (Recommend that parents be notified or initially discuss why the pt does not feel she can share this with her parent(s)

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10
Q

Are parents allowed to refuse lifesaving therapy for minors?

A

No, regardless of parental belief/lifestyle. A minor MUST receive life-saving therapy. If they refuse–>considered child abuse!

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11
Q

What is required for informed consent to be granted by a patient?

A

Pt must have capacity and be fully informed?

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12
Q

What are the 5 prinicples of Informed Consent?

A

1) Pt. must be informed of the benefits
2) Pt. must be informed of the risks
3) Pt. must be given alternatives
4) Information must be in a language pt can understand
5) Informed consent must be given for each intervention/procedure

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13
Q

What is the rule for a woman’s right to refuse life-saving treatment for her fetus?

A

A pregnant woman CAN refuse life-saving treatment for her unborn child.
The fetus is considered a part of her body until it is born

A parent cannot refuse treatment for a child that is living outside of the womb!!

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14
Q

What medical conditions allows a physician to inform close contacts/associates at risk about a pt without their consent?

A 
Transmissible Diseases, such as:
HIV
Tb
Syphilis
Gonorrhea

Psychiatric pt who may be planning to harm others

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15
Q

What is required for an advanced directive to be valid?

A

The patient must have capacity

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16
Q

What is considered the strongest advanced directive?

A

Health Care Proxy

17
Q

What can be used as an alternative if a pt does not have a health care proxy?

A

Living Will

18
Q

What is required of the living will in order for it to be useful/valid?

A

It must be clear and concise; no generalizations

ex: “No heroic measures” cannot be used to determine the type of care a pt should/should not receive

19
Q

What should/should not be done when a DNR is in place?

A

No endotracheal intubation and no CPR if one cannot breathe independently or one’s heart stops.

Testing and medical treatment can still be done

20
Q

When should an ethics committee be used?(3)

A

If pt is an adult who lack capacity
If there are no clear wishes/instructions from the pt
If the caregivers/family are divided regarding what the pt’s wishes are

21
Q

When is a court order necessary?

A

When all other attempts at determining pt wishes (including ethics committee) prove futile

22
Q

What should be done regarding fluids and nutrition to a pt?

A

Adult with Capacity: Whatever they decide

Adult w/o capacity and proxy/clear wishes: as pt stated prior to losing capacity

Adult w/o capacity and NO proxy/clear wishes: provide nutrition/fluids

23
Q

What is the rule regarding pain meds that can end life?

A

It is ok to give pain medication for the purpose of relieving pain/suffering even though that medication/dose may shorten the pts life.

It is NOT ok to give the pt the medication or for the physician to administer it thesole purpose of ending the pts life, this is Physician-assisted Suicide/Euthanasia, both are illegal.

24
Q

What are the criteria to declare someone Brain Dead?

A

Loss of consciousness
Absence of motor response to painful stimulus
Absent Brainstem reflexes
(Pupillay, Oculocephalic, Oculovestibular, Corneal,
Facial grimacing to noxious stimuli, Gag, or Cough)
Apnea
Acute CNS catastrophe
Absence of elctrolyte/acid-base imbalance
Absence of poisoning/drug intoxication

Requires exam by a neurologist/neuro-related subspecialty physician

25
Q

Is a physician obligated to provide care that will not benefit the pt in any way or care to a pt declared brain dead?

A

NO

26
Q

Can gamete donors be paid without penalty?

A

Yes.

27
Q

Is a physician obligated to inform the sex partner or the person(s) with whom a pt shares needles of his/her HIV status?

A

Yes.

28
Q

Does an HIV-pos health care worker/provider have to disclose their status to their pts or employers?

A

No

29
Q

Can physicians legally refuse caring for any pt?

A

Yes, it is not illegal to refuse to care for a pt for any reason, but it can be unethical

30
Q

Is a physician obligated wit accept a pt that is not already established under his/her care?

A

No, a physician does NOT have to accept a pt for any reason, even if he/she is the only physician available.

31
Q

Can a physician refuse to treat/care for an established pt without letting them know and before they find alternative care?

A

No, a physician must let a person know that they will no longer be able to care for them and must continue caring for the pt until they find another provider

32
Q

Can a physician have a sexual relationship with a patient, past or present?

A

Psychiatrist can NEVER have a sexual relationship w/ pts
All other specialties can have a sexual relationship with former patients only.

The doctor-pt relationship must end prior to the sexual relationship starting

33
Q

Does elder abuse have to be reported?

A

Elder (frailty/vulnerability, not just age) CAN be reported w/w/o pts consent

34
Q

When must physician impairment be reported and to whom?

A

Reporting required only when impairment will involve potential danger to medical care

Residents: report to Program Director or Dept. Chair
Faculty: report to Dept. Chair or Dean of Medical School
Attending in private practice: report to State Med Board of Office of Professional Medical Conduct

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