CPS Bioethics Flashcards
What ethical principles are often involved in medical education?
- Truth telling
- Informed consent
- Respect for persons
- Confidentiality
- Distributive justice
A parent refuses to have medical trainees involved in the care of their child. They are adamant. How do you approach this?
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
What are the ethical principles that underlie advance care planning? (3)
- Respect for autonomy
- Beneficence
- Nonmaleficence
What are the 3 categories of decision-making capacity that pediatric patients may fall into?
- Incapable of consent
- Developing capacity for consent
- Fully capable of consent
What is the stipulated legal age for advance directives in most provinces?
16 yo
What are important questions to ask in preparing an advance care plan? (5)
- What is your understanding of your/your child’s illness? How do you expect it to progress?
- What is the most important thing for you? Management of pain? Relief of breathlessness? Being at home or with family?
- If you/your child would not be able to go home if treated, would you rather not have the treatment?
- What are your expectations about the goals of care for you/your child?
- What treatments do you want or do not want for yourself/your child?
State the difference between full DNR order vs. limited DNR order?
-what comfort measures can be included in an advanced care directive?
- 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!
What are the ethical principles impacting research in children? (5)
- Beneficence: applying evidence-based care generated from research specific to children
- Nonmaleficence: avoiding harmful therapies extrapolated from adult patient data or experience
- Distributive justice: allowing research benefits to be available to all populations
- Respect for informed consent: supporting developing autonomy in children considering research participation
- Respect for privacy and confidentiality: providing confidentiality within the limits of legal requirements
What are the contributors to the lack of child-focused research? (5)
- Protectionist attitude of some individuals
- Financial disincentive since it’s a small population and bringing to market new drugs or drug indications is costly
- Difficulty in recruiting adequate numbers for rare diseases
- Fewer researchers
- Limited funding sources
What are the 3 main elements of informed consent?
- Adequate information
- Voluntariness
- Capacity to understand the information
What is “assent”?
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)
What are the types of conflicts of interest? (3)
- Financial
- Academic: promotion or tenure based on productivity, stature based on publication impact scores, etc.
- Personal: research results supporting an ideology or preconceived conclusions, recruitment of own patients to research
What are the two phases of drug development?
- 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 treatment
- 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
What is the definition of anencephaly?
Congenital absence of forebrain, skull and scalp
- functioning brainstem is usually present
- most encephalic infants die within days or weeks without life-supporting interventions
What are the problems with using anencephalic infants as organ donors? (3)
- Anencephalic infants usually have intact brainstem functioning and thus intact spontaneous respirations and heart rate; thus do not satisfy standard brain death criteria
- By the time brain death or somatic death has been declared, the organs have undergone ischemic damage
- Use of life support does not improve the chance of successful organ donation since there’s still organ failure as the brainstem functiond eteriorates
