Flashcards in Ethics Deck (28):
..... refers to an adult with the capacity to understand his/ her medical problems can refuse any therapy/ test
Autonomy (most important ethical concept)
Trying to do the right thing for the patient is called ...
Beneficence (less important than autonomy)
What is the next best step in management of an adult pt with capacity who is refusing therapy/ test?
discuss/ meet/ confer with patient
Who determines a patient's capacity?
When should a psychiatric consultation be performed when managing a patient who is refusing treatment?
if patient's capacity to understand is unclear
What factors determine whether a patient is an emancipate minor (
1. living independently
4. in the military
What categories of medical care are minors considered to be partially emancipated?
1. sex (contraception)
2. reproductive health (STDs, HIV, prenatal care)
3. substance abuse
Are minors partially emancipated with regards to abortion?
not in 36 states that require parental notification (therefore recommend that the pt inform parents)
True or False. Parents can refuse lifesaving therapy for minors.
false (i.e. Jehovah's Witnesses can refuse blood transfusion for themselves but not for their child)
What are the 5 criteria that must be true in order for consent for a procedure/ therapy to be informed consent?
1. benefits of procedure/ therapy
2. risks of procedure/ therapy
3. alternatives to procedure/ therapy
4. in language pt can understand
5. must be given for each procedure
True or False. Consent is implied in an emergency.
True (however if prior wishes are fully known, then the wishes take precedence)
True or False. Pregnant women can refuse therapy, even if the life of the fetus is at risk.
What are the two exceptions to the privacy/ confidentiality rule?
1. transmissible diseases (HIV, syphillis, gonorrhea, tuberculosis)
2. have psychiatric illness and planning to harm others
What is the strongest form of advance directive in case a patient loses the ability to have capacity?
Health Care proxy (include documentation of desires and/ or appointment of an agent)
What is the importance of a DNR order?
refusal of endotracheal intubation and cardiopulmonary resuscitation in the event that one loses the ability to breath or heart stops
What is the initial best step of management for a pt with no capacity and no advanced directives (proxy or living will)?
obtain best possible understanding of clearly expressed wishes from family and friends
When is an ethics committee indicated in the case of a patient with no capacity and no advance directive (proxy or living will)?
1. no clearly stated wishes on the part of the pt
2. caregivers (family) are split or in disagreement about the nature of care
When is a court order indicated in the case of a pt with no capacity and no advance directive (proxy or living will)?
when all other options have not given clarity (friends and family conflicted, ethics committee conflicted)
True or False. An adult pt with capacity may refuse all forms of nutrition.
True or False. In the absence of clearly stated wishes on the issues of fluids and nutrition, they should not be given to a pt without capacity.
False (should be given unless clearly stated wish not to have)
True or False. There is no obligation on the part of the physician to provide care that will not work.
True or False. You need the consent of the father for an abortion.
At point is elective abortion an unrestricted right of a pregnant woman?
first trimester only (second trimester is questionable and third is no accessible)
True or False. Physicians have the legal right to refuse to treat any patient.
True (although it may be unethical)
True or False. HIV positive health care workers are obligated to disclose their HIV status.
What gifts are ethically acceptable?
small gifts not tied to specific treatment/ tests
(gifts with intent of getting specific prescription is not acceptable)
True or False. A physician can certify a tortured patient as dead.
False (physicians can not participate in torture on any level)