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Medical Ethics > Common ethical issues > Flashcards

Common ethical issues Flashcards

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USMLE® Step 1 flashcards
1
Q

What is curing?

A

The alleiation of symptoms of the termination or suppresion of a disease process

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2
Q

What is healing?

A

A gradual awakening to a deeper sense of self in a way that effects profound change

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3
Q

Why is end of life care talked about more now?

A

Technology

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4
Q

What are the four paradigms of dying in our culture today?

A
  1. Death is a natural part of life
  2. The medicalizatinon of dying
  3. Palliative medicine/hospice
  4. Death on demand
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5
Q

What are the four conclusions of the SUPPORT study?

A
  1. poor symptom management
  2. Inconsistent with patient preferences and values
  3. Problematic communication and decision making
  4. Life-prolonging, intensive treatments vs palliative care
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6
Q

What is the first question to ask for a patient at the end of life?

A

What are their goals

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7
Q

Is technology neutral or the cause of end of life issues?

A

Neutral–it’s how we use it

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8
Q

When evaluating modalities of treatment, what five things must be assessed?

A
  1. Risks
  2. benefits
  3. burdens
  4. probability
  5. harm
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9
Q

What is the recommended method of feeding patients with end stage dementia?

A

oral assistance

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10
Q

What are the steps of the “goals of care” conversation?

A
  1. Review situation
  2. Asscess decision maker’s understanding
  3. Establish goals
  4. Present options
  5. Weigh risks/benefits
  6. Measure effects of decision on loved ones
  7. Off additional resources
  8. Provide ongoing support
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11
Q

What does 6-6-6-6 thing mean?

A

What was person like 6 month, weeks, days, hours ago

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12
Q

What are the three questions that shold be asked when withholding/withdrawing resuscitation?

A
  1. Avoid death?
  2. Prolong life?
  3. Define success
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13
Q

What is the difference between euthanasia and physician assisted suicide?

A 
Euthanasia = dr kills
Assisted = dr supplies means
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14
Q

Are euthanasia or physician assissted suicide legal in the U.S.?

A

Euthanasia, no

PAS = in some states

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15
Q

What is non-voluntary euthanasia?

A

Pt did not consent or request death

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16
Q

What is passive euthanasia?

A

Erroneuous term, that means to let pt die

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17
Q

What are the ethical cons of euthanasia in terms of social justice?

A

May devalue marginalized

18
Q

What are the three established practices of euthanasia?

A
  1. Voluntary, informed refusal of treatment by pt
  2. Withhold/withdraw based on best interests
  3. Palliative and hospice care
19
Q

What are the four controversial issues in terms of euthanasia?

A
  1. Voluntarily stopping intake
  2. Palliative sedation
  3. PAS
  4. Pt/surrogate demand futile therapies
20
Q

Does the use of opioids hasten death?

A

No–breathing happens long after earlier symptoms develop

21
Q

What are the four principles of double effect?

A
  1. Nature of the act
  2. Agent’s intentions
  3. Distinction between means and effects
  4. Proportionality b/t good effect and the bad effect
22
Q

What does the “nature of the act mean” in terms of the principle of double effect?

A

The act has to be good or at least morally neutral

23
Q

What does the “agent’s intentions” mean in terms of the principle of double effect?

A

Agent must intend only good. Bad effects can be foreseen and tolerated, but NOT INTENDED.

24
Q

What does the “distiction between means and effects” mean in terms of the principle of double effect?

A

bad effect must not be a means to a good effect

25
Q

What does the “proportionality between the goood effect and the bad effect “mean in terms of the principle of double effect?

A

Good > Bad

26
Q

What is the definition of medical futility?

A

Unacceptable liklihood of achieving a therapeutic benefit for the pt

27
Q

What is the quantitative component to medical futility?

A

How many/ to what degree do we have to fail to call futile

28
Q

What is the qualitative component to medical futility?

A

PATIENT must have capacity to appreciate benefit of the Rx

29
Q

What is the effectiveness component to medical futility?

A

Assessment of the capacity of the treatment to be effective

30
Q

What is the burden component to medical futility?

A

Assessment of costs, discomforts, pain, etc to pt

31
Q

What are the three major legal cases involved in medical futility?

A
  1. Quinlan
  2. Cruzan
  3. Schiavo
32
Q

What did the quinlan case prompt?

A

Formation of ethical comittees

33
Q

What did the cruzan case prompt?

A

Led to patient self-determination act / advanced directive

34
Q

What was the first supreme court case of the right to die?

A

Cruzan

35
Q

What did the Schiavo case prompt?

A

Enhanced communication about advanced directives

36
Q

What is the law in terms of ethics?

A

The minimal ethic; what we must/must not do

37
Q

If a patient does not have decision making capacity, do they still have the right to decline or consent to medical treatment?

A

Yes

38
Q

What are the four aspects of the “circle of decision makers”

A

Self
Direction
Best interest
Court

39
Q

What defines hospice?

A

The medicare hospice benefit

40
Q

What are the qualifications for hospice?

A

Qualified for medicare

Less than 6 months to live (according to two physicians)

41
Q

What is the unacceptable phrase to say to a terminal pt?

A

“There’s nothing more we can do”

Medical Ethics (8 decks)

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