Ethical and Legal Issues in the Treatment of Older Adults Flashcards Preview

Geriatrics Final > Ethical and Legal Issues in the Treatment of Older Adults > Flashcards

Flashcards in Ethical and Legal Issues in the Treatment of Older Adults Deck (48):
1

autonomy

patient is able to make own decisions

2

beneficence

is treatment in the best interest of the patient

3

nonmaleficence

do no harm

4

tort

a civil wrong, other than a breach of contract including negligence, false imprisonment, assault and battery

5

informed consent was conceived from what?

the intentional tort of "battery"

6

intentional tort

no standard of care involved

7

informed consent

standard of care may apply

8

informed consent is usually treated as what?

negligent tort

9

types of torts

1. negligence
2. vicarious
3. intentional
4. strict

10

elements of informed consent

1. describe procedure/treatment
2. explain risks/benefits
3. discuss alternative treatments

11

adequate consent requires that the patient has what?

capacity

12

capacity is determined by who?

a physician

13

competency is determined by who?

the courts

14

two standards for disclosure of informed consent

1. physician-based
2. patient-based

15

physician-based standard for disclosure of informed consent

amount of disclosure based on what physicians would disclose given the same circumstances

16

problems with physician-based standard for disclosure of informed consent

1. plaintiff has to produce expert testimony
2. based solely on physician discretion

17

patient-based standard for disclosure of informed consent

amount of disclosure determined by what the "reasonable patient" would want to know about the treatment

18

T/F: patient-based standard for disclosure of informed consent doesn't require an expert testimony and by focusing on the patient, court believed that autonomy/self-determination preserved

true

19

T/F: states have used case law/statutes to pick one of the standards of informed consent or a hybrid of them

true

20

modalities to present information to patient

1. verbal presentation
2. discussion with physician
3. written information
4. pamphlets
5. video/internet
6. diagrams/charts

21

what is the preferred modality to present information to patients?

discussion with physician

22

what should be disclosed to patients?

1. severe risk, low probability
2. less severe, higher incidence
3. risk specific to procedure

23

rule of thumb when it comes to disclosing risks to patients

1. death
2. serious injury
3. limb/organ damage
4. minor events that happen >5% of the time

24

what are the general risk that should be disclosed to patients?

1. infection
2. vascular/neurological injury
3. death

25

Do Not Resuscitate (DNR) orders

order given by a physician to not attempt resuscitative protocol for someone in cardiopulmonary distress (no ACLS protocol)

26

when can a DNR be written?

after a physician discusses it with the patient or, if they lack capacity, a patient surrogate

27

types of DNR orders

1. DNR
2. DNI
3. chemical code
4. full code

28

DNI (do not intubate)

no invasive airway establishment

29

chemical code type of DNR

meds only

30

full code tyoe of DNR

all supportive measures

31

criteria for capacity

1. ability to communicate a choice
2. understanding relevant information
3. appreciate the situation/consequences
4. ability to reason about treatment

32

types of advance directives

1. living will
2. durable power of attorney for health care

33

when does the living will take effect?

when patient lacks capacity

34

what does the living will outline?

the type of care the patient would like

35

problems with living wills

1. it may not address the therapy that needs to be instituted
2. language can be vague
3. may not clearly indicate code status

36

legal definition of "terminal condition"

will result in death regardless of treatment

37

T/F: "terminal condition" usually requires 2 physicians to agree

true

38

durable power of attorney for health care provides what?

a surrogate to make active decisions

39

T/F: with durable power of attorney for health care, patient can still outline what they prefer as far as treatment modalities

true

40

regular durable POA controls what?

only finances

41

guardianship

a person is stripped of all their rights and declared incompetent by the court

42

emergency exception to informed consent can only be used when?

in the preservation of life... no more, no less

43

when can the "extension doctrine" be applied?

should be a life-threatening risk

44

when does the "extension doctrine" not apply?

1. elective cases
2. when "extension" should be anticipated

45

therapeutic privilege

can only be obtained if it can be proved that an individual patient could not handle that disclosure

46

T/F: therapeutic privilege is very hard to prove

true

47

waiver of consent

should provide at least enough information, so that the general nature of the treatment is expressed so patient can understand what they are forgoing

48

informed refusal

patient should be told the risks/consequences of refusing treatment