Station 3 - Medical Ethics Flashcards
Cultural Sensitivity
Breaking Confidentiality
1) Understand the Situation
2) Recognition of Confidentiality
- patient trust and confidentiality is a priority .It is important when building the trust between a patient and healthcare provider
3) Analyse Scenario
- Suggest that confidentiality may have to be broken, consider potential risk of harm to patient or others
4) Balancing the Act
- Involves careful balancing right to privacy an potential harm that could come form keeping the information confidential
5) Law Relevant
- Guidelines of professional medical board
6) Decision and Rationale
- State what you would do
7) Minimal Disclosure and Documenting
- Mention that if you were to break confidentiality. only the minimum necessary information and would document for your decision.
8) Closure - Summarise points
A 15-year-old girl tells you, a doctor, that she’s pregnant and begs you not to tell her parents.
1) Introduction and Understanding: “I appreciate you sharing this with me. I want you to know that as a doctor, my priority is your well-being. I have a duty to ensure patient safety”
2) Acknowledging Confidentiality and Its Importance: “Under normal circumstances, everything you tell me is confidential.”
3) Assessing Risk or Harm: “However, as you’re still a minor, there are instances where your health and safety might require me to involve an adult. Can you tell me a little bit about your support network, or how you’re handling the situation?”
4) Discussing Exception: “In cases where there is potential harm to you or your baby, I may need to involve others to ensure both of you receive the necessary care and support.”
5) Assuring Ongoing Support: “I want to help you through this situation. Can we discuss your options and next steps?”
6) Closure: “This is a lot to process. I want to assure you that you’re not alone, and we’ll figure out the best way forward together.”
Your patient, a truck driver, admits to experiencing frequent blackouts but implores you not to report this as it would risk his job.
1)Introduction and Understanding: “I appreciate your honesty, and I understand your concerns regarding your job. My main priority is your safety and the safety of others.”
2) Acknowledging Confidentiality and Its Importance: “Our conversations are typically confidential. However, there are certain exceptions.”
3) Assessing Risk or Harm: “Blackouts pose a serious risk when you’re driving, not only to you but to others as well. That’s something I’m obligated to take seriously.”
4) Discussing Exception: “In this case, there is potential harm to you and the public. So, I’m required to report this to the DVLA. They will make a decision regarding your driving eligibility.”
5) Assuring Ongoing Support: “I understand this might have implications on your employment. Let’s also discuss other potential support or resources available to you during this time. I’m here to support you. “
6) Closure: “Your health is our main priority right now, and we will work through the rest of this situation together.”
Is lying
A patient refuses a life-saving treatment because of personal beliefs. How would you handle this situation?
In this scenario, the principles of autonomy and beneficence are in conflict. The patient’s right to refuse treatment based on personal beliefs (autonomy) conflicts with my duty to act in their best interest (beneficence). I would respect the patient’s autonomy by first ensuring they are fully informed about the consequences of refusing treatment, including the risks and potential outcomes. I’d also explore their beliefs and fears, to understand their decision better and ensure it’s made with full knowledge. If after this discussion the patient still refuses treatment, I would respect their decision, while also ensuring they are aware of the available support and palliative care options. This approach balances the respect for patient autonomy with the principle of beneficence, aiming to do what’s best for the patient while respecting their values and decisions.
How would you address a scenario where a patient’s treatment is very expensive and resources are limited?
This scenario touches on the principles of justice and beneficence. Justice requires that we use healthcare resources equitably, while beneficence suggests we should do what is best for the patient. In such cases, I would consider the effectiveness of the treatment, the patient’s quality of life, and the impact of allocating resources to this patient over others who might also benefit from them. I’d also explore alternative treatments that may be more cost-effective. Discussing the situation with colleagues and ethics committees could provide broader perspectives and ensure that decisions are made transparently and fairly. Ultimately, my aim would be to advocate for the patient while also considering the wider community’s needs, striving for a balance between individual care and the equitable distribution of limited resources.
If a patient is diagnosed with a terminal illness and asks not to be told about their prognosis, how would you proceed?
This scenario involves balancing the ethical principles of autonomy and beneficence. Autonomy respects the patient’s right to not know their prognosis, while beneficence involves acting in what is believed to be the patient’s best interest, which might include knowing their prognosis for planning purposes. I would first explore the reasons behind the patient’s request, as understanding their fears or concerns could help in providing support and reassurance. I would also explain the benefits of knowing their prognosis, such as the opportunity to make informed decisions about their care and personal affairs. However, if the patient persists in their decision, I would respect their autonomy, ensuring they understand they can change their mind at any time and that support is always available.
A 14-year-old girl requests birth control pills but asks you not to tell her parents. What do you do?
This question touches on autonomy, beneficence, and confidentiality. The principle of autonomy supports respecting the patient’s wish for confidentiality and autonomy in making decisions about her health care. However, as a minor, the situation also requires considering beneficence, ensuring her safety and well-being. I would discuss the importance of confidentiality and the circumstances under which it might need to be broken for her safety. I’d also educate her about the responsibilities and implications of sexual activity, including the importance of consent and protection against sexually transmitted infections. It’s crucial to ensure she feels supported and understands her options fully. Ultimately, my approach would aim to balance her right to confidentiality and autonomous decision-making with ensuring her well-being.
You suspect a colleague of coming to work under the influence of alcohol. What actions do you take?
This scenario involves the principles of non-maleficence, beneficence, and justice. Non-maleficence and beneficence dictate that I must act to prevent harm to patients and support the well-being of my colleague. I would first consider talking to my colleague directly if it’s safe and appropriate, expressing my concerns and offering support. If this is not effective or appropriate, or if patient safety is at risk, I would escalate the matter to a supervisor or the appropriate department within the institution, following the hospital’s protocol for such situations. It’s crucial to handle the situation sensitively to support my colleague’s need for help while ensuring patient safety is not compromised.
How would you handle a situation where you made a significant medical error that has not yet affected the patient’s outcome?
The ethical principles of honesty, non-maleficence, and beneficence guide the response to this situation. It’s important to promptly disclose the error to my supervisor and the patient, explaining the nature of the mistake, how it happened, its potential effects, and the steps being taken to rectify it. Transparency is crucial, as is taking responsibility for the error. This approach respects the patient’s right to know what happened to their body and maintains trust in the healthcare professional-patient relationship. Additionally, it’s important to review and reflect on the incident to prevent future errors, contributing to the broader culture of safety and learning within the healthcare setting
How would you manage a scenario where an adult patient’s religious beliefs prohibit them from receiving a potentially life-saving treatment?
This scenario involves respecting the patient’s autonomy while also considering the principle of beneficence. I would first ensure that the patient fully understands the potential consequences of refusing treatment, including the risks and the possibility of death. It’s important to engage in an open and respectful dialogue, exploring the patient’s beliefs and values and how they influence their decision. I would also inquire if there are any acceptable alternatives within their belief system that could be considered. Respecting the patient’s autonomy means honoring their decision if they fully understand the implications, even if it conflicts with the medical recommendation. Additionally, offering support and ensuring the patient knows they are not being judged are crucial for maintaining trust and respect in the patient-doctor relationship.
A family requests that you do not disclose a terminal diagnosis to their elderly relative, believing the news would cause undue distress. How would you respond?
In this situation, the principles of autonomy, beneficence, and non-maleficence are all relevant. The patient has a right to know their diagnosis (autonomy) and to make informed decisions about their care. However, the family’s concern about causing distress touches on non-maleficence (do no harm). I would discuss with the family the importance of honesty in the patient-doctor relationship and the potential benefits of the patient knowing their diagnosis, such as the ability to make end-of-life decisions, reflect on their life, and say goodbye to loved ones. I would suggest a sensitive approach to disclosing the diagnosis, offering psychological support for the patient. If the family still insists, I would seek further guidance from an ethics committee or hospital policy but lean towards respecting the patient’s right to know, always considering the most compassionate way to convey the information.
During a routine examination of a child, you notice signs that suggest physical abuse. The child’s parents deny any wrongdoing. How would you proceed?
The welfare of the child is paramount in this scenario, guided by the principles of beneficence and non-maleficence. My primary responsibility is to ensure the safety and well-being of the child, which would involve documenting my findings thoroughly and, if my suspicions are strong, reporting them to the appropriate child protection services for further investigation. It’s also important to approach the situation with sensitivity, avoiding direct accusations that could escalate the situation, particularly before any investigation is conducted. Engaging social services and utilizing hospital protocols for suspected abuse can help ensure the child receives the protection and support they need. The child’s health and safety are the top priorities, and taking action is necessary to prevent further harm.
You discover that a new treatment could significantly benefit your patient, but it’s not covered by their insurance. How would you handle the situation?
This situation calls into question the principles of beneficence, justice, and autonomy. My duty is to act in the best interest of the patient (beneficence) while also navigating the realities of healthcare access and equity (justice). I would discuss the new treatment with the patient, including its benefits and the issue with insurance coverage. Providing the patient with all the information allows them to make an informed decision about their care (autonomy). I would also explore all possible avenues to help the patient access the treatment, such as looking into patient assistance programs, charitable organizations, or clinical trials. Advocating for the patient with the insurance company or seeking alternative funding sources might also be necessary. Throughout the process, it’s important to support the patient and explore all options to provide the best possible care within the constraints of the healthcare system.
