Lecture 8: The Ethical Practice of Medicine

Question 1

Who is the main committee for Medical Ethics?

Answer 1

The Joint Commission

Question 2

When did healthcare ethics start?

Answer 2

1970’s in academia

Question 3

What was the main event that caused the medical community to think about ethics?

Answer 3

WWII, with eugenics experiments by Dr. Joseph Mengele in Germany.

Question 4

What are the two types of eugenics?

Answer 4

Positive eugenics: promotion of higher reproduction of people with desirable traits.

Negative eugenics: reduced reproduction of people with less desirable traits.

Question 5

What are the US experiments that furthered ethics development?

Answer 5

Tuskegee Syphilis experiment
Glaxosmithkline (GSK) in 2004 testing AIDS meds on wards of the state
GSK in 2003 for Hep E vaccine.

Question 6

What GSK experiment abroad helped further ethics development?

Answer 6

2012 Argentina vaccine trials on 1 year olds.

Question 7

What documents began ethics development?

Answer 7

1. Nuremberg Code post WWII (1948)
2. Declaration of Helsinki (1964/2013)
3. Belmont Report (1979)

Question 8

When did healthcare start getting more complex?

Answer 8

1970-1980

Question 9

What are trending changes that began to occur in healthcare?

Answer 9

1. Patients seen by specialists who aggressively treat specific body systems and diseases.
2. House calls no longer a regular part of physician’s practice.
3. Physicians encouraged financially to see as many patients in a day as possible.
4. Patients began educating themselves about their medical conditions and disease processes.
5. Patients expectations regarding recovery dramatically increased with the advances in technology.

Question 10

What are the Bioethical principles?

Answer 10

Autonomy
Beneficence
Nonmaleficence
Truth-telling
Justice
Confidentiality
Preservation of Life

Question 11

What is autonomy?

Answer 11

The right of a patient to make an informed, uncoerced decision about their own health management.

Question 12

What is informed consent?

Answer 12

Extension of autonomy

Process by which the PA provides adequate information that is comprehendible to a patient with capacity so that the patient can make a VOLUNTARY choice to accept/refuse treatment.

Question 13

What can I do if I question a surrogate’s choice?

Answer 13

Request an ethics committee review

Question 14

What are the elements of fully informed consent?

Answer 14

Reasonable alternatives
The nature of the decision/procedure
Assessment of patient understanding
Relevant risks, benefits and uncertainties to each alternative
The acceptance of the intervention by the patient.

Question 15

What standards make up adequate information?

Answer 15

Reasonable physician standard
Reasonable patient standard
Subjective standard

Question 16

What are the types of consent?

Answer 16

Implied consent
Expressed oral consent
Fully informed written and oral consent

Question 17

What is the difference between competence and capacity?

Answer 17

Competence is a legal state, decided by a court. Competent until proven incompetent.

Capacity is an individual’s ability to make an informed decision.

Any licensed physician can make the determination.
If incapacitated or lacks capacity, needs competency hearing/guardian.

Question 18

What is beneficence?

Answer 18

Acting in a patient’s best interest.

Protect and defend the rights of persons
Prevent harm from occurring to persons
Remove conditions that will cause harm to persons
Help persons with disabilities
Rescue persons in danger

Question 19

What is nonmaleficence?

Answer 19

To do no harm
To impose no unnecessary or unacceptable burden upon the patient

Do not kill or physically harm
Do not cause pain
Do not incapacitate
Do not offend by insult or ridicule
Do not deprive others of goods of life

Question 20

What is the key difference between nonmaleficence and beneficence?

Answer 20

Nonmaleficence:
One ought not to inflict evil or harm

Beneficence:
One ought to prevent evil or harm
One ought to remove evil or harm
One ought to do or promote good

Question 21

What is justice?

Answer 21

Patients in similar circumstances should receive similar care.

Question 22

What four main areas do we consider in justice?

Answer 22

Fair distribution of scarce resources.
Competing needs.
Rights and obligations.
Potential conflicts with established legislation.

Question 23

What is truth-telling?

Answer 23

Providing truthful information to patients so they are informed.

Question 24

What is confidentiality?

Answer 24

Keep personal health information private unless consent to release is obtained.

Question 25

What are the two exceptions to breaching patient confidentiality?

Answer 25

1. Concern for the safety of other specific persons. 2. Legal requirement to report certain circumstances/conditions (Public health)

Question 26

What is preservation of life?

Answer 26

A will to treat a patient's illness with the aim of prolonging life. This principle may be overruled if the patient has made a living will stating their desire to not be resuscitated.

Question 27

How do PAs help with preservation of life?

Answer 27

PAs should provide end of life planning. PAs should assume terminally-ill patients want dignity and relief of pain primarily. PAs should explain palliative and hospice care and facilitate patient access to those.

Question 28

What is durable power of attorney?

Answer 28

A document that designates an individual to be your decision maker if you are incapable. Once recovered, you assume responsibility again.

Question 29

What is a living will?

Answer 29

What treatments you want and do not want

Question 30

What is medical futility?

Answer 30

Refers to interventions that are unlikely to produce any significant benefit.

Question 31

What are some futile medical interventions?

Answer 31

Increasing patient's pain and discomfort in the final days and weeks. Give patients and family false hope. Delay palliative and comfort care. Expend finite medical resources.

Question 32

What is euthanasia?

Answer 32

Physician or 3rd party intentionally causes death of terminally ill patient. Active! Illegal in all states!

Question 33

What is Patient-Assisted-Suicide?

Answer 33

Physician provides the means (aka syringe of morphine OD), patient administers it themselves. Passive! Legal in like 10 states.

Question 34

Who is the doctor of death?

Answer 34

Jack Kevorkian, american pathologist that championed the right to die via PAS.

Question 35

What is palliative sedation?

Answer 35

Sedation is not euthanasia! Continuous sedation that is intended to relieve suffering, like extra painkillers.

Question 36

What is terminal sedation?

Answer 36

Practice of sedating a terminally ill patient to point of unconsciousness and letting them die to starvation/disease/dehydration.

Question 37

What is a DNR?

Answer 37

Do not resuscitate. MUST RESPECT!!

Question 38

What are morals?

Answer 38

Morals are PERSONAL opinions on right/wrong. Unlikely to change, and are broad/general.

Question 39

What are ethics?

Answer 39

LEGAL standards that dictate MINIMUM STANDARDS of acceptable behavior. Ethics change over time.

Question 40

Do we use morals or ethics in decision making?

Answer 40

Both, but ETHICS are legal, so if your morals conflict with the code of ethics, you should refer out a patient.

Question 41

What is EMTALA?

Answer 41

Emergency Medical Treatment and Active Labor Act, AKA ethical obligation to treat patients and to responsibly transfer if outside scope.

Question 42

What two ethical duties do we have to patients?

Answer 42

Ethical duty to offer every patient the full range of info on relevant treatment. Ethical duty to see that each patient receives appropriate care.