Definitions

Question 1

Morality

Answer 1

Science of human duty; general rules of human conduct

Question 2

Ethics

Answer 2

Standards of conduct (social norms) that prescribe behaviour

Standars of a particular profession, occupation, institution or group within society

Question 3

Professional Ethics

Answer 3

Standards of conduct applying to people occupying a professional occupation/role

Question 4

Medical Ethics

Answer 4

Relates only to a specific realm of facts & concerns

Same moral principles one would apply in normal circumstances but in the medical world

Question 5

Bioethics

Answer 5

Ethical issues associated with use of living organisms

Question 6

Clinical ethics

Answer 6

Synonomous with medical ethics but less broad
Identifies, analyses and resolves issues in clinical medicine
Aims to improve patient care & patient outcomes by focusing on a right & good decision in individual cases

Question 7

Medical Futility

Answer 7

Medically ineffective or non-beneficial treatment

Question 8

Quantitative/Probabilistic Futility

Answer 8

Judgement of futility is probabilistic and accuracy is based on data drawn from clinical studies and experience

Question 9

Qualitative Futility

Answer 9

Judgement that the goal that might be attained is not worth while

Question 10

Moribund Patient

Answer 10

The patient is (inevitably) about to die within hours

Question 11

Terminal Patient

Answer 11

Refers to any patient with a lethal disease

Medicare/Medicade state less than 6 months to live despite any treatment (days, weeks, months at most)

Question 12

Prognostication

Answer 12

Answer 4 questions of probabilistic futility, no definite prognosis, bedside manner, not overly pessimistic or optimistic, base conclusion in scientific fact

Question 13

4 questions regarding probabilistic futility

Answer 13

1) What level of statistical or experiential evidence is required to support a judgement of futility? (1% success considered futile)
2) Who decides whether an intervention is futile, physicians or patients? (no unilateral decision making)
3) What process should be used to resolve disagreements between patients (or surrogates) and medical team?
4) Is probabilistic futility a substantive or procedural norm for clinical judgment?

Question 14

Physiologic futility

Answer 14

A substantive norm justifying a decision to refrain from continued life-sustaining interventions

Question 15

DNR & DNAR (L4)

Answer 15

Do not resuscitate
Do not attempt to resuscitate
If the physician has concluded that CPR would be physiologically futile, resuscitation need not to be offered as a treatment option
When the patient is terminal but not moribund, consent should be sought from available surrogates

Question 16

Documentation of DNR

Answer 16

Written order be present to authorize omission of CPR for a particular patient

Question 17

Death

Answer 17

Cardiorespiratory criterion: irreversible cessation of circulation and respiration

Question 18

The Autonomy Principle

Answer 18

physicians have a standing duty to respect, and, at times, an obligation to help promote, the free choices of competent patients