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Royal College: Emergency Medicine > Ethics/Practice of EM/Medical Legal > Flashcards

Ethics/Practice of EM/Medical Legal Flashcards

This deck covers the relevant legal and ethical principles and laws relevant to the practice of emergency medicine.

1
Q

What is the age of consent for sex in Canada?

A
  • <12 yo = Can’t be capable
  • 12-13 yo = <2 years older
  • 14-15 yo = <5 years older
  • 16-17 yo = Anything not exploitive (eg. sex trade)
  • >18 yo = Fully capable

We are not obligated to report

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2
Q

What phases of lab processes can result in error?

A
  • Collecting the tubes/sample/tissue
  • Analyzing/interpreting the tubes/sampes
  • Inputting the results
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3
Q

What is the SDM hierarchy?

A
  1. Legal Guardian (parent)
  2. Appointed Power of Attorney
  3. Consent and Capacity Board representative
  4. Spouse/Partner
  5. Child >16/Parent not estranged
  6. Parent with right of access
  7. Sibling
  8. Another relative
  9. Public Guardian and Trustee
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4
Q

Define an adverse event. Define intrinsic and extrinsic sources of error. Provide 3 examples of each.

A

Adverse Event

  • Injury that was caused by medical management, both preventable and non-preventable

Intrinsic Source of Error

  • Part of the nature of emergency care/can’t change it
  • Examples
    1. Decision burden
    2. Patient factors (delirium, language, acuity)
    3. Uncertainty
    4. “Low signal to noise” eg. a 2/10 SAH headache

Extrinsic Source of Error

  • Resource constraints
  • Preventable
  • Examples
    1. ED design
    2. Crowding
    3. Fatigue
    4. Teamwork
    5. Information gap

Violation Producing Factors

  • Make someone more willing to break protocol
  • Violations undermine safety
  • Opposite to workarounds which increase safety
  • Gender
  • Maladaptive behaviour
  • Over/underconfidence
  • Authority gradient
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5
Q

What 4 humanitarian principles do responders adhere by?

A
  1. Humanity - you’re there to address suffering
  2. Neutrality - never take a side
  3. Impartiality - aid is base on need alone
  4. Independence - autonomous from influence
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6
Q

What is the formula to calculate the G -Force of an accident?

A

g = Delta(v2) / (Stopping distance * K)

It means that the G force is inversely related to the stopping distance

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7
Q

Outline the Universal Declaration of Human Rights

A

All human beings are born free and equal in dignity and rights and are entitled to life, liberty, security of person, and “a standard of living adequate for… health and well-being

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8
Q

Draw a Haddon Matrix using an MVC as an example. What are 3 tenants the matrix relies on?

A

Approach to injury prevention that demonstrates interaction

Column Headings

  • Host
  • Agent/Vector
  • Environment

Row Headings

  • Before event
  • During event
  • After event

Tenants

  • Injuries are preventable
  • Injuries follow patterns
  • Can’t rely on human factors alone
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9
Q

What are the 6 domains for quality in healthcare?

A

Safe

  • Avoiding harm from care that is meant to help patients

Effective

  • Care based on scientific knowledge

Patient-centered

  • Care that is responsive to and respectful of individual patient preferences, needs, and values

Timely

  • Reducing waits for those who receive and give care

Efficient

  • Avoiding waste of equipment, supplies, ideas, and energy

Equitable

  • Care not different due to personal characteristics
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10
Q

In ethical dilemmas what is meant by the impartiality test, the universality test, and the interpersonal justifiability test?

A

Impartiality

  • Would you the doctor accept this action done to you?

Universality

  • Would you the doctor feel comfortable with another doctor doing this if they were seeing a similar patient?

Interpersonal Justifiable

  • Would it be accepted by your peers?
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11
Q

What are the 5 elements of informed consent?

A
  1. Capable patient
  2. Voluntary
  3. Informed about risks/benefits
  4. Specific to situation and treatments
  5. No misrepresentation
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12
Q

Define:

  • Autonomy
  • Beneficence
  • Non-maleficence
  • Distributive Justice
A

Autonomy

  • Patients can make their own decisions about themselves

Beneficence

  • Do good

Non-maleficence

  • Don’t do evil

Distributive Justice

  • Resources are allocated to all
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13
Q

What are the top 5 causes of death in Canada?

A
  1. Cancer
  2. Heart Disease
  3. CVA
  4. Injuries
  5. Chronic lower respiratory disease
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14
Q

What are the guidelines for child seats?

  • <9 kg (usually <1 year old)
  • 9-18 kg (<6 years old)
  • 18-36 kg (<8 years old)
A

Errbuddddy get in the back until 13 yo

  • <9 kg (usually <1 year old)
  • Rear-facing seat
  • 9-18 kg (<6 years old)
  • Forward-facing seat
  • 18-36 kg (<8 years old)
  • Booster seat
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15
Q

How do you help a colleague you think is struggling with drugs/addiction and you’re even concerned about their patients?

A
  • OMA/CMA
  • CPSO
  • Talk to them privately
  • Speak with site chief
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16
Q

What are 7 steps to disclosing adverse events as per CMPA?

A
  1. First attend to their safety/care
  2. Plan this disclosure
  3. Invite
  4. Actually do it
    * Sympathize, outline the investigative process
  5. QI review
  6. Conduct the post-analysis disclosure
    * What was learned, what’s changed, you’re sorry
  7. Document
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17
Q

What were the significant results of the landmark Harvard
Medical Practice Study (NEJM 1991)?

A

1991 Harvard Medical Practice Study

  • 4% of hospitalized pts had significant adverse events
  • 30% of adverse events from “human error”
  • Only 3% of adverse events occurred in the ED
  • 90% of ED adverse events were “preventable”

2000 Institute of Medicine Report

Failures or “errors” were the result of intrinsic properties of
the processes of care in which health care professionals work

Efforts to reduce failures should focus on changing the
processes of care, rather than identifying, retraining, and
punishing the workers

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18
Q

A colleague is drunk or high at work. What do you do?

A
  1. Ensure patient safety
    * Chart review/call all patients back for reassessment
  2. Permissive Reporting
    * CPSO: professional and ethical obligation to report
  3. Ensure your colleague is safe
    * Not drinking and driving
19
Q

What does it mean in Canada to have capacity?

A

A person is capable of consenting to treatment if the person is able to:

  1. Understand the information that is relevant to making a decision about treatment, and
  2. Appreciate the reasonably foreseeable consequences of a decision or lack of a decision

CURVES

  • Choose and Communicate
  • Understanding the disease
  • Risk benefits and alternatives
  • Value
  • Emergency
  • Surrogate
20
Q

What is the difference between competence and capacity?

A

Competence

  • Ability to partake in legal proceedings
  • Determined in court

Capacity

  • Ability to make decisions
  • Everyone assumed to have capacity
21
Q

What are the 3 E’s of injury prevention?

A
  1. Education
  2. Enforcement of Laws
  3. Engineering Modification
22
Q

What are 3 exceptions to informed consent?

A
  1. Emergency
  2. Mental health (does not make someone incapable)
  3. Communicable disease
23
Q

Define refugee and internally displaced persons (IDP)

A
  • IDP stays in own country
  • Refugee crosses border
24
Q

Define a humanitarian emergency. What makes it a complex emergency?

A

A critical threat to health, safety, or security of a community

  • Can be natural disaster or man-made

What makes it a complex emergency?

  • Total breakdown of authority from conflict
25
Q

What are 3 problems that can occur during handover and how can we mitigate those effects?

A

Handover Issues

  1. Getting interrupted
  2. Inconsistent format
  3. Patient labels (bias)

Mitigate with standardized formats (SBAR)

  • Situation
  • Background
  • Assessment
  • Recommendation
26
Q

How do we incorporate Injury prevention into practice? What are two broad categories with 3 examples in each?

A

Clinical

  • Document
  • Systemic trauma care
  • Counsel on injury prevention
  • Code ICD-10 injuries

Policy

  • Advocate
  • Lead policy development
  • Do research
  • Educate others
27
Q

Name 10 medical infections that are reportable?

A

Think of all the vaccine-preventable…

  1. HIV
  2. Gonorrhea
  3. Chlamydia
  4. Syphilis
  5. Hepatitis
  6. TB
  7. Measles
  8. Mumps
  9. Rubella
  10. Diptheria
  11. Tetanus
  12. Pertussis
  13. Polio
  14. Anthrax
  15. Botulism
  16. Salmonella
  17. Cholera
  18. Giardia
28
Q

The Institute for Healthcare Improvement (IHI) had developed something called the triple aim framework. What is it?

A
  1. Improving the patient experience of care
    * Quality + Satisfaction
  2. Improving the health of populations
  3. Reducing the per capita cost of health care
29
Q

List 6 mandatory reporting indications

A
  1. Child abuse/neglect
  2. Impaired driving
  3. LTC and RH patients being abused
  4. Sexual abuse of a patient
  5. Births, Still-births, and deaths
  6. Communicable disease
  7. Controlled drugs missing
  8. Gunshot wounds
  9. Healthcare Fraud
  10. Privacy breaches
  11. Any condition that could impact:
    * Pilots or ATC people
    * Railway safety
    * Maritime safety
  12. Serious injury in Correctional Facility
  13. Violated community treatment plans
30
Q

What are 4 indications to call the coroner?

A
  1. Non-natural death (homicide)
  2. Death if non-natural event contributed (fall then septic)
  3. Pediatric
  4. Pregnant
  5. Unexpected
  6. Family concerned
  7. Institutionalized (jail, group home, psychiatric)
  8. Suspicious
31
Q

What is the SPHERE handbook? List 6 components of it.

A

A collaborative project of humanitarian response experts, sets
international standards for the provision of humanitarian aid.

Provides minimum response standards for water and sanitation, food and nutrition, shelter, health care, and protection.

  1. Water
  2. Sanitation
  3. Hygiene
  4. Food security
  5. Nutrition
  6. Shelter
  7. Settlement
  8. Non-food items
  9. Health
32
Q

What is a general approach to an ethical dilemma at work?

A
  1. Maintain confidentiality
  2. Consider mandatory reporting
  3. Consider permissive reporting
  4. Consider ethics/SW
  5. Consider the CMPA
  6. Consider CAS
  7. Assess capacity
    * If incapable, find an SDM
33
Q

What does it mean to be negligent and how is malpractice (a type of negligence) determined?

A

Negligence

  • Failure to exercise the care that a reasonable person would provide in the circumstance

Requirements

  1. You had a duty of care
  2. Breach in the standard of care
  3. Harm or injury suffered
  4. Causal connection
34
Q

List 3 risk factors for injury

A
  1. Male
  2. Young
  3. Low SES
  4. Substance abuse
  5. Previous arrest
35
Q

How is wellness promoted personally and professionally?

A

Professionally

  1. Education
  2. Interventions
  3. Handbooks

Personally

  1. Sleep
  2. Exercise
  3. Diet
  4. Vacation
  5. Self-monitoring
  6. Practice mindfulness
36
Q

How is an injury defined?

A

A harmful event where energy is transferred resulting in tissue or organ damage

37
Q

What are 5 ways the CMPA wants you to chart when a patient wants to LAMA?

A
  1. Patient is capable
  2. Discharge instructions given
  3. Signed AMA form is nice but useless
  4. Document the reason for care, their capacity assessment, and the reason for leaving
  5. Welcome them to come back or direct them to other care
38
Q

What is resiliency?

A

Resiliency

  • Adapting well to stress

Components

  • Attitudes
  • Balance and prioritization
  • Practice management
  • Supportive relationships
39
Q

What are the 3 dimensions of burnout according to CAEP?

A
  1. Emotional exhaustion
  2. Depersonalization
  3. Reduced sense of personal accomplishment
40
Q

What are 6 ways medication errors can occur?

A
  1. Prescription errors
  2. Transcription errors
  3. Dispensing errors
  4. Administration errors
  5. Monitoring errors
  6. Discharge errors
41
Q

What are 5 strategies to manage conflict?

A
  1. Establish common goals
  2. Communicate effectively
  3. Do not take it personally
  4. Avoid accusations and public confrontations
  5. Compromise
  6. Establish commitments
  7. Accept differing opinions
  8. Ongoing communication/follow up
  9. Be pleasant
  10. Consider a mediator
42
Q

If a child has a life-threatening condition can we hold this kid against their parent’s will? What about if it’s not life-threatening?

A

Life-Threatening

  • Yes you can (even Jehova’s witness)

Non-life threatening

  • Call CAS and report this is neglect/abuse of the child
43
Q

List 4 adverse events that can occur with ED crowding?

A
  1. Mistriage of atypical presentation
  2. Delays to care of time-sensitive diagnoses
  3. Increased LWBS
  4. Delay in transfer to appropriate care

Royal College: Emergency Medicine (25 decks)

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