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final 2.0 Flashcards

(62 cards)

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1
Q

Beneficence

A

is a moral right duty

-benefit

-your morally obligation is to do what benefits the patient

-not the same thing as benevolence

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2
Q

Active vs. Passive approaches to beneficence

A

Active: going above and beyond, thinking of the patient in terms of their needs, wants, benefits

Passive: sits and observes, waiting for the patient to come to you

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3
Q

Broad vs. Narrow approaches to healthcare

A

Broad: benefit the patient by doing other things besides their care plan, improve their care plan with patient input

E.g. Can the patient afford the medications? And do they know the about resources to help pay

Narrow: what’s in their care plan and nothing else

E.g. these are the medications that the patient must get

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4
Q

Disease vs. Illness

A

Disease: more science, tests, assessments, scans etc.

Illness: the lived experience of the certain condition; pain and how pain is managed

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5
Q

HARM (non-maleficence)

A

It is impossible to deliver health care with 100% no harm?

-Doctrine of double effect: says that it is okay to do some harm as long as the harm is outweighed by benefit

  • Comes from utilitarianism
  • Remember that the harm doesn’t just happen to the patient Including sometimes the RPN
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6
Q

Difficulties Balancing harm and benefit in mental health care

A
  1. Psychiatric diagnosis

benefit: you get properly diagnosed and treated

Harm: misdiagnosis, lack of resources, stigma (identity)

  1. Nature of treatment

benefit: it may improve conditions

harm: overuse, side affects

  1. Involuntary treatment
  2. Use of restraints
  3. harm reduction strategies

(Save needle programs)

  1. Risk of suicide/ medical assistance in dying
  2. Over and under diagnosis of mental health conditions
  3. Medical research

(Too many involuntary patients are used in research)

  1. Lack of resources and other social problems
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7
Q

Autonomy

A

greater self determination

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8
Q

Paternalism

A

doctor knows best.

-doctor is able to make decisions for the patients medical treatment even if the patient is able to do so alone

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9
Q

De-institutionalization

A

movement to save money disguised as a movement for self determination

-source of homeless problem: patients were let out into the community without the support they needed

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10
Q

Why is Autonomy important in our health care system?

A
  1. Legal reasons: doing things to people without their permission is a illegal offence
  2. Respect for persons
  3. Shift to patient-centered medicine
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11
Q

How to know that a patient has autonomy: Freedom

A

to act on their choices; independent, cannot be pressure

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12
Q

How to know that a patient has autonomy: Rationality

A

the patient must have the ability to understand different possible outcomes and decide on a plan

-Competency is not the same thing as autonomy: Just because a person is deemed incompetent is doesn’t mean that they aren’t involved at all in their care (Include them to some extent if possible [e.g. what they wear, what they eat etc.])

  • Everyone has the right to make a bad choice: when a person makes a choice that you don’t agree with– don’t automatically question their rationality as long as it makes sense to the patient (E.g. patients have the right to decline treatment even if that treatment would safe their life but in cases in mental health)
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13
Q

How to know that a patient has autonomy: Goals and desires

A

the person must be able to identify their goals and desires and make choices to help fulfil them

-work through them with your patient (ask them)

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14
Q

Patient Autonomy Questions

A

-If the patient does not show the appropriate levels of freedom, rationality, and goal orientedness, then it may be necessary to seek alternatives or decisions about their care

-Going in we assume that all patients have autonomy

-if the patient is a child we do not treat them as if they have autonomy (there is no minimal age consent for autonomy; it is the doctors judgement of whether they are sufficiently cognitive maturity)

-if a patient isn’t able to make decisions for themselves, the health care team will look towards, DNR’S, living wills (other medical desires)

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15
Q

Psychiatric Advanced Directive

A

lets the person decide while they are well what kind of treatment they want when they aren’t well

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16
Q

If there is no documentation..

A

talk to a social worker

–don’t talk to the family until you need to – family members don’t always have the patients best interest at heart

  • if they are unable to make decisions, no documentation, no neutral third party (SW), family doesn’t seem like they have the patients best interest in mind, then doctor decides if they have the best interest in mind – this is weak/limited paternalism
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17
Q

Negatives of autonomy

A

-Autonomy expects us to be independent at a time where we are not very independent
-cultural differences around autonomy
-is the concept of autonomy sexist?
-patients often don’t know that they have autonomy
-patient non-compliance
-problem of reduced capacity

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18
Q

Societal views

A

Society views autonomy as a status that a patient either has or lacks

but…. you should view it as:
-a goal you are trying to restore a patient to
-a feature of certain kinds of relationships

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19
Q

informed consent (choice)

A

choice is a ongoing process not a one time thing

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20
Q

Justice

A

-legal sense
-phil sense
-ethical sense

social justice:how we organize society to keep it fair

distributive justice: how we distribute our sources or social goods to help keep society fair

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21
Q

Canada Health Act

A

is supposed to govern distributive justice in this country unless your indigenous

-5 fundamental principles of justice:

1, Comprehensiveness (what’s covered)

  1. Universality (who’s covered)
  2. Accessibility (can you get what your entitled to)
  3. Portability (your care travels with you)
  4. Public administration (the level of government that is responsible for providing health care is provincial/territorial and not federal)
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22
Q

Health Care Spending: societal level

A

-taxes: either increase taxes it cut services

other opinions:
-pay politicians less
-stop/reduce tax breaks –> corporations/ wealthy ind’s
- less military funding

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23
Q

POLITICIANS

A

ARE BIG FAT DIRTY LYING RAT BAGS

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24
Q

Health Care Spending: personal level

A

where you work

-nurses should be aware that they sometimes

undermine the values of their own profession

-ask candidates for public office about health care

Funding

-be a educator and a advocate for the public as well

-the values you defend in your practice should be

rpn values not corporate values

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25
Truthfulness (veracity)
It's not just about being accurate or stating facts it's about acting with the right intentions; speaking with the moral duty to be honest Truthfulness is acting with the intention of being honest, rejecting the intention to deceive -KANT
26
Why does Truthfulness matter?
1. Legal reasons: RPN'S must be truthful to avoid fraud 2. Respect for persons: we understand to deceive a person is to degrade them (deception undermines dignity) --> deceiving patients reinforces inequality 3. Shift to patient centered care: you can't have autonomy without truthfulness (shift away from parental ways of medicine) 4. TRUST: the relationship between you and your patient is bound with trust; without trust its very hard to build a therapeutic bond and if its destroyed its almost impossible to restore - Patients need to feel non-judgement - They need the truth for autonomy -We need patient as a group to have faith in our healthcare system
27
Therapeutic privilege
because the physician has all of the knowledge and all of the power they should decide what the patient should know -physicians thought it was ethically justified
28
Going in position
OUR GOING IN POSITION WHEN IT COMES TO DEALING WITH YOUR PATIENTS IS THE KANTION ONE BUT NO MATTER WHAT I DEONTOLOGIST MIGHT THINK, VERACITY AND TRUTHFULNESS CANNOT BE A ABSOLUTE MORAL PRINCIPLE IN HEALTHCARE IT JUST CANT BE
29
Where not telling the truth is permitted vs. not permitted
permitted: - When the client doesn't want to know it - When the hospital or clinic your working in as a no new information policy - Trying to protect patient confidentiality - To protect anonymity in medical research not permitted: -Patient's condition is serious -Patient's condition is incurable -Patient is cognitively impaired
30
Grey Areas in truthfulness
-False paternity -Potential health risks -Lying to gov't or other agencies to get resources for patients - Patient delusions and dementia
31
Confidentiality
protection of public and private information - it's a patient's claim right: responsibility of the RPN (always your default)
32
private vs public info
public information: accessible to anyone private information: not accessible to anyone
33
Why we need confidentiality?
1. legal reasons 2. respect for persons 3. vulnerability ( info and boy vulnerability)
34
when can you share patient info?
1. when you have their permission 2. when it's with someone within their circle of care
35
Types of breaches
1. Unintentional: morally wrong and legally unacceptable (e.g. gossip) 2. Deliberate: takes place when u share pt. info with a third party outside the circle of care because there is a duty that overrides your obligation to protect patient privacy (e.g. Illnesses that come from food or water, Infectious diseases, Sexually transmitted infections) -Ensure the patient you only breach when absolutely necessary and you try to protect their identity as much as you can
36
Background Checks
Information about a person's mental health in BC cannot be included in a persons background check
37
Argument of patient information
people argue that patient information are overly protected They think less protection will: - improve the way resources of distributed - help the detection of fraud
38
New Technology
- people may get access to medical records - causes security concerns
39
Ethics in medical research
if people are receiving treatment, people should be tested if the treatment works
40
Differences between research and clinical care
1. different goals -clinical: therapeutic -research: gathering data 2. $$$ -research requires large amounts of money, very few treatments make it through the entire research process so money is lost 3. Past harms: continues to happen to vulnerable patients (misused) 4. You'll probably care for patients who are also research participants
41
Research Ethics Board
-looks out for patients and the ethics resolving them (not scientists because they already have the education) -if you want federal funding you must go through REB -wealthy people may not want federal fundings because they don't want to go through the REB (they fund themselves)
42
RCT (randomized controlled trial)
2 armed RCT (comparing 2 things, e.g. comparing x with existing treatment) 3 armed RCT (x with existing treatment and placebo)
43
Phases of RCT
Phase I - dosage (toxicity)- small, healthy, volunteers, use placebos Phase II - Safety - larger pop, healthy people, may use placebos, longer Phase III - efficacy - statistical measures, large® pop, sick volunteers Phase IV - post-market - make sure any adverse reactions get reported appropriately
44
Canada Vigilance Program
It collects and assess all reports of suspected adverse reactions to health products marketed in Canada
45
randomized controlled trial vs double blind
RCT: researchers randomly assign individuals to either an experimental or a control group DB: both researcher and patient does not know what group they are in
46
research beneficence
benefit is for science not patient
47
research non-maleficence
we don't know how safe things are (unknown=risks)
48
research autonomy
patient can drop out anytime (voluntary) proxy consent can be given
49
research truthfulness
can't do good research without deceiving (double blind study)
50
research confidentiality
before files were confidential but now are used as evidence
51
research justice
in the past the way people were recruited was unjust (poor, native, physical disabilities) past: women were not involved because of their hormones now: US prisoners can only be involved if the research is about prison populations
52
Moral autonomy
your ability to reject authority -You autonomy might conflict with your patients autonomy -Might conflict with your supervisors orders -May come into conflict with your professional obligations as a RPN -You have the right to ask for a patient to be restrained if you feel unsafe around them -Know what kinds of choses you are expected to make to make better decisions
53
Moral Fidelity
staying faithful - Keeping a promise is an act of fidelity (Self care promise to yourself) - Think about the promises you make to yourself and your profession - Think about the future and how you are going to keep those promises when making promises today
54
Moral Steadfastness
to be able to withstand pressure Time pressure: the most common reason unethical acts are committed
55
Moral Wholeness
moral consistency Across all your different roles you should be the same moral person
56
Moral Awareness
understanding the difference between an explanation and justification - Being able to give moral reasons for justifying your actions - You are not the only person who has moral integrity
57
Moral Accountability
if you are going to have moral integrity you have to acknowledge your mistakes and learn from them - Extra important in health care because some decisions are life and death decisions
58
moral dilemma
when your faced with competing ethical choices and you don't know what to do
59
moral distress
when you know what you should do but you are being prevented from doing it - The barriers are things that are beyond your control - Is a part of our job was RPNs
60
moral residue
the uncomfortable feeling you get long after the moral distress - the bad feeling you carry around with you after the moral distress
61
moral resilience
the capacity to restore their integrity and sustain it in the face of moral distress
62
moral courage
the ability or willingness to speak up when their might be bad consequences for you

ethics (4 decks)

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