Flashcards in Final Exam Deck (86):
What are some reasons that truth-telling and confidentiality are important aspects of clinical relations between patients and health care providers?
Truth is a right, a utility, and a kindness. Respect for a person demands truth-telling. Truth-telling is the basis of interpersonal trust, covenants, contracts, and promises. The truth is also a utility, because it is required in order for a person to make informed judgements about their actions.
What are the two different types of deception?
Lying and withholding information.
Which is worse, lying or withholding information?
What does weak paternalism appear to say about when we can deceive patients?
It is never okay to lie to competent or incompetent patients. It is okay to withhold information from incompetent patients in some situations.
What does strong paternalism appear to say about when we can deceive patients?
It’s okay to lie and withhold information from both competent and incompetent patients if you are doing it for the patient’s own good.
What does the Smith v Jones case say about when health care providers can breach confidentiality?
HCPs can breach confidentiality when it is done for public safety. The threat to public safety must be serious and imminent.
What is professional responsibility?
Professional responsibilities are found in professional ethics codes and related policy documents.
What is professional autonomy?
Professional autonomy is the duty to promote and maintain patients' wellbeing and rights, and to uphold the standards of the profession.
How are professional responsibility and professional autonomy related?
Professional autonomy requires an understanding of professional responsibilities.
What are the range of situations where a hcp may wish to say “no” to a patient’s or a health care colleague’s request on the grounds that in conflicts with her professional responsibilities?
When a hcp disagrees with another hcp’s professional judgement, or if they disagree with gatekeeping.
What are proper grounds for refusing treatment?
Cost, harm to others, harm to self.
What are some different concepts of futility?
Physiological futility, futility in relation to a patient’s goals, or futility in relation to the standard of professional integrity.
What are some reasons that futility should never be used on its own to deny a request for treatment?
If there is a greater than 0% chance, it's not really futile. Even if it's 0%, there might be other psychological benefits.
Explain how futility is often confused with other reasons for saying “no” to a request for treatment?
Assumptions are made by the HCP in order to justify saying no for reasons related to cost. Futility is a short-cut to doing the ethical heavy-lifting.
In what ways does professional autonomy regulate relations between health care providers?
It is the right/duty to say no to other hcps when asked to do things that are contrary to one's professional responsibilities. It also entitles hcps to have voices heard when they have knowledge based on areas of speciality/practice that are relevant to a patient's care.
Do HCPs have duties sometimes to expose themselves to risk on grounds of professional responsibility?
Yes. There is a duty to provide care in emergencies, natural disasters, and pandemics.
What is the rationale that HCPs have duties to expose themselves to risks on the grounds of professional responsibility?
HCPs ability to provide care is greater than that of the general public. By freely choosing a profession devoted to care for the ill, they assume risks. The profession has a social contract that calls on members to be available in times of emergency.
Is conscientious objection a form of professional autonomy?
No. Conscientious objection is about personal values and professional autonomy is about professional values.
What process must a hcp observe if she conscientiously objects to a health care practice?
If the conflict is foreseeable, the HCP must let their employers know of any conflicts likely to occur. They must not abandon their patients, they must continue to provide care until an alternative arrangement is in place.
Why is it important for health care providers to meet as equal participants in clinical decision making?
Because they all have specialized knowledge that might be relevant to the decision making. Also it’s important for establishing trust and respect.
What are the etymological origins of the word euthanasia?
“Eu” means good and “thanatos” means death.
What is active euthanasia?
Active euthanasia is where you administer treatment in order to cause death.
What is passive euthanasia?
Passive euthanasia is where you withdraw/withhold treatment, and withholding treatment causes death.
What is physician-assisted dying (PAD)?
What is lethal palliation?
Lethal palliation is when you provide palliative care that could potentially result in a person’s death.
What are the legal criteria for PAD in Canada based on the Supreme Court’s 2015 decision in Carter v The Attorney General?
PAD is permitted for competent adults, with “grievous and irremediable illness” that causes “enduring intolerable suffering” and who actively consent to termination of life.
What classes of patients does PAD appear to not cover?
Incompetent adults. Minors.
What are the main arguments for active euthanasia/PAD?
Right to minimize suffering, right to preserve dignity. Not allowing PAD limits the right to life, denies people right to make their own decisions. There is no difference between withdrawing treatment and PAD.
What are the main arguments against active euthanasia/PAD?
"Do no harm." Risk of bad consequences/slippery slope.
What are some consequentialist arguments against PAD?
Risk of bad consequences/slippery slope.
What is a response to consequentialist arguments against PAD?
There is no evidence of a slippery slope.
What is a deontological argument against PAD?
PAD is intrinsically wrong. Violation of Universal Law and Principle of Respect for Persons.
What are some responses to a deontological argument against PAD?
Morally the same as WLST. Deontological approach should put autonomy above all else. Rights should trump considerations of general good/welfare.
What is an advance directive?
A directive that anticipates circumstances where a patient may be unable to make decisions about treatment and provides direction to hcps or substituted decision-makers about treatment choices, including when to withdraw or withhold life sustaining treatment.
What is a proxy advance directive?
Authorization of a trusted representative to make decisions about personal care, health care, and legal and financial matters.
An example of a proxy advance directive.
An Enduring Power of Attorney.
What is an instructional advance directive?
An instructional advance directive is an instrument whereby a person, when competent, specifies which types of treatment he or she wishes to have or not have, under certain circumstances, should he or she become incompetent.
An example of an instructional advance directive.
A Living Will
What are the moral considerations involved in assessing whether to follow an advance directive?
How long ago it was written/signed. How knowledgeable the patient was about the circumstances addressed in the advance directive. If the patient was incompetent or under duress when they signed. How well the advance directive anticipated the current situation
What are some reasons for proxy and instructional advance directives?
Don't trust or don't have a proxy. If you have very specific wishes.
What are some problems with advance directives?
$$$. Informed consent is questionable. They don't get updated. Very complex. Serve lawyers and doctors more than patients.
What is distributive justice?
It is about identifying just norms for the fair allocation of scarce resources.
What is the problem of distributive justice.
Problems of distributive justice arise under conditions where there is competition for scarce resources. When there is scarcity of resources, there is a need to identify norms of fair distribution of goods and responsibilities in a society.
Why is the partitioning and allocation of health care resources part of the problem of distributive justice.
Resources are scarce.
What is macro allocation?
Partitioning of a portion of all societal resources for health care.
What is maso allocation?
Allocating resources within a health care institution.
What is micro allocation?
Allocating resources to patients/clients.
What level of funding for medical services is the Canada Health Act supposed to provide?
At the level of macroallocation, it is supposed to provide funding for all medically necessary services.
What is the rescue principle?
The perceived duty to save a human life whatever the cost.
Is there any relationship between the Canadian Health Act and the rescue principle?
Yes. The Canadian Health Act mandates it.
What is the dignity argument for equal access to health care?
People are not responsible for talents, social/economic class, and upbringing. Such things are by and large a matter of luck. Therefore, it is morally arbitrary to differentiate access to health care based on talent and social/economic class. Treating people in a morally arbitrary way violates their dignity. Therefore, equal access to health care is justified because it preserves dignity.
To what extent, if at all, does the dignity argument solve the problem of distributive justice for health care?
Tells us that we must provide equal access to health care, but it does not tell us how much health care should be provided or how much money should be spend.
What is a utilitarian argument for equal access to health care?
Equal access to health care will promote greatest good consequences. Therefore, it is just to provide equal access to health care.
To what extent, if at all, does a utilitarian argument solve the problem of distributive justice for health care?
Tells us that we must provide equal access to health care, but it only vaguely indicates how much health care is to be provided.
What are the five main principles of just access to health care under the Canada Health Act?
Public administration. Comprehensiveness. Universality. Portability. Accessibility.
What are the basic ideas of rationing and prioritization in micro-allocation?
Reducing the demand (the number of patients who need treatment) to supply (the number of patients who can receive treatment).
What is rationing?
Rationing is excluding classes of individuals from treatment.
What is hard rationing?
Adopting a rationing policy after public deliberation and consultation.
What is soft rationing?
Rationing choices are made without public debate.
What is prioritizing in micro-allocation?
Excludes individual patients based on prioritizing criteria.
What are the main theories/models of prioritizing?
Complex/Substantive Criteria and Formal/Random Criteria.
What screening methods do both Complex and Formal Criteria share?
Medical suitability, prospect of success, quality of life/age factors and need for treatment.
What is Complex/Substantive Criteria?
Criteria that looks at the characteristics of a person to see who is more deserving of treatment, such as social criteria and responsibility for illness.
What is Formal/Random Criteria?
Criteria that does not look at personal characteristics. Formal Criteria uses queuing and chance to select who receives treatment.
Which theory is the standardly accepted approach to prioritizing and why?
Formal/Random Criteria is preferable because it is efficient in terms of cost and it preserves dignity.
What is research?
An undertaking intended to extend knowledge through a disciplined inquiry or systematic investigation.
What is the difference between observational and experimental research?
In observational research, researchers observe a subject population; whereas in experimental research, researchers assign subjects to an experimental treatment group and a control group.
What is a randomized double blind clinical trial?
Subjects have been randomly assigned to treatment and control groups. Neither the subjects nor the researchers know who is assigned to the experimental group and who is assigned to the control group.
What are ethical issues in clinical human research?
Consent, privacy, confidentiality, risk of harm, therapeutic misconception, equipoise, benefit to medicine/science, and rights of the community.
What is the fundamental ethical issue in clinical human research?
Reconciling the rights of research subjects/participants with the need to increase medical knowledge/benefit to others.
What are some ways that informed consent in research differs from clinical care?
Greater demands on assessing understanding and appreciation in research. More information to be disclosed when doing research. In research, consent is documented in writing.
What is the concept of equipoise?
Equipoise is when there is genuine uncertainty among expert communities as to which treatment is better.
How is equipoise supposed to ensure participant/subject safety?
Subjects are not exposed to unnecessary risks, and trust is not violated.
When is it acceptable to use a placebo or sham treatment in a clinical trial?
When there is no standard therapy, or if there is a standard therapy then only when there is no significant risk to subjects who received the placebo.
What is conflict of interest?
Conflict of interest exists where an individual or organization has a moral obligation toward another person or institution and has another interest that competes with (and thus conflicts with) that obligation.
What are some examples of conflicts of interest in clinical research?
Researcher has a financial interest in the outcome of the study. Researcher’s career could be advanced if the research is successful. Wanting to obtain as much information as possible from the participants because of scientific interest (in contrast to the participants needs).
What are Phase I trials?
When drugs are first tested in a human population. Usually subjects are healthy and paid. Goals: determine acute dose-related toxicity, early evidence of effectiveness. Trials usually small, not controlled and proceed step-wise.
What are Phase II trials?
Goal is to provide initial evidence of safety and efficacy. Controlled. Small size, but larger than Phase I.
What are Phase III trials?
Conducted once some evidence of safety and efficacy has been established. Goal: establish safety and efficacy so medication can be licensed.
What are Phase IV trials?
Post-marketing. Goal is long-term evidence of safety and efficacy.
What is assent in clinical research?
When incompetent subjects have some ability to understand the significance of the research, they are able to either assent (agree) or dissent (refuse).
How is assent different from informed consent?
Informed consent can only be given by competent subjects, not incompetent subjects. Assent can be given by incompetent subjects.
What is the role of assent in clinical research?
When research is done on incompetent subjects, assent is routinely required for them to participate in the research.
What is therapeutic misconception?
The assumption that the goal of clinical research is to provide a medical treatment benefit to the research participant/subject.
What are some ways to avoid therapeutic misconception?
To involve the clinicians who provide the patient’s regular as little as possible in the recruitment and consent process. Ideally, treatment and research functions should be performed by different people.