Bioethics Flashcards
Declaration of geneva
WMA ethics unit:
•excerside independent professional judgement
•maintain highest standards of profesional conduct
•deal honestly with patients and colleagues
•report to authorities those physicians who paractice unethically, incompetently, or engage in fraud or deception
•certifiy only that which he/she has personally verified
•give patients complete loyalty and all scietific resourses available
Cognitive Competencies
- Knowledge
- Information Management
- application of information to real life situations
- use of tacit knowledge and personal experience
- recognition of gaps in one’s knowledge
- self directed acquisitoin of new knowledge through questions and other means
- awareness of, and ability to make adjustments for, biases that affect knowledge
Integrative competencies
- application of scientific, clinical, and ethical information
- use of logic and reasoning strategies
- linking of interdisciplinary adn clinical knowledge
- managing uncertainty
- critical reflection about fallacies
Relational Competencies
- communication skills
- handling conflict
- teamwork
- teaching others
Moral Competencies
- attentiveness
- curiosity
- awareness of emotion
- recognition of, and response to, their own biases
- readiness to acknowledge and correct others
Types of competencies:
cognitive, integrative, relational, moral
Informatics
science of processing data for strage and tretieval
Distance Medicine
provision of healthcare services, clinical information, and/or education of distance and time using ICT
ICT
information communication technology
Female risk of alcohol abuse
> 7 drinks per week or 3 per occasion
Male risk of alcohol abuse
> 14 drinks per week or 4 drinks per occasion
Med student alcohol statistics
10% >20 drinks/week during med school 25% abusing alcohol when they start 32% by graduation reporting on impairment usually 7 yrs after graduation avg age on referral 44
Fallacies
Tradition, popularity, authority, silence, attack
More to medcial school than grades
Gregory lopez–>shift in thinking, not about tests, about future pts, interpersonal skills, professionalism and Mel rosenfeld–>don’t know what future will be like, critical thinking
Doc i need a smart pill
dan larriviere–>up to the doctor, patient-physician relationship
imparied resident
erin egan–>duty to report, threat to pt care?, look for advice
dewitt c baldwin–>whats going on?, depression, treatment
Ethics
deals with how we outh to behave. means of examining and understanding what is right and wrong, good and bad, moral and immoral. seeks to define and understand morality
Morality
conforming to accepted rules and standards guiding human behavior. reflects what given society defines and morally acceptable
Law
enacted or customary rule enjoining or prohibiting certain actions. integrated with but distinct from morality and ethics. typically enforce moral values of their society
PHILOSOPHY
use of reason adn argument ins seeking truth and knowledge or reality, especially causes and nature of things
cultural competency
requires drs to deliever idividualized pt centered care
culturally competen students and drs must
reflect on and recognise own cultural beliefs, ask pts about their beliefs about health and disease, develop communication skills to improve pt compliance and outcomes, acknowledge adn respond to health disparities
Principalism
using bioethics principles to analyse and negotiate dilemmas
Principles
- Respect for persons
- beneficence
- nonmaleficence
- utility
- justice
respect for persons
foundation of doctor-pt relationship, decisions in light of each pt’s wishes, needs adn lifestyles; dignity; autonomy; veracity; fidelity; avoidance of killing; informed consent; privacy; confidentiality
Limits: harm principle, paternalism, loss of capacity
Beneficence
concerned with with pt’s best interest–>palliative care and pain management
Utility
combines beneficence and nonmaleficence to encourage actions that produce net good adn minimize net harm
pt and social utility
Justice
an action or situation is just if it is fair, equitable, adn appropriate in light of what is due or owed to persons
one who has a valid claim based in justice has a right and is therefore due something; injustice involves wrongful acto ro omission that denies people benefits to which they have a right or fails to distribut burdens fairly
utilitarian theory
uses divers criteria to maximize public utility
libertarian theory
emphasizes rights to social and economic liberty and is concerned more with fair procedures than outcomes
communitarian theory
considers the evolution of priniples and practices of justice in communities
egalitarian theory
suppors equal access to goods that that every rational person would value
procedural justice
concerned with fairness of law and policy
distributive justice
concerned with the criteria for how risks, benefits, arms, rights, and responsibilities are distributed
social justice
based on priniple of equality adn on human rights and dignity
refual of care “but doctor I want to go home”
carrese 2006–>respect autonomy but try to convince them with different framing
treatemtn of sickle cell pain
zempsky 2009–>SCD pain study, more pain, give them meds
what’s in a number
weisberg 2012–>pain measuring
treating sickle cell pain like cancer pain
brookoof and polomano 2002–>more meds
reasonable person standard
drs should give pts all information a reasonable person would want to know for informed consent
Elements of informed consent
- decision making capacity
- disclosure
- understanding
- voluntariness
- authorization*
excpetions to informed consent
- practicing on dead bodies
- emergencies
deontological theory
some things are inherently morally wrong, moral worth stems from reason, reason enables one to recognizes adn do ones duties, moral duties are categorical imperatives that apply to everyone everywhere regardless of context and override self interest
value of human life centers on dignity which stems from rationality adn autonomy, ephasizes justice
consequential/utility theory
maximize goodness/happiness, minimize harm; places superogatory demands on everyone; aligned with the principle of utility
virtue theory
actions can be morally right or good if they exemplify virtuous traits, but that actions are not inherently virtuous simply by conforming to some moral rule, deals wieth intentions and character (not rules and outcomes)
bioethics theories
suppositions or systems of ideas that explain someting and are often based on principles
character
collective qualities or traits taht distinguish a person, like moral strength and reputation
CRAP
Currency, Reliability, Authority, Purpose
Euthanasia
painlessly killing or permitting death of individuals who are ill or injured beyond hope of recovery
Voluntary active euthanasia
hastening one’s own eath by use of drugs or other means with a doctor’s direct assistance
passive euthanasia
hastening death by withdrawing life-sustaining treatment and letting nature take its course
involuntary euthanasia
causing or hastening the death of someone who has not asked for assistance with dying such as a pt who has lost consciousness and is unlikely to regain it
physician-assisted death
physician providing the means for a patient to end his own life, usually barbituate script, pt thatkes themselves
traditional goals of medicine
saving life, curing disease, relieving suffering and promoting health
modern goals of medicine
prevent disease and injury, promote and maintain health, relieve pain and suffering, care for and about patients including those one can’t cure, avoid premature death, pursue a peaceful death for patients
abortion reading
conservative: don marquis–>abortion is wrong the same as killing, deprives victim of a valuable future (future like ours)
liberal: judith thomson–>fetus doesn’t necessarily have the right to jsue the pregnant woman’s body; margret little–>not murder, but not necessarily moral, wrong to have a child when they are not capable of being good mothers
moderate: zygoe≠human, but late-gestation fetus is virtuallly identical to a born infant, early abortions better than late ones
therapeutic misconception
belief that a drug or treatement is efficacious when it has not been conclusively proven to do so
therapeutic misrepresentation
implying that a drug or treatment is efficacious knowing that it has not conclusively been proven to be so
Declaration of Helsinki
well-being of the human subject should take precedence of the interest of science and society
nuremburg code
voluntary consent is essential
belmont report
response to tuskegee—>IRBs
requirements for medical research
- provids accurate and meaningful data
- utilizes fair subject selection
- maintains a favorable benefit to arm ratio for participants
- upholds respect for persons
- obtains each element of informed consent
- ensures voluntariness of participants
- undergoes ethical review and IRB approval
