Ethics

Question 1

Normative Ethics

• Moral norms we accept for guidance and on what basis
• Tells you what to do (as an approach/process)
• Used to justify and clarify behavior

Answer 1

Normative Ethics

Examines which moral norms we accept for guidance and on what basis. Theories and principles derived from them are attempts to justify and clarify normative and ethical behavior. These ethics tell you what you should do.

Question 2

Non-normative ethics

• The factual investigation of moral beliefs and behavior.
• Used to deliberate in particular cases and scenarios.
• Describes factually what is the case (objective), not what ethically out to be the case.

Answer 2

Non-normative ethics

The factual investigation of moral beliefs and behavior. Differing from studies of theoretical ethics, practical or applied or clinical ethics uses these concepts and norms to deliberate in particular cases and scenarios. Non-normative ethics describes factually what is the case, not what ethically out to be the case.

Question 3

What are common characteristics of ethical dilemmas?

Answer 3

What are common characteristics of ethical dilemmas?

• Uncertainty
• Conflict/failure to communicate
• Need for education/cultural humility

Question 4

What are the five core principles of medical ethics?

A) Respect for Autonomy, Beneficence, Ethics, Veracity, and Kindness
B) Respect for Autonomy, Beneficence, Non-maleficence, Veracity and Justice
C) Respect for Autonomy, Beneficence, Malfeasance, Verification, and Justice
D) Respect for Autonomy, Beneficence, Non-maleficence, Veracity and Ethics

Answer 4

What are the four core principles of medical ethics?

B) Respect for autonomy, Beneficence, Non-maleficence, Veracity, and Justice

Question 5

Which ethical principle does the information below speak to?

Acting in the best interest of the patient and not just avoiding harm. There is an implicit assumption that all medical and health care professionals provide non-harmful care to pts.

A) Justice
B) Non-maleficence
C) Autonomy
D) Beneficence
E) Veracity

Answer 5

D) Beneficence

Acting in the best interest of the patient and not just avoiding harm. There is an implicit assumption that all medical and health care professionals provide non-harmful care to pts.

Question 6

Which ethical principle does the information below speak to?

The individual has the right to self-determination in making medical decisions in the health care and research environment. Individuals must have enough understanding to make meaningful and value-based choices.

A) Justice
B) Non-maleficence
C) Autonomy
D) Beneficence
E) Veracity

Answer 6

C) Autonomy

The individual has the right to self-determination in making medical decisions in the health care and research environment. Individuals must have enough understanding to make meaningful and value-based choices.

Question 7

Which ethical principle does the information below speak to?

This principle seeks to create equality, fairness, and appropriate allocation of resources.

A) Justice
B) Non-maleficence
C) Autonomy
D) Beneficence
E) Veracity

Answer 7

This principle seeks to create equality, fairness, and appropriate allocation of resources.

A) Justice

Question 8

Which ethical principle does the information below speak to?

This principle obligates us to abstain from causing harm to others. This includes examining situations and scenarios where treatments, risks, medical interventions, and QOL are at play.

A) Justice
B) Non-maleficence
C) Autonomy
D) Beneficence
E) Veracity

Answer 8

B) Non-maleficence

This principle obligates us to abstain from causing harm to others. This includes examining situations and scenarios where treatments, risks, medical interventions, and QOL are at play.

Question 9

Which ethical principle does the information below speak to?

This principle focuses on truth-telling, accurate, timely, objective and comprehensive presentation of information.

A) Justice
B) Non-maleficence
C) Autonomy
D) Beneficence
E) Veracity

Answer 9

E) Veracity

This principle focuses on truth-telling, accurate, timely, objective and comprehensive presentation of information.

Question 10

Competency vs. Capacity

Legal / Clinical
Determined by a judge / Can wax and wane
All or nothing / Sliding scale based on decision

Answer 10

Competency vs. Capacity

Legal / Clinical
Determined by a judge / Can wax and wane
All or nothing / Sliding scale based on decision

Question 11

Capacity 1/2

• Pt must have knowledge of the benefit and risks to a proposed situation, the ability to reach an informed decision, and the ability to communicate said decision.
• Mental illness or dementia is NOT an automatic rule-out for pt to have decision-specific capacity. However, the pt must not be experiencing any delusions or have any mental incapacities at the time of said decisions.

Answer 11

Capacity 2/2

• Attending physician taking care of pt can determine incapacity each time pt is seen and capacity can wax/wane.
• Evaluation of incapacity does NOT require a psychiatric assessment unless Attending is unsure or believes there is a psych component to be evaluated. Urgency of decision making also plays a role.

Question 12

Competency 1/2

Legal finding that allows a court to determine an individual’s mental capacity. These proceedings include guardianship and conservatorship hearings.

Answer 12

Competency 2/2

These court proceedings may be action specific, such as finding someone incompetent to enter into a financial agreement, but still competent to make health care decisions for themselves.

Question 13

Do you need a court order to determine whether a pt with moderate dementia can complete their own POLST?

A) Yes, the pt has lost decision making capacity with a diagnosis of dementia.
B) No, dementia is not an automatic rule-out for decision making capacity.
C) Only if the pt’s family/DPOA contests the decisions the pt wants to make.

Answer 13

Do you need a court order to determine whether a pt with moderate dementia can complete their own POLST?

B) No, dementia is not an automatic rule-out for decision making capacity.

If the pt’s Attending has evaluated the pt and determines that pt is capable to make each decision, one decision at a time, for each question on a POLST form, then pt is deemed capable of completing their own POLST form. The legal system is not involved in this matter.

Question 14

Do ethics committees render a decision?

A) Yes, and it must be followed.
B) No, they provide an opinion and recommendation.
C) Only when asked.

Answer 14

Do ethics committees render a decision?

B) No

Ethics committees provide an opinion and recommendation describing an analysis of the situation, however the decision about treatment options remains with the pt, surrogate, an Attending.

Question 15

The Patient Self-Determination Act (1990) required that every health care organization in the U.S. receiving Medicare or Medicaid payments convene meetings to assure compliance w regarding health care advance directives.

Answer 15

Soon after (1992) the Joint Commission mandated that all JCAHO-approved hospitals must have a means to discern ethical concerns.

An ethics committee/bioethics committee model is one means to discern ethical concerns for hospitals accredited by the Joint Commission.

Question 16

What are some of the various models for ethics consults?

Answer 16

What are some of the various models for ethics consults?

• Full committee consults (multidisciplinary group)
• Single individual consult
• Consult subcommittee (select group from the larger committee)

Question 17

What are some of the pros and cons to the Full Committee Consult (multidisciplinary group) model?

Answer 17

What are some of the pros and cons to the Full Committee Consult (multidisciplinary group) model?

Pros: provides multiple perspectives

Con: May not be able to meet expediently and/or members may not have sufficient ethics training

Question 18

What are some of the pros and cons to the Single Consult model?

Answer 18

What are some of the pros and cons to the Single Consult model?

Pros: Is commonly a person with ethics training who can respond quickly and is familiar with the clinical setting

Cons: most hospitals do not have the resources to commit to paying for this level of expertise; relies upon one individual to analyze and render opinion

Question 19

What are some of the pros and cons to the Consult Subcommittee model?

Answer 19

What are some of the pros and cons to the Consult Subcommittee model?

Pros: Provides multiple perspectives; likely to respond more quickly than a larger committee model; allows more than one perspective on the care

Con: Members may not have higher level ethics training; adds complexity to scheduling consults

Question 20

Utilitarianism/Consequentialism: Right acts should produce the greatest amount of good for the greatest number of people; the means justify the ends.

Deontology (Kantian ethics): Ethics is a matter of duty, not of consequences. A right act always treats the person as ends-in-themselves, never as a means to an end.

Principlism: There is a literal duty to respect pt autonomy, provide beneficent care, do no harm, and consider just allocation of resources.

Answer 20

Utilitarianism/Consequentialism:
- Ex. If pts dies in clinical study to find the right dosing of a new clinical trial drug, a breakthrough medication was discovered in the end.

Deontology (Kantian ethics):
- Examples include: do not lie, kill, steal.

Principlism:
- Ex. The main focus in weighing options in a situations would be based on the aforementioned principles.

Question 21

The following related to which ethical theory?

Ethics is a matter of duty, not of consequences. A right act always treats the person as ends-in-themselves, never as a means to an end.

A) Utilitarianism/Consequentialism
B) Deontology (Kantian ethics)
C) Principlism

Answer 21

The following related to which ethical theory?

Ethics is a matter of duty, not of consequences. A right act always treats the person as ends-in-themselves, never as a means to an end.

B

Question 22

The following related to which ethical theory?

There is a literal duty to respect pt autonomy, provide beneficent care, do no harm, and consider just allocation of resources.

A) Utilitarianism/Consequentialism
B) Deontology (Kantian ethics)
C) Principlism

Answer 22

The following related to which ethical theory?

There is a literal duty to respect pt autonomy, provide beneficent care, do no harm, and consider just allocation of resources.

C) Principlism

Question 23

The following related to which ethical theory?

Right acts should produce the greatest amount of good for the greatest number of people; the means justify the ends.

A) Utilitarianism/Consequentialism
B) Deontology (Kantian ethics)
C) Principlism

Answer 23

The following related to which ethical theory?

Right acts should produce the greatest amount of good for the greatest number of people; the means justify the ends.

A) Utilitarianism/Consequentialism

Question 24

You as a hospice nurse have been caring for a patient for over a year now and over the course of that time have become very close to the patient and family. The patient begins to actively die just prior to your planned family vacation out of the country. An example of good professional boundaries and patient care would be which of the following?
a. Cancelling/rescheduling your planned vacation to continue to provide care to the patient/family.
b. Informing the family that you will be unable to present, but giving them your personal cell phone to contact you.
c. Informing the family of your vacation plans, arranging and introducing them to the nurse who will be providing care during your absence.
d. Not telling the family anything about your vacation as you do not want to upset them further.

Answer 24

c - The best professional boundaries/patient care example here is informing the family of the vacation and introducing them to the nurse who will be providing care during your absence. Cancelling vacations or giving out personal cell phone numbers are not examples of good professional boundaries and not informing the family of your absence is not good patient care.

Question 25

There are five components essential to the pursuit of cultural competence. These include all of the following except:
a. Cultural excellence
b. Cultural awareness
c. Cultural skill
d. Cultural desire

Answer 25

a - Cultural excellence is not a component of cultural competence. The five components include: cultural awareness, cultural knowledge, cultural skill, cultural encounter and cultural desire.

Question 26

Culture impacts many aspects of hospice/palliative care, like communication. Which of the following are common themes within hospice/palliative care that are affected by culture?
a. Decision-making
b. Nutrition and hydration
c. Death rituals and mourning
d. All of the above.

Answer 26

d - Culture impacts communication, decision-making, nutrition and hydration, death rituals and mourning, as well as pain and symptom management within hospice and palliative care.

Question 27

Culture is outlined by the National Consensus Project for Quality Palliative Care - Clinical Practice Guidelines Quality Palliative Care (3rd edition) as which of the following that must be recognized by hospice and palliative staff?
a. The race and ethnicity of patient groups.
b. The values, practices and beliefs shared by members of the same group.
c. A source of resilience and strength for the patient and family.
d. The passing of values, practices and beliefs from one generation to another.

Answer 27

Culture is outlined in the NCP for Quality Palliative Care-Clinical Practice Guidelines as a source of resilience and strength for the patient and family.

Question 28

HPNA identified several ethical principles within their Code of Ethical Conduct guidelines. These include all of the following except:
a. Beneficence
b. Role fidelity
c. Respect for persons
d. Non-maleficence

Answer 28

d - The ethical principles listed within the HPNA Code of Ethical Conduct are: Respect for persons, Justice, Beneficence, Confidentiality, and Role fidelity.

Question 29

When visiting a patient recently, he wanted to discuss policy changes that are being introduced to the state legislature that would impact hospice care in your state. Which of the following responses would have been most helpful to the patient?
a. “I’m a MSW, I don’t follow hospice legislation.”
b. “Maybe you can contact my manager to discuss that.”
c. “I’m aware of those proposals, what would you like to discuss?”
d. “I’m sure the changes won’t impact your hospice care.”

Answer 29

c - Replying, “I’m aware of those proposals, what would you like to discuss?” would have been most helpful to this patient, who would obviously like to discuss his concerns. Hospice nursing can be very intense, which can create a laser focus on providing patient and family care. However, it is important to also be aware of legislative issues which may impact the agency that you work for, and the patients and families who are under your care. Advocacy for hospice issues, by those who actually do the work, can have a powerful impact on the few who make decisions that may affect so many.

Question 30

Which of the following behaviors would clearly maintain professional boundaries?
a. Meeting a patient’s spouse after hours for dinner.
b. Meeting a survivor for coffee during work hours.
c. Giving money from personal funds to a family in need.
d. Going to a movie with a patient.

Answer 30

b - Meeting a survivor for coffee during work hours is an acceptable behavior which maintains professional boundaries. Counseling visits often occur in such settings, which may enhance the survivor’s desire to participate in an enjoyable activity outside the home. When meeting patients or families in public settings, care must be taken to maintain confidentiality during conversations.

Question 31

Of the following, which is an appropriate option for addressing ethical concerns in patient/family care situations?
a. Allow the patient’s primary care physician to make the final decision.
b. Allow the patient to make the final decision.
c. Consult with the ethics committee.
d. Allow the IDT to make the final decision.

Answer 31

c - Consulting with the ethics committee would be an appropriate option. All other options may not provide the objectivity required for such a situation. Most organizations have some type of ethics committee that functions in a consultative role regarding patient and family situations which present ethical concerns. Such committees are typically made up of a variety of professionals within the agency who represent various disciplines and viewpoints, and can provide objective opinions regarding ethical concerns.

Question 32

Of the following, which is the best practice regarding use of the electronic health record in patient care?
a. Real-time documentation
b. Documentation for all patients in one sitting
c. Documenting in the office
d. Documenting before the end of the day

Answer 32

a - Real-time documentation is the best practice regarding use of the electronic health record in patient care. Since hospice and palliative care is provided in an interdisciplinary manner, several professionals may be accessing the same record to review collaborative notes within the same day. Delayed documentation creates a barrier to optimal patient care by making vital information inaccessible to other care providers. There are many benefits to real-time documentation, including increased accuracy in the patient care record, and decreased staff burn-out. When documentation is completed during the patient care visit, instead of after hours, hospice staff can enjoy personal time for self-care, instead of patient care.

Question 33

Example of how ethical theories impact clinical care–
are Cancer clinical trails ethical?
Deontologist
Consequentialist
Principlist

Answer 33

Deontologist: not ethical as there may not be any direct benefit to the individual patient and that the patient is being use as a means to an end.
Consequentialist: approve as that Pt as well as others would achieve breakthroughs in curing cancer.
Pinciplist: weigh the patient own autonomous choice in light of preferences, QOL, likelihood of good outcome, risk of harm, and access to clinical trials

Question 34

Substitute judgement refers to the ethical duty of guardians and surrogate decision makers to make an effort to understand:
A. Patient’s financial limitations
B. Patient’s beliefs and values
C. Patient’s loved ones wishes
prior to making decisions on patient’s behalf

Answer 34

B

Question 35

NASW code of ethics:
Social worker’s primary responsibility is to promote the well being of clients.
In what cases may client’s interests by superseded?

Answer 35

when social worker has obligation to larger society or specific legal obligation
(self harm, threat to harm others)
Client should be advised

Question 36

According to NASW code of ethics when may a SW limit client’s right to self-determination?

Answer 36

When in SW professional judgment client’s actions or potention actions pose a serious, foreseeable, and imminent risk to themselves or others