Week 5 Bioethics (L40, L42, L44, L46, L48) Flashcards
(38 cards)
list some useful criteria used when assessing evidence and context
currency, relevance, accuracy, authority (who completed it), purpose (question experiment is asking)
what are the 3 types of peer reviewed reports (include trial / study types)
- Publication: original research report, RCTs, case studies
- Review: meta-analysis, literature review
- Summarization: manuals, textbooks, clinical support tools
list some challenges to Informed Consent
- anxiety, pain
- bias, value judgments
- language
- time
- cultural difference
- exhaustion
list the requirements for ethical research
- valuable
- scientifically valid
- fair subject selection
- favorable benefit to harm ratio
- ethical review (IRB)
- Respect for Persons
- Informed Consent
list the goals of public health (not ethics)
- promote health: prevent disease / disability
- study determinants of health
- develop, implement, evaluate interventions
- alter social conditions affecting morbidity and mortality
list the goals of public health Ethics
1) balance competing interests
2) provide justification for public health policies and decisions
(social ethics, social responsibility, public trust)
list the 7 criteria for duty to act for physicians
1) expertise
2) proximity
3) effectiveness
4) lower risk or cost
5) unique (no others available)
6) severity
7) public trust
describe the components and reason for RCR
(responsible conduct of research)
- using established professional norms and ethical principles to conduct research
- critical for integrity of findings
- uphold public trust
- must be taught to future researchers - commitment to RCR training
describe how conflicts of interest affect / challenge RCR
- disrupts objectivity
- clash with academic, social, health, and other priorities
- may report unreliable results
- people / animals may die
- threatens public trust
list the 3 responsibilities doctors/researchers have to their subjects
1) research is important, has equipoise (researchers are uncertain of outcomes)
2) research is well designed and implemented
3) risks and harms are minimized
much of the ethical principles of research in the US are derived from…..
Belmont Report (prompted by issues with Tuskegee Syphilis Study, 1932-72)
define therapeutic misconceptions and the groups that are at most risk
-subject’s belief that enrolling in research study provides direct benefit for their disease when it may not
At risk groups: elderly, those with poor health status, those with lower levels of education
list some groups that are vulnerable to research involvement b/c they lack freedom / capacity to choose
- children / minors
- intellectually disabled
- elderly
- prisoners
- extremely poor
compare inducement v coercion
Inducement: reasons to participate in study (altruism, $$, food, ect)
Coercion: person assumes unacceptable risk b/c of undue pressure to participate
list the 5 themes for the future of medicine
- population growth / climate change
- science and technology
- bioengineering and bioenhancement
- personalized medicine (genomics)
- commodification of medicine
how does physician burnout relate to empathy and professionalism
- too much empathy can lead to burnout and unprofessionalism
- burnout erodes empathy and professionalism
list the 3 pillars of medical education (include their associated competences)
- medical knowledge (cognitive competence)
- clinical skills (relational and integrative competence)
- moral development (moral competence)
define moral distress
emotional state- arises from situation where one feels the ethically correct action is different from policy or procedures
what are the 3 signs of physician burnout
1) emotional exhaustion
2) impersonal attitude towards patients and coworkers
3) perceived lack of accomplishment
list some causes/drivers of burnout
- excessive workload
- inefficient environment / inadequate support
- loss of autonomy / flexibility
- problems with work-life integration
- loss of meaning in work
list some effects of physician burnout
- medical errors
- depression / other mental health problems
- poorer patient care
discuss the challenges to (or questions of) the Bioethical Principles in terms of ‘Start of Life’
- Autonomy: how to separate best interests of mother and fetus
- Beneficence: is living with profound life long impairment a benefit
- Non-maleficence: is life with impairment a harm
- Distributive justice: do all children get a fair chance
in the legal view, when does a fetus derive moral status
birth
define the concept of personhood in regards to the ‘Start of Life’
bridge that connects the fetus with the right to life
