4. Rights & Principles In Healthcase Ethics (do)

Question 1

What is article 1 do the universal declaration of human rights?

Answer 1

All human beings were born free and equal in dignity and rights.

Question 2

what is dignity in care?

Answer 2

Respecting someone’s privacy and toward their illness. Being treated as worthy

Question 3

The four principles of health care ethics developed by Tom beauchamp and James Childress in the book of principles of biomedical ethics is used to

Answer 3

Provide medical practitioners with guild-lines to make decisions when they face complicated situations involving patients

Question 4

The four principles of health care ethics are

Answer 4

Autonomy
Beneficence
Non-maleficence
Justice

Question 5

Principles are more of ____ than a precise action guide

Answer 5

General Norms that are open to judgement / basic principles

Question 6

Principle 1: respect for autonomy, explain

Answer 6

Autonomy is self-determination. A medical practitioner cannot impose treatment on an individual for whatever reason. Respect for autonomy requires health professionals to help patients come to their OWN decisions and to respect and follow those decisions

Question 7

Give examples of respecting a persons autonomy

Answer 7

Obtaining informed consent for treatment

Supporting patients treatment choices

Allowing patients to refuse treatments

Disclosing comprehensive and truthful information to patients (to help them decide)

Maintaining privacy and confidentiality

Allowing patients to make an either or choice

Allowing long term hospitalized patients to choose their favourite foods if medically prescribed (patients Choice in mind)

Question 8

CASE

A 30-year old man is involved in a car accident and is brought to the hospital with a head wound bleeding
The patient refuses treatment saying he feels fine and wants to leave.

Are there any limits to patient autonomy?

Answer 8

Patients autonomy is not absolute
- capacity
- necessity
- risk to others

If patients are contagious they have no choice but to stay in isolation due to a risk for others (covid 19)

Question 9

Principle of beneficence refers to

Answer 9

the moral importance of doing good to others (patients) as well as doing what is best for others

Question 10

List the 5 rules of beneficence

(Beneficence: the moral importance of doing good to others (patients) as well as doing what is best for others)

Answer 10

• protect and defend the rights of others
• prevent harm from occurring to others
• remove conditions that will cause harm to others
• help people with disabilities
• rescue people in danger

Question 11

What factors should one consider when ranking the available treatment options

Answer 11

• Will this treatment option resolve this patient’s medical problem?
• Is it proportionate to the scale of the medical problem?
• Is the treatment option compatible with this patient’s
individual circumstances?
• Is the specific option and its outcomes in line with patient’s expectations of treatment?

Question 12

Autonomy vs beneficence

Question 13

CASE continues…

A 30-year old man is involved in a car accident and is brought to the A&E with a head wound bleeding
The patient has been unconscious since the collision and the doctors start with medical examinations and proceed to suture the head wound on the basis of doing what is best for the patient

How do you act

Answer 13

In Emergency Medicine the principle of beneficence is often given priority over the principle of respect for patient autonomy.

Question 14

Principle of non-maleficence states that

Answer 14

Health professionals should AVOID HARM on patients.

HOWEVER most medical treatments have some chance of doing harm (side effects). It does not follow that such treatment should always be avoided (The good out ways the bad). Meaning potential benefits and harms should be compared and weighed

Question 15

Non maleficence & beneficence are the same but different, how?

Answer 15

Beneficence is doing good on others while non maleficence is avoiding harm.

Question 16

CASE

A man collapses in the street complaining of severe acute pain in his right abdomen. A surgeon happens to be passing and examines the man, suspecting that he is about to face rupturing of his appendix. The surgeon decides the best course of action is to remove the man’s appendix right there, using his pen-knife.

What is the beneficence perspective of the case?

Answer 16

successful removal of the appendix in situ would certainly improve the patient’s life. (It does good by the patient)

Question 17

CASE

A man collapses in the street complaining of severe acute pain in his right abdomen. A surgeon happens to be passing and examines the man, suspecting that he is about to face rupturing of his appendix. The surgeon decides the best course of action is to remove the man’s appendix right there, using his pen-knife.

What is the non-maleficence perspective of the case?

Answer 17

• high risk of infection in a non-
sterile environment;
• low chances of a successful operation; no other clinical staff or surgical equipment available; no prior experience of doing an appendectomy at the roadside

Question 18

if you see a patient collapsing in the corridor you have
duty to provide medical attention, this refers to

Answer 18

Beneficence & non-maleficence, a constant standard ion clinical practice

Question 19

Treatments causing more harm than good, should not be considered and with beneficence, we consider all valid treatment options and then prioritise

This shows that non maleficence acts as a

Answer 19

Threshold for treatment

Question 20

Principle of justice involves

Answer 20

Health professionals have to make decisions about distribution of time, money, clinical resources.

Question 21

The principle of justice emphasizes two points, which are?

Answer 21

• Patients in similar situations should have access to the
same healthcare

• In determining what level of care should be available for one set of patients, we must take into account the effect of such use of resources on other patients

Question 22

Justice (pg 25)

Question 23

What is John Rawls theory of justice

Answer 23

Fairness and equality should be evaluated from a
position free of biases as well as equal access to healthcare services

Question 24

Rawls advocated two principles, what are they?

Answer 24

everyone should be given equal liberty regardless of their adversities

differences among people should be recognized by making sure the least-advantaged people are given opportunities for improvement.

Question 25

CASE; conflict between principles

A 40-year woman is diagnosed with cancer
Patients with cancer are prioritised for referral to specialist oncology services. They are entitled to a range of treatments, including radio-therapy, chemotherapy, immuno-therapy. These treatments are expensive and treat a small, but significant proportion of patients.

Where is the conflict of principles?

Answer 25

AUTONOMY - patients have the right to be given access to specialized health services and make treatment decisions for themselves

JUSTICE - allocation of resources; not all treatments can be funded for all patients;
prioritising cancer patients means limiting the ability of other patients to access healthcare

(Principle of justice is compromised)

Question 26

The four principles are non-_____

Answer 26

Hierarchical

Question 27

For ethical clinical reasoning, one may be required to

Answer 27

Take all principles into account when applicable to the clinical case under consideration

Question 28

When 2 or more principles apply, they may

Answer 28

Conflict each other

Question 29

CASE

A patient has an ovarian cyst that, if left untreated, will result in kidney failure. An operation to remove the cyst is the best treatment, but the patient is frightened of needles and is against the surgery that would require a needle to give her anesthesia

How would you apply this under all 4 principles

Answer 29

Autonomy: the patients dislikes need,es and doesn’t want the operation

Beneficence: needs to find a solution that would prevent kidney failure (The best decision is to go ahead with the surgery)

Non-maleficence: forcing the patient to accept the needle might be harmful (not all about physical health but mental/ psychological well being)

Justice: if she starts to go into preventable kidney failure, she’ll need dialysis, this impacts other people who need the same treatment, while she can prevent it in the first place and not need it.

Question 30

Contribution of the four principleles approach

Question 31

Criticisms of the four principle approach

Answer 31

• Strictly adhering to the same principles/guidelines for different situations can be problematic

• the principles are nonspecific, appearing to simply remind the decision maker of considerations that should be taken into account (Gert et al 1997)

• there is no agreed upon method for resolving conflicts when two different principles conflict about what ought to be done

➢The four principles should not be treated as a general moral theory, but rather, they assist in reflecting on moral problems and in moving to an ethical resolution.

Question 32

What are different ways to analyze clinical cases

Answer 32

Four principle approach
Four topics approach
Structures case analysis model

Question 33

What are the main four topics under the four topics approach

Answer 33

Medical indications
Patient references
Quality of life
Contextual features

Question 34

The four topics model is considered when the patient

Answer 34

Refuses treatment

Question 35

List the steps behind the structures case analysis model (page 39)

Question 36

Ethical reasoning

Question 37

What happens if after you have developed ethical arguments related to possible courses of action, it remains difficult to reach a decision over what to do?

Question 38

Why do we need clinical ethics committees

Question 39

Clinical ethics/hospital ethics committees

Question 40

Clinical ethics committees function

Question 41

Freq issues

Question 42

Describe the difference between human, moral and legal rights

Question 43

Outline the concept of dignity in care; when is dignity at risk?

Question 44

Describe the strengths and criticisms of the 4 principles approach

Question 45

Outline the principle of autonomy; why is it important in clinical practice?

Question 46

Outline the principle of beneficence; why is it important in clinical practice?

Question 47

Outline the principle of non-maleficence; why is it important in clinical practice?

Question 48

Outline the principle of justice; why is it important in clinical practice?

Question 49

What is the contribution of clinical ethics committees in resolving ethical dilemmas in healthcare?