Medical Ethics Limits and Boudnaries Flashcards

1
Q

What are the 5 main values for this profession?

A
  1. first, do no harm (non-maleficence)
  2. Respect the patient (autonomy)
  3. Benefit the patient (beneficence)
  4. Use scarce resources wisely (justice)
  5. Be honest
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2
Q

What are the thre emodels that reflect the locus of power in decision?

A
  1. paternalistic
  2. Informative (autonomy)
  3. Deliberative (negotiated/balanced)
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3
Q

When can you decline to treat someone? Which ones are not necessarily legal or ethical?

A
  1. when it’s outside of your scope of practice
  2. when it’s beyond your clinical skills
  3. when there’s a concern for exposure to infection (legal, but ethical?)
  4. Torture/Execution
  5. Referral
  6. Reproductive health
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4
Q

Under most situations, refusing to refer a patient for treatment is illegal and unethical. What’s the exception?

A

reproductive health issues

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5
Q

What is a conscience clause?

A

it legally permits professionals to NOT provide certain medical services, based on MD’s personal beliefs

in regards to birth control, abortion, stem cell trx

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6
Q

What’s the difference between proxy/surrogate and guardian/conservator? Which trumps which?

A

proxy is personallyl designated by the patient

guardian is court appointed and will trupmp a proxy

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7
Q

What is substituted judgement?

A

when a proxy makes a decision based on what they think the patient’s preference would be

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8
Q

What sources of info can you use to make a substituted judgement?

A

written documents like living wills, advanced directives,
discussions with th eperson
life story/life style

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9
Q

If you don’t have any information to use in substitute djudgement, what should a proxy base the decision on?

A

best interests - based on pain and suffering, funcitonality and prognosis

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10
Q

FOr the case with the guy who killed a police officer, what law forces you to give care and to what extent?

A

EMTALA

you have to treat them in the ER (implied consent) and must stabilize them

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11
Q

Does EMTALA apply to children?

A

yes - in most cases they say you need a parent’s permission to go ahead, but if it’s dire and you can’t find a family member for decision making, you can go ahead

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12
Q

What does the Good Samaritan protect you for?

A

you are protected as long as you are only doing things you were trained to do

but you can be exposed if you cause harm or just walk away? I’m confused.

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13
Q

Where is the Death with Dignity act legal?

A
oregon
washington
montana
vermont
new mexico
failed barely in colorado
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14
Q

What are the ethical issues surrounding the death with dignity act?

A

autonomy for the patient

beneficence/non-maleficence on our side

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15
Q

Is this euthanasia?

A

no - it gets to the self administration of the med

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16
Q

What is the issue with intent or double effect?

A

if there is a patient who is pregnant and has breast cancer, the intent is the chemo to cure the cancer. the double effect is that the chemo harms the fetus

17
Q

Are you obliged to provide any care the patient requests?

A

no - we are not obligued to provide care that we judge to be non-beneficial - this limits patient’s autonomy (can refuse, but not demand care)

18
Q

Can we forego medical interventions as physicians?

A

yes

we can say no CPR, we can say no feeding tube, we can say no vent or dialysis - it doesn’t have to be considered futile

but you need to have a trusted patient/doctor relationship

19
Q

What are some ways to resolve ethics boundary issues

A

consultants/ethics committees
court decisions
landmark cases

20
Q

What are the exceptions to confidentiality laws?

A
  1. public health reporting for ID
  2. Tarasoff
  3. Impaired professionals
  4. Emancipated minors
  5. Patient’s/others at risk
21
Q

What are the public health reporting requirements?

A
  1. infectious conditions
  2. firearm injuries
  3. elevated blood lead
  4. cancer registries
  5. birth defects
22
Q

What are the mandated reporting situations regarding patients/others at risk?

A
  1. tarasoff
  2. child and culnerable adult abuse
  3. domestic abuse (depending on state)
  4. impaired patients like unsafe drivers and public safety
  5. infectious conditions
  6. genetic conditions
23
Q

What are the considerations in regards to reporting impaired professionals?

A
  1. illness - mental illness, dementia, MS (etc). goes to the board of heatlh
  2. drugs and alcohol
  3. chronic infectious conditions
24
Q

What program works with impaired professionals to help them keep working?

A

the Health Professionals Services Program

25
Q

What are some situations that will emancipate or overrule the law to notify parents?

A
  1. specific care isuses like birth control and STIs, also mental health concerns and drug or alcohol abuse
  2. legally married
  3. consenting as a parent (if over 15)
  4. military emancipates them
  5. court ordered emancipation