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Professional Development II - DPT 680 > Beneficence & Autonomy > Flashcards

Beneficence & Autonomy Flashcards

1
Q

Relationship-Centered Care:

Three relationships within PT = ?

“Don’t over think”

Beneficence & Autonomy

A

Relationship-Centered Care:

  • Accents the importance of interactions among people as the foundation of any therapeutic activity.
  • These relationships include:
  1. PT and patient (primary relationship).
  2. PT and co-workers / supervisors.
  3. PT and community.
  • Emphasizes concern for patients, sensitivity totheir needs, empathy for their suffering,respect for their rights, and value of health(biopsychosocial).
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2
Q

Four important principles of Biomedical Ethics = ?

Beneficence & Autonomy

A

Principles of Biomedical Ethics:

(1) Beneficence:

  • Promote good of others, besensitive topatients fears/needs related to their care; standards of excellence in care.

(2) Respect for autonomyof patients:

  • Value the self-governance of the patient and use it as a guide when providing services.

(3) Nonmaleficence:

  • Do no harm.

(4) Justice:

  • Treat patients fairly; support fair procedures in health care.
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3
Q

“Acting in the patient’s best interest; being kind” = ?

Beneficence & Autonomy

A

Beneficence:

  • Acting in the patient’s best interest; being kind.
  • Cornerstone motive of professional healthcare
  • “Helping others”
  • This is an obligation for us.

Think:

  • But….. how much help should we give
  • Is there a limit to the obligation we have?
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4
Q

The “Beneficence Continuum” ranges from = ?

Beneficence & Autonomy

A

Beneficence:

In order to define the limits to the obligation, a continuum exists;

The “Beneficence Continuum”: Ranges from Obligation to Supererogation.

(a) Obligation:

  • Strict Obligation:Honesty, don’t steal, don’t kill.
  • Weak Obligation:Remaining civil despite disagreement; don’t cut in line.

(b) Supererogation:

  • Beyond the obligatory;
  • (1.) Optional
  • (2.) They exceed common obligation.
  • (3.) Intentionally undertaken to promote welfare of others.
  • (4.) Morally good and praiseworthy , heroic.
  • Most acts of supererogation do not put people at risk for harm or financial ruin
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5
Q

Specific vs. General Beneficence = ?

Beneficence & Autonomy

A

Beneficence:

(a) Specific Beneficence:

  • Acts performed for family, partners, friends, loved ones.

(b) General Beneficence:

  • Acts performed for strangers,
  • Less intuitive
  • Less well understood
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6
Q

Beneficence Laws:

  • What are they = ?
  • Give one example = ?

Beneficence & Autonomy

A

Beneficence Laws:

  • Most states have Good Samaritan Laws.
  • Protect off duty health care professionals from criminal & civil chargeswith negative outcomes during their attempt to help stranger(s). physicallyinjured or in danger.
  • Laws do not reward beneficence, just prevent misfortune of providers.
  • In most states there is no legal obligation to provide Good Samaritan care.
  • These are not “hero” laws….In no case is a person expected to act if doing so puts him/her in harm’s way.
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7
Q

Why do we do what we do?

  • Craft Motives = ?
  • CompensationMotives = ?
  • Moral concern = ?

Beneficence & Autonomy

A

Professional Motives - Why do we do what we do?:

(a) Craft Motives:

  • Desires to meet the standards of technicalexcellence, as defined by state-of-the-artprofessionalism;
  • Desire to seek creativesolutions to technical problems.

(b) CompensationMotives:

  • Desires to earn a living, have job stability,gain professional recognition, exercisepower and authority, and other primarilyself-oriented desires.

(c) Moral concern:

  • Desires tomeet one’s responsibility and maintainone’s moral integrity;
  • Desires topromote the good of others for their sake.
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8
Q

Medical Paternalism = ?

Beneficence & Autonomy

A

Medical Paternalism:

(a) Paternalism: When someone fails to recognize another individual’s rights and autonomy.

(b) Medical Paternalism: When this practice occurs in the medical field.

  • Old / past practice and mentality.
  • Health care provider had authority to make treatment decisions on behalfof their patient.
  • This occurred regardless of whether the patient provided consent.
  • becausethe physician knew ‘what was best’

Notes:

  • This practice is declining dramatically and moving toward an emphasis on respect for autonomy.
  • Currently used in cases of emergency (unless DNR order).
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9
Q

____ requires that the wishes of competent individuals must be honored.

Beneficence & Autonomy

A

Respect for Autonomy:

(a) Autonomy: Self-determination

  • Autonomy requires that the wishes of competent individuals must be honored.
  • We have the responsibility to respect autonomy / self determination of each person.
  • Locates control with the patient or designated representative rather thanthe provider.
    • Pilot/co-pilot

“No principle is more important to health-care ethics, or indeed to allprofessional ethics”

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10
Q

Duties of Autonomy include = ?

Beneficence & Autonomy

A

Duties of Autonomy include:

  • Informed consent
  • Veracity (Honesty/Truth telling)
  • Confidentiality (privacy)
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11
Q

Failure to obtain informed consent can result in = ?

Beneficence & Autonomy

A

Failure to Obtain Informed Consent:

  • Failure to obtain informed consent is considered a form of helathcare malpratice.
  • Equates to substandard care which is the essence of health care negligence.
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11
Q

Informed Consent = ?

Beneficence & Autonomy

A

Informed Consent:

  • Patient right to know, accept and / or refuse intervention.
  • Is one of the most important ethical and legal issues for health care professionals.
  • This is an ongoing interaction with patients, not just at eval or beginning of eachsession, but throughout sessionsand plan of care.

Notes:

  • Is paramount for the ethical principle of autonomy.
  • This isn’t just a signature on the intake forms.
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12
Q

For patients to give informed consent, what three conditions mustbe met = ?

Beneficence & Autonomy

A

For patients to give informed consent, 3 conditions mustbe met:

(1) Information:

  • Patients must be givenrelevant informationregarding their condition and treatment options in amanner they can understand to allow them an informed decision.

(2) Competence:

  • Patient must be sufficiently rational or competent to understand and makehealth-care decisions.

(3) ** Voluntariness**:

  • Patients must be free to make decisions without being coerced, intimidated or otherwisemanipulated.
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13
Q

Informed Consent - (1) Information:

  • The information should include a clear explanation of = ?

Big list

Beneficence & Autonomy

A

Informed Consent - Information:

(a) The information should include a clear explanation of:

  • The planned examination/assessment.
  • The evaluation, diagnosis and prognosis/plan.
  • The intervention/treatment to be provided.
  • The risks which may be associated with the intervention.
  • The expected benefits of the intervention (includes discussing the goals with the patient).
  • The anticipated time frames.
  • The anticipated costs.
  • Any reasonable alternatives to the recommended intervention.
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14
Q

Informed Consent - (2) Competence:

  • Legal competency = ?

Beneficence & Autonomy

A

Informed Consent - Competence:

(a) Patient must be sufficiently rational or competent to understand and makehealth-care decisions.

(b) Legal Competency:

  • A person must have some threshold of substantial decision making capacity to be allowed to make health care decisions.
  • Individuals 18years or older are presumed competent until courts declare otherwise.

(c) When the patient is not deemed competent or when the patient is a minor, a legal guardian or advocate may act as surrogate decision maker.

  • Is often a spouse, close relative, durable power of attorney (DPOA)
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15
Q

Informed Consent - (3) Voluntariness:

  • Violations may include = ?

Beneficence & Autonomy

A

Informed Consent - Voluntariness:

(a) Patients must be free to make decisions without being coerced, intimidated or otherwisemanipulated.

(b) Violations may include:

  • Lying, intentionally misleading the patient, withholding information, exaggerating.
  • Subtle threats or emotional manipulation.
  • Physically forcing therapy on someone against their explicit desires.
    • May constitute battery (I.g. ROM without consent).

(c) Fine line between substandard care and patient refusal.

16
Q

A “Spectrum” of Strategies/Encouragements:

  • Persuasion = ?
  • Inducements = ?
  • Interpersonal leverage = ?
  • Threats = ?
  • Compulsion = ?

Beneficence & Autonomy

A

A “Spectrum” of Strategies/Encouragements:

(1) Persuasion:

  • Educating the patient of risks/benefits of proposed treatment and maybe patient will be more inclined to accept the treatment.
  • Is the most ethical strategy to get a patient to participate.
  • Respects autonomy and patient decision making.
    • E.g. “You need to get up today; walking can help reduce risk for a blood clot”

(2) Inducements:

  • Offering the patient an “incentive” to cooperate.
  • Is usually ethically acceptable – but maybe infantilizes an adult patient.
  • E.g. “If you walk to the door and back I’ll get you a Coke”

(3) Interpersonal leverage:

  • Takes advantage of the trusting relationship we have with patients to pressure them.
  • More problematic from an ethical standpoint; can be manipulative.
  • E.g. “I counted on you to not let me down, Mrs. Scott; I’m disappointed in you…”

(4) Threats:

  • Coercive statements; threats that the patient will be worse off if they don’t adhere.
  • Ethically more problematic.
  • E.g. “If you don’t get out of bed today I’ll make sure you don’t get any further PT services”

(5) Compulsion:

  • Overriding a patient’s express wishes
    Is the most ethically problematic treatment pressure.
    E.g. Two people physically pulling a competent patient out of bed after she has refused.
    Can be considered assault/battery
17
Q

Patient Self-Determination Act = ?

Beneficence & Autonomy

A

Patient Self-Determination Act:

  • Is a federal law to ensure that a patient’s right to self-determination in health care decisions be communicated and protected.
  • Requires that hospitals, long term care facilities and other health organizations participating in Medicare and Medicaid inform patients of their right to accept/refuse treatment.
  • Includes the right to control theuse of extraordinary treatment measures, suchas artificial lifesupport.
18
Q

If a patient refuses treatment, what should we do = ?

We = Physical Therapist

Beneficence & Autonomy

A

Refusal of Treatment:

  • If a patient refuses treatment, this fact and asummarization of the “informed refusal”prevention measures used on the patient’sbehalf should be well documented.
  • Theclinician is legally and ethically responsible tocoordinate with any referring health careprofessional about the patient’s refusal ofcare.
  • Show beneficence - patient’s best interests
  • Respect patient autonomy
19
Q
  • Durable Power of Attorney
  • Living Will
  • Do Not Resuscitate (DNR)

Are examples of = ?

Beneficence & Autonomy

A

Common Advance Directives:

(a) Legal documents that provide instructions for medical care, that only go into effect if the patient cannot communicate their wishes.

(b) Common Advance Directives:

(1) Durable Power of Attorney:

  • A type of advance directive in which you name another person to make health care decisions for you in the event that you are unable to do so.
  • Can be a spouse, family member, clergy member, attorney, medical advocate…

(2) Living Will:

  • A legal document used to state certain future health care decisions in case you become unable to make the decisions/choices on your own.
  • Used only at the end of life.
  • Describes what type of medical treatment you would want/not want to receive.
  • Includes the use of dialysis, feeding tubes, life support, organ donation after death, Do Not Resuscitate (DNR) orders.

(3) Do Not Resuscitate (DNR):

  • Written directives to health careprofessionals that preclude the otherwiseautomatic initiation of CPR efforts in the event ofpatient cardiorespiratory arrest.
  • Needs to be at the request of a competent patient
  • Or, at the request of a properly designated durable power of attorney for healthcare decision making.
20
Q

Euthanasia:

  • What is it = ?
  • Three Types = ?

Beneficence & Autonomy

A

Euthanasia:

  • “Good” or “easy” death; is the intentional ending of one person’s life by another, motivated solely by the best interest of the person who dies.
  • Most often patients terminally ill or a persistent vegetative state.

Types:

(1) Passive:

  • Intentionally letting a patient die by withholding/withdrawing artificial life support such as ventilator or feeding tube; “let the patient die”.

(2) Active:

  • Involves deliberate intervention by health careproviders that facilitate or cause patients’ deathin ordertorelieve patient pain andsuffering. (sometimes called “aggressive” euthanasia).

(3) Physician-assisted suicide:

  • The physician provides the means, but the patientactually administersthemeans of death (not the same as euthanasia) usually bymeans of lethalmedication.
  • Currently legal in about 10 states.
21
Q

Veracity = ?

Beneficence & Autonomy

A

Veracity:

  • The duty to tell the truth = principle of truthfulness, honesty, or veracity.
  • Truth is expected in fiduciary relationships (trust) in health careproviders.
  • Transparency!!!!
  • Applies to patient and provider relationships;colleagues / co-workers; employees and employers.
  • Truth telling includes reporting medical errors.

Failure to tell the truth:

  • Generates badconsequences, violates patient rights to truth, manifests dishonesty.
22
Q

The duty to maintain the privacy of informationconcerning patientsby not disclosing it to unauthorized persons = ?

Beneficence & Autonomy

A

Confidentiality:

(a) We have a duty to maintainconfidentiality:

  • The duty to maintain the privacy of informationconcerning patientsby not disclosing it to unauthorized persons.
  • Divulging medical information on a “need-to-know” basis.

(b) Includes all information about patientsobtained during professional interactions with them.

(c) Violations can result in civil lawsuits for invading privacy, emotional distress;license could be at risk.

23
Q

HIPPA ensures = ?

Beneficence & Autonomy

A

Confidentiality:

  • Health and Insurance Portability and Accountability Act(HIPAA) regulations.
  • HIPPA ensures patients their legal rights to privacy, accessto examine their records.
  • HIPPA forbidsdisclosure of their medicalrecords without their consent, as well as limited access toother health care professionals without need-to-know.
  • Is a Federal Statute
  • Enforced by licensing board and Joint Commission.
24
Q

Confidentiality:

  • Two justifiable exceptions = ?

Beneficence & Autonomy

A

Confidentiality - Exceptions:

  1. Medical records may be ordered by the courts in criminal investigations.
  2. Health care workers must report; (see lecture on mandatory reporting).

Professional Development II - DPT 680 (14 decks)

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