Ethical Issues and Problems

Question 1

a situation in which one or more moral norms or principles are present but do not create a problem.

Answer 1

Ethical Issue

Question 2

a situation in which two or more moral norms or principles create a challenge about what to do

Answer 2

Ethical Problem

Question 3

there are 4 basic types of ethical problems:

Answer 3

ethical distress
ethical dilemma
ethical dillemma of justice
locus of authority issue

Question 4

3 types of ethical problem that is focused on what to do

Answer 4

ethical distress
ethical dilemma
ethical dilemma of justice

Question 5

type of ethical problems that focus on who should do it

Answer 5

locus of authority issue

Question 6

3 basic concepts of ethical problem

Answer 6

moral agent
course of action
desired outcome

Question 7

anyone who is in a situation in which he must (and can) assure responsibility for the outcome of his actions

Answer 7

moral agent

Question 8

capable of thinking, deciding and acting in accordance with moral standards and rules

Answer 8

moral agent

Question 9

may not always fulfill the requirements of a moral standard or rule i.e. he need not be morally perfect but must have the capacity to judge himself

Answer 9

moral agent

Question 10

the agent’s judgments process and final decision about what will happen if one or more paths are chosen

Answer 10

course of action

Question 11

also called the process of applying ethics

Answer 11

course of action

Question 12

the projected positive result/s of having taken the course of action

Answer 12

desired outcome

Question 13

a kind of ethical problem a health professional faces when ho knows exactly what course of action is right but there is a barrier keeping the person from doing it 

Answer 13

ethical distress

Question 14

arises when one knows the right thing to do but institutional constraints make it nearly impossible to pursue the right course of action

Answer 14

ethical distress

Question 15

the most common type of ethical problem

Answer 15

ethical dilemma

Question 16

involves 2 (or more) morally correct courses of action but you cannot do both (or all)

Answer 16

ethical dilemma

Question 17

sometimes considered as a problem in which there is no right or wrong solution 

Answer 17

ethical dilemma

Question 18

there is more than one right thing to do but to act on one necessarily prohibits you from acting on the others

Answer 18

ethical dilemma

Question 19

as a result, you (the agent) necessarily are doing something right and also wrong (by not doing the other right thing)

Answer 19

ethical dilemma

Question 20

may be presented in special case of paternalism or parentalism

Answer 20

ethical dilemma

Question 21

the patient’s autonomy conflicts with the health professional’s judgment of what is best for the patient

Answer 21

paternalism

Question 22

when a physician or other healthcare professional makes decisions for a patient without the explicit consent of the patient

Answer 22

paternalism

Question 23

the health professional is acting as a parent to the patient

Answer 23

paternalism

Question 24

a dilemma that arises in regard to distributing societal benefits and burdens

Answer 24

dilemmas of justice

Question 25

the scarce supply of these resources requires difficult decisions by the agent

Answer 25

dilemmas of justice

Question 26

because to choose to provide the good to one group may necessarily mean there are no resources available for others

Answer 26

dilemmas of justice

Question 27

these situations arise as problems when roles or other institutional policy or societal arrangements create a confusion about who is in charge

Answer 27

locus of authority issue

Question 28

in the diagram, the 2 agents, each of whom assumes himself to be the legitimate authority for making a particular decision, they may come to different conclusions about how to achieve the best outcome for a patient

Answer 28

locus of authority issues

Question 29

they may disagree on the course of action and benefit, or they agree on the course of action and desired outcome, disagreeing solely on who is the proper authority to effect that outcome

Answer 29

locus of authority issues

Question 30

there are several aspects that may consider in deciding who is in charge

Answer 30

difference in professional expertise traditional arrangements institutional arrangements and mechanisms the weight of experience

Question 31

five steps of process of ethical decision making

Answer 31

Gather relevant information identify type of ethical problem determine ethics approach to be used explore practical alternatives complete the action

Question 32

relevant facts include (4)

Answer 32

clinical indications patient preferences quality of life external factors

Question 33

Is the illness or condition reversible? Is the life saving treatment medically useless? What is the usual treatment for this type of condition in the community? What is needed to relieve suffering and provide comfort? Is the patient brain dead or in persistent vegetative state? what kind of relevant facts

Answer 33

clinical indications

Question 34

Is the patient informed? Is the patient competent? If the patient is not competent, how can I discern what this patient would want? (substituted or surrogate judgment) If the patient is not competent, how can I discern what this type person would want? (best interest) what kind of relevant facts

Answer 34

patient preferences

Question 35

What is the patient’s judgment? What is the health professional’s judgment? Is there any hope for improvement from present quality of life? what kind of relevant facts

Answer 35

quality of life

Question 36

Costs? Reimbursement issues? What policies are there? Hospital, judicial opinions, professional societies, etc. What are the legal implications? (court cases, statutes) Is allocation of beds, other resources an issue? what kind of relevant facts

Answer 36

external factors

Question 37

simultaneous with the initial fact-finding and sorting of information, the health professional can begin to determine the type of ethical problem he is facing as he observes, asks questions, and reflects, he can begin to decipher where his initial observations were correct and where they were not until he arrives at a point where he has as clear a picture of the situation as he is able to put together what step

Answer 37

identify the type of ethical problem

Question 38

if the moral agent is a ____his thinking will be guided by the duties and/or rights that are in conflict

Answer 38

deontologist

Question 39

he will spend a lot of time weighing the two duties in dilemma and will probably decide that the weightier or more compelling duty is to the patient what type of moral agent

Answer 39

deontologist

Question 40

if the moral agent is a ___, he will spend less time thinking about the duties and will be guided by his desire to bring about the over-all best consequences in the situation

Answer 40

utilitarian

Question 41

the over-all best consequences might well be to leave well enough alone, not to make waves with the patient what kind of moral agent

Answer 41

utilitarian

Question 42

the health professional has to explore the actual strategies and options open to him these alternatives should be duty-bound and would produce the desired outcome what step

Answer 42

explore practical alternatives

Question 43

the final and necessary step in moral judgment and action without the necessary attention to a strategy for carrying out the plan, the entire process, steps 1 to 4, is just an intellectual exercise the health professional must assume that he is prepared to accept the consequences of his actions, and that he has the motivation to go beyond mere identification of the problem in order to see the benefits of his own struggle he must now proceed to action to do this, he needs the character traits of compassion, a sense of responsibility, and the courage to go ahead what step

Answer 43

complete the action

Question 44

read doctor patient relationship beginning and ending the relationship

Answer 44

a voluntary relationship entered freely by both sides a patient cannot be compelled to accept a particular doctor as his/her physician; a physician cannot be compelled to accept a patient without his/her agreement there is no legal obligation on the part of the physician to accept a patient; this is true no matter what need the patient has and whatever expertise the doctor may possess this is different from a hospital’s mandate to provide emergency treatment to anyone who comes to the emergency department; hospital cannot turn anyone away at the door of the emergency room once a patient and a physician have entered into a care relationship, there is far greater complexity in ending the relationship the doctor cannot suddenly end the relationship; he/she must maintain the care of the patient until the patient can find an appropriate alternate source of care and the doctor must give reasonable notice

Question 45

read doctor patient relationship gifts from patients (or from pharmaceutical industry)

Answer 45

small gifts from patients of nominal or modest value are acceptable provided that there is no expectation of a different form of therapy or a higher level of care based on the value of the gift rules on gifts from patients are less rigorous, precise or clear than the rules on gifts from pharmaceutical industry there is an automatic presumption that gifts from pharmaceutical industry always carry an influence toward a product, service or prescribing practice gifts from industry are viewed differently because there can only be no other intention behind them except to buy influences

Question 46

read doctor/patient sexual contract

Answer 46

sexual contact between a physician and a patient is always inappropriate at the very least, the physician and the patient must mutually agree to end the formal professional relationship of a doctor and a patient not clear how much time must elapse between the ending of the formal relationship and the start of the personal relationship the American Psychiatric Association guidelines specifically state that there can never be a sexual or personally intimate private relationship between doctor and patient even after the professional relationship these guidelines apply no matter who initiates the relationship; it is not more acceptable for a doctor and patient to have sexual relations if the patient initiates the relationship no account is given on gender or sexual orientation it is always unacceptable for a physician of any kind to have sexual relationship with a current patient

Question 47

If the patient is not competent, how can I discern what this patient would want?

Answer 47

(substituted or surrogate judgment)

Question 48

If the patient is not competent, how can I discern what this type person would want?

Answer 48

best interest