Medical Ethics Flashcards
4 Elements of Principle-Based Model of Ethics:
- Autonomy
- Beneficence
- Non-malfeasance
- Justice
Autonomy
- Self-determination - must know pt’s wishes with respect to his/her illness and must respect pt’s autonomy
- Pts are entitled to informed consent and confidentiality
- Autonomy can be compromised if pt has diminished decision-making capacity (ie. psychiatric illness, cognitive impairment)
Beneficence
- Physician must do the most good for the pt and act in the pt’s best interest (Usually, respect for pt autonomy SUPERCEDES benificence if pt has capacity)
- Sometimes invoked as reason to limit pt’s autonomy if pt cannot make decisions for or care for self
Non-malfeasance
- First do no harm -> benefits must outweigh known risks/harms of any intervention
- Involves physician and pt weighing risks and benefits of a given procedure
- Physicians must offer care that carries the least chance of illness/death
Justice
- Must consider fairness/equality in distribution/delivery of a proposed tx or intervention.
- Must consider costs to society and weigh that with benefits to pt
Other factors to consider in Ethics Consults:
- Countertransferance
- Cross-cultural factors
- Third-party issues
- Group dynamics/Group-think
Capacity to give informed consent depends on:
-Pt’s ability to understand illness, prognosis and proposed tx and alternatives, as well as ability to weigh risks and benefits of having tx
Informed Consent
Mneumonic = BRAIN (Benefits, Risks, Alternatives, Indications, Nature)
-Willing or voluntary acceptance of a medical intervention by a pt after adequate discussion with doctor about Nature of intervention, Indications, Risks, Benefits and potential Alternatives.
When is Informed Consent required?
- Required for any significant procedure unless:
1) Emergency Tx is required
2) Pt lacks Decision Making Capacity (must obtain consent from a surrogate)
-For minors, consent OF ONE PARENT is sufficient, even if other parent disagrees.
When do minors (<18) not require parent/guardian to give consent on their behalf:
1) Life-threatening emergencies - when parents can’t be contacted
2) Legal emancipation of minors (d/t marriage, in military, financially independent and obtained emancipation)
3) STIs and Substance Abuse Tx - Consent rules for Contraception/Abortion/Pregnancy/Drug & Alcohol Tx vary by state.
4) Refusal of Tx - If a parent’s decision to refuse tx for child is not in best interest of child and poses a serious threat to child’s wellbeing, doctor may provide tx AGAINST parents’ wishes
When must ethics committees be consulted? When are court orders needed?
Helpful when:
1) Pt lacks capacity AND/OR Pt has no proxy or advanced directive
AND
2) Disagreement among family OR between family and providers about tx/care
In absence of a living will or DPOA, who can make decisions for pt?
In order of preference:
1) Spouse - 1st choice
2) Children
3) Parent
4) Sibling
5) Friend
Competence:
- A person’s global and legal capacity to make decisions and be held accountable in a court of law.
- Assessed by courts
- DIFFERENT than decision-making capacity
Capacity:
- Pt’s ability to understand relevant information, appreciate severity of the medical situation and its consequences, communicate a choice, and deliberate rationally about his/her values in relation to the decision being made.
- Assessed by doctors
-Pts who have capacity have the right to refuse or stop tx
When can a pt’s decision to refuse tx be overruled?
-When it endangers the health and welfare of others
Ex: Pt w/active TB must take Abx
