Ethics

Question 1

What are teh core ethical principles?

Answer 1

• Patient autonomy
• Beneficence
• Nonmaleficence
• Justice

Question 2

What is Patient autonomy?

Answer 2

Obligation to respect pts as individuals & to honor their preferences in medical care

Question 3

What is Beneficence?

Answer 3

Physicians have a special ethical (fiduciary) duty to act in the pt’s best interest. If the pt can make an informed decision ultimately the pt has the right to decide

Question 4

What may beneficence conflict w/?

Answer 4

Pt autonomy

Question 5

What is Nonmaleficence?

Answer 5

“Do no harm”

Question 6

What is Justice?

Answer 6

To tx persons fairly

Question 7

What does informed consent legally require?

Answer 7

• Discussion of pertinent info
• Pt’s voluntary agreement to the plan of care
• Freedom from coercion

Question 8

What are the exceptions to informed consent?

Answer 8

• Pt lacks decision-making capcity or is legally incompetent
• Implied consent in an emergency
• Therapeutic privilege
• Waiver

Question 9

What is Therapeutic privilege?

Answer 9

With holding info when disclosure would severely harm the pt or undermine info decision-making capacity

Question 10

What is Waiver?

Answer 10

Pt waives the right of informed consent

Question 11

What must pts have an intelligent understanding of?

Answer 11

• Risks
• Benefits
• Alternavtives
• No intervention

Question 12

When can a written consent be revoked by the pt?

Answer 12

Any time, even orally

Question 13

Who is considered a minor?

Answer 13

Any pt <18yo

Question 14

When does parental consent need to be obtained?

Answer 14

Any minor unless the pt is emancipated

Question 15

When is parental consent NOT required?

Answer 15

• Emergency situations
• Prescribing contraceptives
• Treating STDs
• Medical care of pregancy
• Treatment of drug addiction

Question 16

What is Decision-making capacity?

Answer 16

Physician must determine whether the pt is psychologically & legally capable of making at particular health care decision

Question 17

What are the components of decision-making capacity?

Answer 17

• Pt makes & communicates a choice
• Pt is informed
• Decision remains stable over time
• Decision is consisten w/ pt’s values & goals, not clouded by a mood disorder
• Decision is not a result of delusions or hallucinations

Question 18

What are advanced directives?

Answer 18

Instructions given by a pt in anticipation of the need for a medical decisions

State specific

Question 19

What is an Oral advanced directive?

Answer 19

Incapacitated pt’s prior oral statements commonly used as guide

Question 20

Where do problems arise from in oral advanced directives?

Answer 20

Variance in interpretation

Question 21

What makes an oral advanced directive more valid?

Answer 21

• Pt informed
• Directive was specific
• Pt made a choice
• Decision was repeated over time to multiple people

Question 22

What is a Living will (written advance directive)?

Answer 22

Describes tx the pt wishes to receive or not receive if he/she loses decision-making capacity

Question 23

What do pts direct physicians to do w/ Living wills?

Answer 23

W/hold or w/draw life-sustaining tx if he/she dev a terminal dz or enters a persistent vegetative state

Question 24

What is a medical power of attorney?

Answer 24

Pt designates an agent to make medical decisions in the event that he/she loses decision-making capacity & specify decisions in clinical situations

Question 25

When can a medical power of attorney be revoked?

Answer 25

Anytime pt wishes (regardless of competence)

Question 26

A medical power of attorney is more flexible than a ____ \_\_\_\_.

Question 27

What is a Surrogate decision-maker?

Answer 27

If an incompetent pt has not prepared an advanced directive, individuals who know the pt must determine what the pt would have done if he/she were competent

Question 28

What are the priorty of surrogates?

Answer 28

* Spouse * Adult children * Parents * Adult siblings * Other relatives

Question 29

\_\_\_\_ respects pt privary & autonomy.

Answer 29

Confidentiality

Question 30

What are the general principles for exceptions to confidentiality?

Answer 30

* Potential harm to others is serious * Likelihood of harm to self is great * No alternative means exists to warn or to protect those at risk * Physicians cna take steps to prevent harm

Question 31

What are some examples of exceptions to confientiality?

Answer 31

* Reportable dz (STD, TB, hepatitis, food poisoning) * The Tarasoff decision * Children &/or elder abuse * Impaired automobile drivers * Suicidal/homicidal pts

Question 32

What is the Tarasoff decision?

Answer 32

California Supreme Court decision requiring physicians to directly inform & protect victim from harm