Lecture 2 - Ethics Flashcards
(22 cards)
what is distinctive about rehab ethics?
Ethics and rehabilitation: What dilemmas identified by Foye and Carpenter?
What ethical issues identified by HCPs in rehabilitation institutions?
what are the 4 key ethical considerations?
- Capacity
- Consent
- Confidentiality
• Managing risk
define: Competency
Competency assessment evaluates whether individual understands:
– the condition for which treatment is proposed
– the nature and purpose of the treatment
– the risks involved in treatment
– the risks in forgoing treatment
– whether or not individual s ability to consent is affected by his/her condition.
define consent (legally and in practice)
Legal context in QC
Everypersonisinviolableandisentitledtotheintegrity of his person.
Exceptincasesprovidedforbylaw,noonemayinterfere with his person without his free and enlightened consent.
Nopersonmaybemadetoundergocareofanynature, whether for examination, specimen taking, removal of tissue, treatment or any other act, except with his consent.
In Practice
- Information, voluntariness, comprehension
- Implicit and explicit consent
- Written consent
what are the duties of confidentiality and exceptions
The right to have health information kept private
Confidentiality is a duty owed to the patient
Confidentiality based on the fiduciary (trust) nature of health care provider- patient relationship
describe risk management - types of risk
Risk to the public
– Driving
– Returning home but at risk of starting a fire in his apartment as forgets to turn off the stove
Risk to self
– Dysphagia - risk of aspiration
– D/C to unsafe location
– Not following precautions/ contraindications/ recommendations
Risk to family, friends of patient
what are the 3 different levels allocation happens at?
what are Three broad (and inter-linking) ways of viewing resource allocation:
what is a needs-based assessment?
what are some Reference points for ethical analysis?
Codes of ethics: OEQ and OPPQ
Principles of medical ethics
1) autonomy
2) beneficence
3) non-maleficence
4) justice
- fidelity, veracity
Moral role models
Evaluation of likely consequences
Law
define autonomy/decision-making autonomy
Autonomy
- Functional independence, capacity for self-care, freedom from handicaps…
- Capacity to make and enact choices that align with your goals, plans and responsibilities, to self-govern
Decision-making Autonomy
– Respect for persons (preferences, choices, priorities)
– Protection of those who are vulnerable
– Negative duty: non-interference
– Able to act in a way that is consistent with personal integrity (individual defines what is important to him or herself)
define: Beneficence/Non-maleficence
Beneficence/Non-maleficence
– Maximize benefits
– Promote health, dignity and welfare of patient and family.
– “First, do no harm”
– Seek to avoid or at least minimize negative outcomes
define justice
define: fidelity, veracity
What is needed for a multidisciplinary team to be effective at addressing challenging ethical issues?
5 components identified by Thomasma…
- The team must develop a common moral language for discussion of moral issues.
- Team members must have cognitive and practical training in articulating their feelings about issues rationally.
- Value clarification exercises are needed.
- The team must have common experiences upon which to base workable moral policies.
- The team must develop a moral decision-making method for all to use.
name 3 “special tests” for ethics
“icky feeling test”
“your mom test”
“front page test”
another special test for ethics:
Delany et al’s active engagement model
What are the three steps they identify?
1) Listen actively
2) Think reflexively
3) Reason critically
what is the patient-centred care ethics analysis model for rehabilitation?
what steps to take on the final exam
1) Identify the ethical issue
a) Succinctly identify what is at stake (the core ethical issue/problem)
b) Identify the most important ethical principles or values implicated by the case (and explain WHY they are relevant) identifying any principles/values that appear to be in tension or opposition
2) Collect information: Not part of the exam…
3) Review and analyze
- Identify 3 elements of the OEQ or OPPQ Code of Ethics that you think are most relevant to the case.
- Explain WHY these sections of the Code are relevant to the case and
- HOW they inform your understanding of the ethical issue.
4) Identify and weigh options
5) Make a decision
- Identify the best option and explain why it is the best under the circumstances
- Explain the steps that you would take to implement this decision
- Explain how you would follow-up and evaluate the decision and its implementation
what is the takeaway message?
