Behavioral Science- Ethics

Question 1

Name the four ethical principles

Answer 1

1. Respect patient autonomy
2. Beneficence
3. Nonmaleficience
4. Justice

Question 2

Define: Respect patient autonomy

Answer 2

Obligation to respect patients as individuals (telling the truth and confidentiality), to create conditions necessary for autonomous choice (informed consent), and honor their preference in accepting or not accepting medical care

Question 3

Define: Beneficence

Answer 3

Physicians have a special ethical (fiduciary) duty to act in the patient’s best interest. May conflict with autonomy (an informed patient has the right to decide) or what is best for society (traditionally patient interest supersedes).

Question 4

Define: Nonmaleficence

Answer 4

“Do no harm”. Must be balanced against beneficence; if the benefits outweigh the risk, a patient may make an informed decision to proceed (most surgeries and medicaltion fall into this category)

Question 5

Define: Justice

Answer 5

To treat persons fairly and equitably. This does not always imply equally

Question 6

Define: Informed consent

Answer 6

A process (not just a document/signature) that legally requires:
1. Disclosure: discussion of pertinent information
2. Understanding: ability to comprehend
3. Mental Capacity: unless incompetent (legal determination)
4. Voluntariness: freedom from coercion and manipulation
Patients must have an intelligent understanding of their diagnosis and the risks/benefits of proposed treatment and alternative options, including no treatment.

Question 7

Can patients revoke written consent orally?

Answer 7

Yup

Question 8

Name the exceptions of informed consent

Answer 8

1. Patient lacks decision-making capacity or is legally incompetent
2. Implied consent in an emergency
3. Therapeutic privilege- withholding information when disclosure would severely harm the patient or undermine informed decision-making capacity
4. Waiver- patient explicity waives the right of informed consent

Question 9

How do you get consent for minors?

Answer 9

A minor is generally any person under 18 years of age. Usually you have to get parental consent

Question 10

Name three situations in which parental consent is usually not required

Answer 10

Sex- contraception, STDs, pregnancy
Drugs- addiction
Rock and Roll- emergency and trauma

Question 11

Define: Decision-making capacity

Answer 11

Physician must determine whether the patient is psychologically and legally capable of making a particular health care decision.

Question 12

Name the components of decision-making capacity

Answer 12

1. Patient is 18y or older or emancipated
2. Patient makes and communicates a choice
3. Patient is informed
4. Decision remains stable over time
5. Decision is consistent with patient’s values and goals, not clouded by a mood disorder
6. Decision is not a result of delusions or hallucinations

Question 13

What are advanced directives?

Answer 13

Instructions given by a patient in anticipation of the need for a medical decision. Vary by state law

Question 14

What is an oral advance directive?

Answer 14

Incapacitated patient’s prior oral statements commonly used as guide. Problems arise from variance in interpretation. If patient was informed, directive was specific, patient made a choice, and decision was repeated over time to multiple people, the oral directive is more valid.

Question 15

What is a living will?

Answer 15

Describes treatments the patient wishes to receive or not receive if he/she loses decision-making capacity. Usually, patient directs physician to withhold or withdraw life-sustaining treatment if he/she develops a terminal disease or enters a persistent vegetative state.

Question 16

What is medical power of attorney?

Answer 16

Patient designates an agent to make medical decisions in the event that he/she loses decision-making capacity. Patient may also specify decisions in clinical situations. Can be revoked anytime patient wishes (regardless of competence). More flexible than a living will

Question 17

What is a surrogate decision-maker?

Answer 17

If an incompetent patient has not prepared an advance directive, individuals (surrogates) who know the patient must determine what the patient would have done if he/she were competent. Priority of surrogates: spouse, adult children, parent, adult siblings, other relatives.

Question 18

What is confidentiality?

Answer 18

Confidentiality respects patient privacy and autonomy. If patient is not present or is incapacitate, disclosing information to family and friends should be guided by professional judgement of patient’s best interest. The patient may voluntarily waive the right to confidentiality.

Question 19

What are some general principles for exceptions to confidentiality?

Answer 19

1. Potential physical harm to others is serious and imminent
2. Likelihood of harm to self is great
3. No alternative means exists to warn or to protect those at risk
4. Physicians can take steps to prevent harm

Question 20

True or False: An exception to confidentiality is informing people at risk of reportable diseases like STDs or food poisoning

Answer 20

True. Some other exceptions are child and/or elder abuse, impaired automobile drivers, and suicidal/homocidal patients

Question 21

What is Tarasoff decision?

Answer 21

A California Supreme Court decision requiring physician to directly inform and protect potential victim from harm

Question 22

Please give the appropriate response for the following situation: Patient is not adherent.

Answer 22

Attempt to identify the reason for nonadherence and determine his/her willingness to change; do not coerce the patient into adhering or refer him/her to another physician

Question 23

Please give the appropriate response for the following situation: Patient desires an unnecessary procedure.

Answer 23

Attempt to understand why the patient wants the procedure and address underlying concerns. Do not refuse to see the patient or refer him/her to another physician. Avoid performing unnecessary procedures

Question 24

Please give the appropriate response for the following situation: Patient has difficulty taking medications.

Answer 24

Provide written instructions; attempt to simplify treatment regimens; use teach-back method (ask patient to repeat medication regimen back to physician) to ensure patient comprehension.

Question 25

Please give the appropriate response for the following situation: Family members ask for information about patient’s prognosis

Answer 25

Avoid discussing issues with relatives without the permission of the patient.

Question 26

Please give the appropriate response for the following situation: A patient’s family member asks you not to disclose the results of a test if the prognosis is poor because the patient will be “unable to handle it.”

Answer 26

Attempt to identify why the family member believes such information would be detrimental to the patient’s condition. Explain that as long as the patient has decision-making capacity and does not indicate otherwise, communication of information concerning his/her care will not be withheld

Question 27

Please give the appropriate response for the following situation: A child wishes to know more about his/her illness.

Answer 27

Ask what the parents have told the child about his/her illness. Parents of a child decide what information can be relayed about the illness

Question 28

Please give the appropriate response for the following situation: A 17-year-old girl is pregnant and requests an abortion.

Answer 28

Many states require parental notification or consent for minors for an abortion. Unless she is at medical risk, do not advise a patient to have an abortion regardless of her age or the condition of the fetus

Question 29

Please give the appropriate response for the following situation: A 15-year-old girl is pregnant and wants to keep the child. Her parents want you to tell her to give the child up for adoption

Answer 29

The patient retains the right to make decisions regarding her child, even if her parents disagree. Provide information to the teenager about the practical issues of caring for a baby. Discuss the options, if requested. Encourage discussion between the teenager and her parents to reach the best decisions

Question 30

Please give the appropriate response for the following situation: A terminally ill patient requests physician assistance in ending own life

Answer 30

In the overwhelming majority of states. refuse involvement in any form of physician-assisted suicide. Physician may, however, prescribe medically appropriate analgesics that coincidentally shorten the patient’s life

Question 31

Please give the appropriate response for the following situation: Patient is suicidal

Answer 31

Assess the seriousness of the threat; if it is serious, suggest that the patient remain in the hospital voluntarily; patient can be hospitalized involuntarily if he/she refuses

Question 32

Please give the appropriate response for the following situation: Patient states that he/she finds you attractive

Answer 32

Ask directly, closed-ended questions and use a chaperone if necessary. Romantic relationships with patients are never appropriate. Never say, “There can be no relationship while you are a patient,” because this implies that a relationship may be possible if the individual is no longer a patient

Question 33

Please give the appropriate response for the following situation: A woman who had a mastectomy say she now feels “ugly”

Answer 33

Find out why the patient feels this way. Do not offer falsely reassuring statements like “You still look good”

Question 34

Please give the appropriate response for the following situation: Patient is angry about the amount of time he/she spent in the waiting room

Answer 34

Acknowledge the patient’s anger, but do not take a patient’s anger personally. Apologize for any inconvenience. Stay away from efforts to explain the delay.

Question 35

Please give the appropriate response for the following situation: Patient is upset with the way he/she was treated by another doctor

Answer 35

Suggest that the patient speak directly to that physician regarding his/her concerns. If the problem is with a member of the office staff, tell the patient you will speak to that person.

Question 36

Please give the appropriate response for the following situation: A drug company offers a “referral fee” for every patient a physician enrolls in a study

Answer 36

Eligible patients who may benefit from the study may be enrolled, but it is never acceptable for a physician to receive compensation from a drug company. Patients must be told about the existence of a referral fee.

Question 37

Please give the appropriate response for the following situation: A physician orders an invasive test for the wrong patient

Answer 37

No matter how serious or trivial a medical error, a physician is ethically obligated to inform a patient that a mistake has been made

Question 38

Please give the appropriate response for the following situation: A patient requires a treatment not covered by his/her insurance

Answer 38

never limit or deny care because of the expense in time or money. Discuss all treatment options with patients, even if some are not covered by their insurance companies