Exam I Flashcards
(47 cards)
Define autonomy.
Medical decision making capacity of an individual; requires capacity to make decisions.
Define beneficence.
Best interest of the patient (well-being, health, life). Should be the primary motivation in decision making. Is not always achieved despite best efforts by physician.
Define non-maleficence.
Acting with due care, measuring benefits and risks to comply with the perspective of the patient. Do no harm.
“Limits the power of HCPs to exacerbate rather than ameliorate their pt’s vulnerability”
Define justice.
Fair allocation of resources. Prohibits discrimination in provision of services.
Define the legal doctrines of confidentiality and the privilege of doctor-patient communication.
Confidentiality is standard in the [{United State of America]] by HIPAA laws, specifically the Privacy Rule, and various state laws, some more rigorous than HIPAA. However, numerous exceptions to the rules have been carved out over the years. For example, many American states require physicians to report gunshot wounds to the police and impaired drivers to the Department of Motor Vehicles. Confidentiality is also challenged in cases involving the diagnosis of a sexually transmitted disease in a patient who refuses to reveal the diagnosis to a spouse, and in the termination of a pregnancy in an underage patient, without the knowledge of the patient’s parents. Many states in the U.S. have laws governing parental notification in underage abortion
Distinguish competency from medical decision making capacity.
Capacity: The ability to understand the nature and effect of one’s acts. Capacity is a fluid concept; an individual may have the requisite capacity in one moment and lack capacity in another.
Competency. Competency is a legal finding. Competency proceedings, including guardianship and conservatorship hearings, are conducted to allow the court to determine the individual’s mental capacity. An individual is incompetent when declared by the court to be in need of a guardian or conservator. This determination is made only after the individual meets the proper “standards” under Iowa law.
Distinguish dependence vs. vulnerability.
Dependence: state of relying on being controlled by someone or something else. Independence is a myth - we are all dependent or interdependent. Multiple domains.
Vulnerability: state of being open to injury, degree of dependence correlates with degree of vulnerability.
Risk factors for vulnerable populations.
Adverse financial circumstances, poor health, hazardous environments, inadqeuate housing, extremes of age, presence of chronic or terminal illness or disability.
Define advocacy.
A response to vulnerability; obligation to foster autonomy to the extent possible and avoid discrimination, stereotyping, and paternalism that not infrequently accompany responses to vulnerability.
Name an important central feature of responding to patient vulnerability.
Taking into account the social context and factors that support or undermine the patient’s autonomy and to then respond in ways that consciously aim to support or foster the patient’s autonomy in the clinical setting.
What are the clinician’s obligation regarding vulnerability and pt care?
Twofold: respond to the pt’s immediate ailment & attend to the particular ways that each pt may be vulnerable, to find out which pt interests are at stake, and what resources the pt commands (or lacks) in order to protect the pt’s interests.
Stereotypes
Ageism (demented, assumption of too much experience, outmoded backward, infantilization - elderspeak).
Racism.
Sexism.
Cultural sensitivity.
Describe the physician’s responsibilities when disagreement occurs between family members and the wishes of the pts who lacks medical decision making capacity for his/her medical care. (Objective)
.
State the physician’s duties to minors, dependent and vulnerable adults, and their families. (Objective)
Meet needs, provide appropriate care, minimize risk of harm, avoid exploitation.
Foster autonomy to the extent possible.
Result is advocation.
Identify the ethical principles, virtues and goals that guide palliative care. (Objective)
Autonomy, Beneficence, Non-Maleficence, Justice
Understand how goals of care interact with other dimensions of decision making. (Objective)
…
Identify the ethical principles and virtues that guide end-of-life decisions that involve withholding or withdrawing life support, analgesia, sedation.
…
T/F. A dependent adult is a vulnerable adult.
True
Obligations to the vulnerable?
Meeting needs, providing appropriate care, minimize risks of harm avoid exploitation, counter sense of powerlessness & loss of agency.
What is advocation?
When HCPs are cognizant of and responsive to the different sources of a patient’s vulnerability.
Older patients & good communication.
Doctor has duty to listen and offer information, avoiding elderspeak, advocating for pt, using interpreters/facilities when needed.
Older patients & consent.
Keep an open mind and do not have pre-existing assumptions about older people’s abilities or needs.
T/F. Dx of mental impairment means the pt cannot make valid choices.
FALSE. There is an ethical obligation to help people make their own choices to the degree that they are able and to maximize their abilities by carrying out assessments in familiar premises and helping them choose at times when they are likely to be most lucid. (Referring to demented adults & elderly pts.)
Older patients & privacy.
Older people have same confidentiality rights as others, should be consulted about disclosure of their information, including to their friends and relatives.
