Behavioral Science- Ethics Flashcards
Name the four ethical principles
- Respect patient autonomy
- Beneficence
- Nonmaleficience
- Justice
Define: Respect patient autonomy
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
Define: Beneficence
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).
Define: Nonmaleficence
“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)
Define: Justice
To treat persons fairly and equitably. This does not always imply equally
Define: Informed consent
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.
Can patients revoke written consent orally?
Yup
Name the exceptions of informed consent
- Patient lacks decision-making capacity or is legally incompetent
- Implied consent in an emergency
- Therapeutic privilege- withholding information when disclosure would severely harm the patient or undermine informed decision-making capacity
- Waiver- patient explicity waives the right of informed consent
How do you get consent for minors?
A minor is generally any person under 18 years of age. Usually you have to get parental consent
Name three situations in which parental consent is usually not required
Sex- contraception, STDs, pregnancy
Drugs- addiction
Rock and Roll- emergency and trauma
Define: Decision-making capacity
Physician must determine whether the patient is psychologically and legally capable of making a particular health care decision.
Name the components of decision-making capacity
- Patient is 18y or older or emancipated
- Patient makes and communicates a choice
- Patient is informed
- Decision remains stable over time
- Decision is consistent with patient’s values and goals, not clouded by a mood disorder
- Decision is not a result of delusions or hallucinations
What are advanced directives?
Instructions given by a patient in anticipation of the need for a medical decision. Vary by state law
What is an oral advance directive?
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.
What is a living will?
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.
What is medical power of attorney?
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
What is a surrogate decision-maker?
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.
What is confidentiality?
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.
What are some general principles for exceptions to confidentiality?
- Potential physical harm to others is serious and imminent
- Likelihood of harm to self is great
- No alternative means exists to warn or to protect those at risk
- Physicians can take steps to prevent harm
True or False: An exception to confidentiality is informing people at risk of reportable diseases like STDs or food poisoning
True. Some other exceptions are child and/or elder abuse, impaired automobile drivers, and suicidal/homocidal patients
What is Tarasoff decision?
A California Supreme Court decision requiring physician to directly inform and protect potential victim from harm
Please give the appropriate response for the following situation: Patient is not adherent.
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
Please give the appropriate response for the following situation: Patient desires an unnecessary procedure.
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
Please give the appropriate response for the following situation: Patient has difficulty taking medications.
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.
Please give the appropriate response for the following situation: Family members ask for information about patient’s prognosis
Avoid discussing issues with relatives without the permission of the patient.
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.”
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
Please give the appropriate response for the following situation: A child wishes to know more about his/her illness.
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
Please give the appropriate response for the following situation: A 17-year-old girl is pregnant and requests an abortion.
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
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
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
Please give the appropriate response for the following situation: A terminally ill patient requests physician assistance in ending own life
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
Please give the appropriate response for the following situation: Patient is suicidal
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
Please give the appropriate response for the following situation: Patient states that he/she finds you attractive
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
Please give the appropriate response for the following situation: A woman who had a mastectomy say she now feels “ugly”
Find out why the patient feels this way. Do not offer falsely reassuring statements like “You still look good”
Please give the appropriate response for the following situation: Patient is angry about the amount of time he/she spent in the waiting room
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.
Please give the appropriate response for the following situation: Patient is upset with the way he/she was treated by another doctor
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.
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
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.
Please give the appropriate response for the following situation: A physician orders an invasive test for the wrong patient
No matter how serious or trivial a medical error, a physician is ethically obligated to inform a patient that a mistake has been made
Please give the appropriate response for the following situation: A patient requires a treatment not covered by his/her insurance
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
