Bioethics Flashcards
1
Q
What are the three components of ethics?
A
- Beneficence
- Nonmaleficence
- Autonomy
2
Q
When should palliative care be introduced into a child’s care?
A
- When a child is identified with a life-limiting condition
- Early in the clinical course
- Introduced simultaneously with potentially curative treatments
3
Q
List the principles embodied by contemporary palliative medicine
A
- Relief of suffering
- Focus on quality of living and dying, rather than being limited to end-of-life care
4
Q
Whose responsibility is it to initiate discussions about advance care planning?
A
- Physicians preferable to waiting for families to initiate
5
Q
List the principles to follow when forgoing medically provided nutrition or hydration.
A
- Children capable of safely eating and drinking who show signs of wanting to, should not be withdrawn
- Decisions about it should be based on whether intervention provides net benefits to child
- Focus on best interests of child
- May be withdrawn from a child who permanently lacks awareness and ability to interact with environment
- Can be withdrawn from children when such measures only prolong and add morbidity to process of dying
- Get ethics involved if controversial decisions are being considered
- provide palliative care measures (oral swabs for dry mouth, management of symptoms of pain)
6
Q
What is the dead donor rule?
A
- Requires that potential organ donor be declared brain dead or pronounced somatically dead before organ donation using standard cardiorespiratory criteria
7
Q
Define anencephaly
A
- CNS abnormality that is characterized by congenital absence of forebrain, skull, scalp
- Most die within days/weeks without life-supporting interventions
8
Q
Discuss the issue of organ donation in ancencephalic patients
A
- usually don’t satisfy standard brain death criteria because of adequate brainstem function (spontaneous respirations and HR)
- by the time brain death or somatic death has been declared, organs have undergone ischemic damage, making them unsuitable for transplantation
- use of life support does not improve the chance of successful organ donation from anencephalic infants
- can offer parents information on stem cell and tissue donations (can do these in non-braindead patients)
9
Q
When is genetic testing of a child appropriate?
A
- to confirm a medical diagnosis in a symptomatic infant/child as part of medical care
- medical monitoring, prophylaxis or treatment in a healthy asymptomatic child at risk for a genetic condition
10
Q
List the recommendations regarding genetic testing in a healthy child
A
- parents should be informed of potential psychological and social risks associated with testing (ie. stigmatization, insurance/third party implications)
- best interests of the child should be primary consideration
- for genetic conditions that won’t present until adulthood, defer testing until child is adult and can consent to getting tested or not
- discourage carrier testing unless child able to participate fully in decision to be tested
- genetic testing by a competent, well-informed teen for purpose of reproductive decision making should be considered
- physician not obligated to carry out testing that is not in best interest of child
- adopted kids should not be subjected to genetic testing where there is no timely medical benefit
11
Q
What are the 3 components to informed consent?
A
- Disclosure: Appropriate information provided
- Capacity: Decision-making capacity assessed, able to receive, understand and communicate information and appreciate the effects, alternatives and non treatment, not age or disease related
- Voluntariness: no manipulation or coercion
12
Q
List situations where parents might not be appropriate decision makers for a child or teen
A
- parents lack decision-making capacity
- irresolvable differences between parents regarding the child or teen’s care
- when parents have clearly relinquished responsibility for the child/teen
- when legal guardian has been appointed
