Test 1 Flashcards
(122 cards)
1
Q
What are virtue ethics narrowly defined?
A
A systematic formulation of the traits that make someone praiseworthy or blameworthy
2
Q
what are virtue ethics broadly defined?
A
practical wisdom as integrating values with intentions and consequences
3
Q
how does the book see ethics?
A
virtue ethics broadly defined (ethics of practical wisdom)
4
Q
what is the role of society in ethical decision making?
A
society is the context in which we live our lives; we impact society, and society impacts us
5
Q
What is ambiguity?
A
when the facts of the situation don’t provide clarity concerning ethical judgements
6
Q
What is opacity?
A
when our knowledge of the situation is so limited that it hampers our ethical reflection
7
Q
What is a legal right
A
a right guaranteed by a legal institution
8
Q
what is a moral right?
A
a right guaranteed by moral individuals or communities (ie. right to be told the truth(
9
Q
what is a public good?
A
public good exists for the good of the individual person, it always precedes the personal good
10
Q
what are the two “tragedies” of human life?
A
- don’t always have enough information to make ethical decisions
- sometimes our decisions turn out badly even with all the information
11
Q
what is applied ethics?
A
when we look to the concrete and practical rather than to the abstract
12
Q
What is the definition of medical practice?
A
primary purpose is to CARE for the patients
13
Q
What are the models of nursing?
A
- bureaucratic: knowing protocol, institutional coordination
- physician advocate: extension of physician
- patient advocate : primary goal is to speak on behalf of the patient
14
Q
What are the models of medicine?
A
- engineering: MD as applied scientist, treat problem not the person
- Priestly: MD has authority over everything
- Collegial: pt and MD work together as a team
- Contractual: MD performs a service, you pay a specific amount
- Covenant: strong MD patient relationship
15
Q
What are hospitalists?
A
certain doctors who are ONLY in the hospital, don’t have private practice outside hospital
16
Q
What is the healthcare formulation of the principle of autonomy?
A
You shall not treat a patient without the informed consent of the patient or surrogate except in narrowly defined emergencies
17
Q
What is autonomy?
A
when you are the decision maker
18
Q
What is heteronomy?
A
When someone else makes decisions for you
19
Q
What is the ability to make an autonomous decision determined by?
A
COMPETANCY or incompetency
20
Q
What are some groups of incompetent people?
A
- minors
- temporarily incompetent;: drunk, knocked out, etc.
- permanently incompetent: coma
- developmentally delayed
- dementia
21
Q
Competent and Incompetent are legal terms. What are the corresponding medical terms?
A
Capable and incapable (in regard to making deicions about their own healthcare)
22
Q
What is competence?
A
the ability to make choices based on an understanding of the relevant consequences of that choice on oneself or others
23
Q
What is important about the information given during informed consent?
A
the information MUST BE UNDERSTANDABLE TO THE PATIENT –> if no understanding, no consent
24
Q
What is paternalism?
A
When one person has authority over another person
25
How does paternalism exist in a healthcare context?
when a healthcare worker intervenes to stop a patient from harming themselves in a serious way
26
What is an example of strong paternalism?
overriding the wishes of a competent person --> NOT ethically appropriate
27
what is an example of weak paternalism
overriding the wishes of an incompetent or doubtfully competent patient
28
What is therapeutic privilege?
privilege of withholding information from the patient that the MD believes that the disclosure will have an adverse effect on patient's condition
29
What is a surrogate?
substitute decision maker for an incompetent patient
30
What are the three exceptions to obtaining informed consent in emergencies?
1. pt. must be incapable of giving consent & no lawful surrogate available
2. danger to life or serious impairment of health
3. immediate treatment necessary to avert these dangers
31
Does the patient have the right to refuse treatment/
YES
32
What is beneficence?
to do good (bene facere)
33
what limits the principle of beneficence?
the principle of maleficence (first do no harm)
34
What is the principle of maleficence?
do no harm (non male facere)
35
How do we determine what good is to be pursued in healthcare?
patient makes the final call, but it should be an ongoing conversation between HCP and patient
36
what is the principle of double effect?
when there are two effects to every decision (one positive, one negative)...need to be able to tolerate the harm if the good is to be achieved
37
what is the principle of proportionality?
when there are more than two effects of a given decision --> there must be proportionate good to justify risking an evil effect
38
What are the four factors to judge proportionality?
1. is there another way that will cause less harm?
2. what is the level of good intended and evil risked
3. What is the probability of good or evil
4. causative factors
39
What is the patient's obligation in healthcare?
individuals are obliged to use ordinary but not extraordinary means of preserving and restoring their health
40
what are "ordinary" measures?
that which, all things considered, produces more good than harm
41
what are "extraordinary" measures?
that which, all things considered, produces more harm than good
42
what is the healthcare provider's obligation?
MEDICAL INDICATIONS PRINCIPLE: granted informed consent, the MD should do what is medically indicated such that more good than evil will result
43
If the wishes of a once competent person are known, what should the surrogate use?
SUBSTITUTE JUDGEMENT PRINCIPLE: surrogate decides in accord with the known wishes of the patient
44
If the wishes of a now incompetent patient are UNKNOWN, how should the surrogate proceed?
1. BEST INTEREST PRINCIPLE: act in best interest of patient ONLY
2. RATIONAL CHOICE PRINCIPLE: surrogate chooses what patient would have chosen if competent (considers all factors)
45
When is it appropriate for a doctor to refuse patients?
1. if he lacks the skill needed
| 2. if he has too many patients
46
What is the definition of health?
lack of a deficit
47
what is the definition of a disease?
deficit in physical/psychological functioning
48
Who decides if you are sick?
the individual, although it occurs in the context of society
49
What are the limiting factors in being able to help someone who is sick?
knowledge & resources
50
Can we respond to all healthcare requests?
NO, only reasonable ones
51
What are the goals of healthcare?
1. prolong life
2. alleviate suffering
3. optimize pt chance for happy & productive life as defined by patient
52
What are the two basic concerns with healthcare distribution?
NEED & CONTRIBUTION TO SOCIETY
53
What is distributive justice?
when needs and contribution are both considered & respected
54
What are the three levels of allocation?
1. microallocation (within the individual)
2. mesoallocation (within an institution)
3. macroallocation: on a state or national level
55
What is a for profit institution?
pay as you go market economy
56
What is a not-for-profit institution?
either GOV OWNED: usually general funds of society or PRIVATE: other means of support
57
How do conservatives do resource distribution?
MARKET ECONOMY APPROACH, market guides distribution of available resources
58
How do liberals do resource distribution?
GOVERNMENT ASSISTANCE APPROACH, where government guides distribution of available resources
59
What is truth?
speaking according to your mind
60
What is our truth?
PERSPECTIVAL
61
What are the two basic commands concerning the ethics of truthfulness?
1. if you communicate, do not lie
| 2. you must communicate with those who have a right to the truth
62
What is a falsehood?
speech against the mind when the listener DOES NOT have a reasonable expectation of the truth
63
What is a lie?
a falsehood when the listener HAS A REASONABLE expectation for the truth
64
What are the ethics of falsehood and lies?
falsehood: ethically right
lie: ethically wrong
65
What are the three conditions for reasonable expectations?
1. place of communication
2. roles of communicators
3. nature of truth involved
66
Do you need to tell the truth if you volunteer information?
YES, because volunteering information announces an intention to communicate, creating a reasonable expectation for the truth
67
What are the two "rights" to the truth?
1. truthful information needed to make informed consent
| 2. right by way of purchase
68
What is a secret?
knowledge that a person has the right or obligation to conceal, because harm will follow if the knowledge is revealed
69
What are the three types of obligatory secrets?
1. natural secret
2. promised secret
3. professional secret
70
What is a natural secret?
information that comes into your possession that was not meant for you, and the information is by its nature harmful if revealed
71
What is a promised secret?
When a person tells you a secret directly and makes you promise not to tell
72
What is a professional secret?
any information revealed within the confines of a doctor patient relationship
73
Why is it important to keep a professional secret?
1. the nature of the knowledge
2. the implied promise
3. the good of the profession & society
74
What is HIPAA?
health insurance portability and accountability act
75
What is the principle of confidentiality in regards to consultation?
information sharing occurs on a need to know basis (medically)
76
What are the exceptions to confidentiality?
1. required by statute law
2. required by court decision
3. unusual relationships
4. proportionality
5. familial exceptions
6. child/adolescents
77
What are other issues concerning confidentiality?
1. media publicity
2. hospital records (electronic)
3. third party payers
4. public good
78
How do we judge quality?
1. inputs
2. process
3. outcomes
79
How do we judge inputs?
analyze preparation of health care professionals and equipment
80
How do we judge process?
look at protocol and procedure (protocol ratio)
81
How do we judge outcomes?
analyze results of the care given through patient interview and assessment
82
What is individual conscience?
our own personal values/ethics
83
What is an institutions conscience?
mission statement (tells you the institution's values)
84
What is the ethics committee responsible for?
making sure the mission statement is being pursued
85
When is it appropriate to ask to be recused from a case?
1. act is not in line with your personal standards
2. reflects a consistently held value
3. the act you are being recused from is not fundamental to the profession
86
What is the ethics committee responsible for?
1. public education
2. policy writing
3. policy enforcement
4. institutional watchdog
87
Who are the official police of medicine?
state board, TJC, etc.
88
Who do you have an obligation to when denouncing?
a specific patient and all actual/possible patients
89
Where is reporting done?
internally within the hospital, going up the chain of command
90
What is public denunciation?
WHISTLEBLOWING; external announcement of what has occurred and how the problem was not resolved
91
What is the obligation to whistleblow grounded in?
1. anyone who is silent is consenting
| 2. the inaction of good people is the reason why bad people continue to harm others
92
Who should be denounced?
anything that violates the rights of the patient or threatens the well-being of the patient/profession
93
What are the two concerns of whistle blowers?
1. MORAL concerns: obligation to protect society as a whole
| 2. PRUDENTIAL CONCERNS: obligations to protect oneself or ones family
94
What is the obligation of professions and institutions for denouncing?
to set up boards to deal with allegations and make sure complaints are appropriately submitted; also to protect whistleblowers
95
What is the issue with trying to contain costs by reducing RNs?
reduced quality of care to the patient and added stress for nurses
96
What does "euthanasia" mean historically?
"good death"
97
What is another term for euthanasia:
mercy killing
98
What is the definition of euthanasia? how does it differ from suicide?
Euthanasia: someone else does the actual killing
suicide: you kill yourself
99
What is a physician assisted suicide?
When doctor sets up the lethal dose of medicine, but the patient actually gives himself the dose/opens the flow/ whatever
100
What is passive euthanasia?
when medical team stands by the bedside and does nothing, allowing patient to pass away
101
What is passive voluntary euthanasia?
Patient voluntarily sets up a DNR that if something happens they don't want to be resuscitated
102
What is passive nonvoluntary euthanasia?
when patient is unable to speak, so the surrogate makes a decision based on what the patient would want
103
What is passive involuntary euthanasia?
When the patient WANTS to be resuscitated, but the medical team does not take action
104
Is passive involuntary euthanasia ethical?
MOST OF THE TIME, IT IS UNETHICAL AND ILLEGAL
105
When might passive involuntary euthanasia be allowed?
FUTILITY of care: if there is no chance at recovery and medical care is being wasted but family wants to keep patient alive, MD can go to the judge and get a court order for a "walk slowly" code
106
What is active euthanasia?
when the medical team actually gives poison/something to intentionally cause death
107
What is active voluntary euthanasia?
when a patient tells the MD to give them injection WITH explicit consent and THE DOCTOR ADMINISTERS THE INJECTION
108
What is active nonvoluntary euthanasia?
When the surrogate makes a decision to have a doctor give the injection while the patient is in a coma (still doctor giving poison)
109
What is active involuntary euthanasia?
Patient wants to stay alive, but medical professional GIVES POISON AGAINST PATIENT WILL --> MURDER
110
What does it mean to consider someone terminal?
They will die from the disease within one year
111
What does it mean to consider someone imminently terminal?
They will die from the disease within two weeks
112
What is fruitful treatment?
apply the treatment to help you get over a trauma, then withdraw it when you no longer need it
113
What is futile treatment?
a treatment that can never be stopped, is required for life
114
What are advanced directives?
papers you can fill out to tell medical professionals what your intentions/wishes are (DPAHC or living will )
115
What is a DPAHC
durable power of attorney for health care: document where you outline for your surrogate what you do/do not want done
116
What is a living will?
when you write down the types of treatments you do want and don't want
117
What is the hierarchy of surrogates?
1. DPAHC
2. spouse
3. majority of adult children
4. parents
5. majority of adult siblings
6. next nearest adult relative
118
What are the five stages of dying?
1. denial
2. anger
3. bargaining
4. depression
5. acceptance
119
When are feeding and hydration NOT medically indicated?
1. futile procedures
2. procedures would be no help to patient even if successful
3. burdens outweigh benefits
120
What are the different codes for medical treatment with terminal patients?
1. no-code order: do not do anything if they die
2. walk slowly code: verbal order
3. partial code: written order to omit some medical interventions, but to employ others
121
When can DNRs be issued without patient consent?
1. 2 physicians judge that resuscitation would be futile
| 2. judicial finding that DNR is consistent with patient's known wishes
122
What is the role of the ethics committee in death and dying?
1. educate hospital & employee
2. develop policies for problem areas
3. advisory consultants to help HCP and families
