Behavioral Sciences Flashcards
(114 cards)
Autonomy
Obligation to respect pateitns ad individuals and to honor hteir preferences in medical care.
Beneficence
hysicians have a special ethical duty to act in the patient’s best interest. May conflict with autonomy. If the patient can make an informed decision, the patietn has the righ tot decide.
Nonmaleficence
Do no harm; however, if the benefits of an intervention outweight the risks, a patient may make an informed decision to proceed.
Justice
To treat persons fairly.
Informed consent requirements (3)
Discussion of pertinent information, patient’s voluntary agreement to the plan of care, and freedom from coercion. Pateint must be made aware of risks, benefits, and alternatives.
Exceptions to informed consent (4)
Patietn is incompetent, implied consent in an emergency, therapeutic privilege (witholding information when disclosure would severely harm the patient or undermine informed decision-making capacity), waiver (patient waives the right of infomred consent).
Consent for minors
Any person < 18 years of age; parental consent must be obtained unless a minor is emancipated (married, self supporting, has children, in military). However pareitnal consetn is NOT required in emergency situations, when prescribing contraceptive,s or in treatment of STDS/medical care during pregnancy/management of drug addiction.
Decision-making capacity
Patient makes and communicates a hoice, patietn is informed, decision rem aisn stable over time, decision is consistent with patient’s values and goals, decision is not a result of delusions or hallucinatoins.
Oral advance directive
Given prior to incapacitation; takes precidence if most current.
Living will
Written directive on what care should be provided on incapacitation; usually to withdraw life-sustaining treatment or in a persistent vegetative state.
Durable power of attorney
Patient designates a surrogate to make decisions in the event of incapactiation; patient may also specify decisions in clinical situations. Surrogate retains power until reoked by patient.
Decision making surrogates
If patient hasn’t prepared instructions and becomes incomptent, individuals who know patient may determine what the patient would have done if he/she were competent. Priority of surrogates: spouse > adult children > parents > siblings > other relatives.
Confidentiality
Respects privacy and autonomy; disclosing information to family and friends should be guided by what the patient would want. Patient may right to confidentiality (e.g. insurance companies).
Exceptions to confidentiality
Potential harm to others, self-harm risk is great, no alternative exists to warn or protect those at risk, physician must takes step sto prevent harm (STD, TB, hepatitis, food poisoning to warn public officials; child/elder abuse, imparied automobile drivers, suicidal/homicidal patients)
Tarasoff decision
Physician must directly inform and protec tpotential victim from harm; may involve breach of confidentiality.
Patient is noncompliant; appropriate response?
Attempt to identify the patient’s reason for noncompliance and determine his/her willingness to change; do not attempt to coerce the patient into complying or refer the patient to another physician.
Patient desires an unncessary procedure; appropriate response?
Attempt to understand why the patient wants the procedure and address underlying concerns. Do not refuse to see the patient or refer him to antoher physician. Avoid performing uncessary procedures.
Patient has difficultty taking medications; appropriate response?
Provide written instrucitons; attempt to simply treatment regimens.
Family members ask for information about patient’s prognosis; appropriate response?
Avoid discussing issues with relatives without the permission of the patient.
A child wishes to know more about his illness; appropriate response?
Ask what the paretns have told the child about his/her illness. Parents of a child decide what information can be relayed about the illness.
A 17 year old girl is pregnant and requests an abortion; appropriate response?
Many states require parental notification or consent; unless she is at medical risk, do not advise a patietn to have an abortion regardless of her age or the condition of the fetus.
A 15 year old girl is pregnant and wants ot keep her child; her parietns want you to tell her to give her up for adoption; appropriate response?
The patietn has the right to make decisions regarding her child, even if her parents disagree. Provide information to teen about pratical issues of childcare. Discuss options. Encourage discussion between her and her parents.
A terminally ill patient requests physician assistance in ending his life; appropriate response?
Refuse involvement; may give analgesics that coincidentally shorten the patient’s life.
Patient is suicidal; appropriate response?
Assess the seriousness of the treat; if serious, suggest that the patient remain in the hospital voluntarily; patient may be hospitalized involuntarily if he/she refuses.
