Bioethics

Question 1

What ethical principles are often involved in medical education?

Answer 1

1. Truth telling2. Informed consent3. Respect for persons4. Confidentiality5. Distributive justice

Question 2

A parent refuses to have medical trainees involved in the care of their child. They are adamant. How do you approach this?

Answer 2

Respect their wishes and tell them that they have a right to make such a request but should make sure they clearly understand the implications and limits of this refusal since trainees play a critical role in in house and on call coverage

Question 3

What are the ethical principles that underlie advance care planning? (3)

Answer 3

1. Respect for autonomy2. Beneficence3. Nonmaleficence

Question 4

What are the 3 categories of decision-making capacity that pediatric patients may fall into?

Answer 4

1. Incapable of consent2. Developing capacity for consent3. Fully capable of consent

Question 5

What is the stipulated legal age for advance directives in most provinces?

Answer 5

16 yo

Question 6

What are important questions to ask in preparing an advance care plan? (5)

Answer 6

1. What is your understanding of your/your child’s illness? How do you expect it to progress?2. What is the most important thing for you? Management of pain? Relief of breathlessness? Being at home or with family?3. If you/your child would not be able to go home if treated, would you rather not have the treatment?4. What are your expectations about the goals of care for you/your child?5. What treatments do you want or do not want for yourself/your child?

Question 7

State the difference between full DNR order vs. limited DNR order?-what comfort measures can be included in an advanced care directive?

Answer 7

-Full DNR order = “in the event of a cardiac arrest, no resuscitative efforts will be attempted.”-A limited DNR order = “in the event of a cardiac arrest, the following limited resuscitative efforts may be attempted:-bag mask ventilation?-chest compressions?-resuscitative medications?-intubation and mechanical ventilation?-inotropes?-dialysis?-artificial nutrition and/or hydration?-antibiotics?-transfusions?-suctioning?-Oxygen?Comfort measures: oral fluids, opioid analgesia, medications for breathlessness*****Need to make sure parents know that this advanced care directive is REVERSIBLE AT ANY TIME and it is not set in stone!

Question 8

What are the ethical principles impacting research in children? (5)

Answer 8

1. Beneficence: applying evidence-based care generated from research specific to children2. Nonmaleficence: avoiding harmful therapies extrapolated from adult patient data or experience3. Distributive justice: allowing research benefits to be available to all populations4. Respect for informed consent: supporting developing autonomy in children considering research participation5. Respect for privacy and confidentiality: providing confidentiality within the limits of legal requirements

Question 9

What are the contributors to the lack of child-focused research? (5)

Answer 9

1. Protectionist attitude of some individuals2. Financial disincentive since it’s a small population and bringing to market new drugs or drug indications is costly3. Difficulty in recruiting adequate numbers for rare diseases4. Fewer researchers5. Limited funding sources

Question 10

What are the 3 main elements of informed consent?

Answer 10

1. Adequate information2. Voluntariness3. Capacity to understand the information

Question 11

What is “assent”?

Answer 11

Concept of providing agreement to participation in research where full consent is not possible due to compromise of one of the 3 main elements of consent (adequate information, voluntariness, capacity to understand the information)

Question 12

What are the types of conflicts of interest? (3)

Answer 12

1. Financial2. Academic: promotion or tenure based on productivity, stature based on publication impact scores, etc.3. Personal: research results supporting an ideology or preconceived conclusions, recruitment of own patients to research

Question 13

What are the two phases of drug development?

Answer 13

1. Phase I: experimental models in tissue culture or animals to humans, focused on establishing safety profiles and toxicity information of new drugs in patients with advanced disease for which there is no effective treatment2. Phase II: applies drugs in doses that are found to be reasonably safe to determine a preliminary assessment of potential efficacy again in patients with advanced disease

Question 14

What is the definition of anencephaly?

Answer 14

Congenital absence of forebrain, skull and scalp-functioning brainstem is usually present-most encephalic infants die within days or weeks without life-supporting interventions

Question 15

What are the problems with using anencephalic infants as organ donors? (3)

Answer 15

1. Anencephalic infants usually have intact brainstem functioning and thus intact spontaneous respirations and heart rate; thus do not satisfy standard brain death criteria 2. By the time brain death or somatic death has been declared, the organs have undergone ischemic damage3. Use of life support does not improve the chance of successful organ donation since there’s still organ failure as the brainstem functiond eteriorates

Question 16

What are the recommendations on use of anencephalic newborns as organ donors?

Answer 16

WE SHOULD NOT DO IT!-shouldn’t even use medical therapy or mechanical ventilation to maintain organ function pending the declaration of death in these infants

Question 17

What is the difference between substitute decision makers vs. surrogates?

Answer 17

Substitutes: know the patient so well that they have already discussed with the patient what he or she would want! They are subbing for the patient and promoting the patient’s expressed wishes-surrogate decision makers: do not know what the patient would want done and are thus charged to decide in the best interests of the patient (ie. think surrogate mom who is having the pregnancy for the person because the person can’t do it themselves)