E&P Midterm

Question 1

Profession

Answer 1

self-defineself-defined group of specialized workers whose expert knowledge and skills earn it the right to function as an independent semiautonomous group

Question 2

Professionalism

Answer 2

extent to which members of a profession maintain a level of conduct above an ethical threshold determined by the profession

Question 3

consequentialism

Answer 3

no type of action is automatically wrong
morally right action. Morally right action is the one that maximizes good consequences

actions are morally wrong because of the consequences they have

primary focus is ACTION
decision procedure: greatest happiness principle

Question 4

Deontology

Answer 4

some types of actions are just wrong, independent of consequences they may have

primary focus is action
decision procedure: categorical imperative
(act in way that you treat humanity as an END and never simply as a means (to do should rob them of dignity)

Question 5

Virtue ethics

Answer 5

actions/feelings should be guided by a virtuous character

purpose internal to the profession of medicine provides moral guidance

Question 6

beneficence

Answer 6

doing good for patients

Question 7

respect for autonomy

Answer 7

honoring pt’s prima facie right to make decisions regarding their own life and body

Question 8

non-maleficence

Answer 8

primus non-nocere (first, do no harm)

Question 9

justice

Answer 9

protecting patients from discrimination and exploitation

balancing interests of other parties addicted by the decision

Question 10

postnatal genetic diagnosis

Answer 10

non-symptomatic (carrier states), pre-symptomatic (genetic risk) or symptomatic individuals (genetic diagnosis, precision or personalized medicine)

Question 11

Prenatal genetic diagnosis

Answer 11

post-implantation (abortion decision) vs. pre-implantation with IVF

Question 12

prenatal genetic selection and modification

Answer 12

identify or create embryos with desirable genes prior to implantation

Question 13

genetic screening

Answer 13

genomic profiling of a population

Question 14

Genome-wide sequencing (GWS)

Answer 14

statistically significant correlations between SNPs and increased susceptibility of disease; analytic validity is high but clinical utility remains LOW

Question 15

Genetics Information and Non-Discrimination Act (GINA)

Answer 15

prohibits insurers and employers from collecting and using genetic information

does NOT protect against possibility of discrimination in life, disability, or long-term care insurance

Question 16

Are physicians required to inform patients or their affected relatives about the transferability of genetic risk>

Answer 16

There is legal precedent requiring physicians to inform patients about the transferability of their genetic risk BUT informing affective relatives is directly controversial and raises issues of respect for autonomy, beneficence and justice

Question 17

Explain a proxy

Answer 17

Proxy –> a legally designated person
All it says is “if I lose decision making capacity, this person can speak for me”
Does NOT say physician is legally obligated to do what the proxy says

Question 18

strict futility

Answer 18

no physiologic rationale; allows for unilateral withdrawal or withholding of intervention

No law holds you to act contrary to your professional judgement – unilateral withdrawal is allowed

Question 19

loose futility

Answer 19

very low probability of success, no worthwhile goal, unacceptable quality of life; unilateral withdrawal or withholding unjustifiable (alternative term - “potentially inappropriate treatments”)

Question 20

Physicians determine __________; courts determine ________

Answer 20

Physicians determine decisional capacity; courts determine competency

Question 21

Patients with certain mental illnesses are more likely to lack decisional capacity, but having such an illness does not …

Answer 21

a priori preclude decisional capacity

Question 22

Decisional capacity

Answer 22

ability to (1) communicate choices, (2) understand relevant information, (3) rationally manipulate that information, (4) appreciate the situation and its consequences

Question 23

substituted judgement

Answer 23

Proper surrogate –> supposed to BE the person. Sources of evidence (living will, fam/friends who know pt) help guide surrogates

Question 24

In cases of a dispute, the decision of a legally appointed ___________________________ takes priority over family members not so designated

Answer 24

power of attorney (POA) or health care proxy

Question 25

Advance care planning

Answer 25

includes POA empowered to serve as a health care proxy; living will helpful for guiding decisions, but no making them

Question 26

Surrogates are not legally bound to follow the instructions in a _________ (in most states)

Answer 26

living will

Question 27

______ forms recommended for documenting a detailed plan for last year of life

Answer 27

POLST forms

Physician Orders for Life Sustaining Treatment

Question 28

Peds

Answer 28

Parents given wide latitude in decision making on behalf of children. In rare cases of conflict, peds physician responsibility is to ped patient indep of parent’s wishes

respect for autonomy=decision making capacity of child

exp of tx w/o parent consent –> sexual health, substance use, mental health

Question 29

Primary duty to pediatric patients

Answer 29

Beneficence
Respect for autonomy is commensurate with developing decision making capacity of the patient (informed assent vs informed consent)

Question 30

Physicians cannot refuse patients on basis of…

Answer 30

ethnic background, race, gender, religious beliefs, personal dislike, smoking/alcohol/substance abuse/non adherence to meds

but can refuse based on bad attitude or attraction (?)

Question 31

problematic pt-physician relationships

Answer 31

accepting valuable gifts
secret info from relatives or others
sexual relationships of any kind with current or past pts

Question 32

Virtue ethics

Answer 32

Aristotle
primary focus: character
decision procedure: what would virtuous person do?
ethics=skill, practice makes perfect
downplay strict rules, instead develop skills, learn from wise, be guided by purpose of your profession

Question 33

Solutions to challenges to the moral integrity of clinicians

Answer 33

negotiate
refer, if compromise not reached
disclose practice limitations PRIOR to establishing physician-pt relationship

Question 34

The best interest standard is most closely aligned with the principle of _____ rather than _____.

Answer 34

beneficence rather than non-maleficence.

Only patients themselves can ultimately determine what is in their best interest, assuming they have the capacity to freely make and express this determination. If they do not, physicians should not rely solely on their own judgement, but should first turn to patients’ designated health care proxies or family members to help clarify what the patient would have wanted under the circumstances.

Question 35

Physicians are under no ethical obligation to order any intervention (diagnostic or therapeutic) that is not…

Answer 35

medically indicated, irrespective of the wishes of their patients. Acquiescing to patient demands for unnecessary tests often fails to reassure them, leads to additional requests for further testing, and risks false positive results, which may cause harm.

Question 36

It is currently ____ in the US to base hiring decisions on the results of an applicant’s genetic screening results

Answer 36

ILLEGAL

Question 37

For which of the following single-gene mutations would you be LEAST compelled to breach patient confidentiality?

a.	 BRCA 1 

b.	 Huntington’s disease

c.	 hereditary non-polyposis colon cancer

d.	 cystic fibrosis

Answer 37

Unlike the other conditions, the gene for cystic fibrosis is transmitted in an autosomal recessive pattern. Therefore, the greatest harm to the sisters would be a lack of knowledge regarding their potential carrier state, which is unlikely to affect anyone. Since genes for the other conditions are autosomal dominant, each sister would have a 50% risk of possessing a given gene should the patient screen positive for it. Though their penetration is variable, such information would have major implication for the sisters and their children.

Question 38

Who would the utilitarian put on his lifeboat?

Answer 38

As a utilitarian, the ship’s captain is most interested in saving as many lives as possible. Recognizing that he is unable to save everyone, he must make a decision (and if necessary enforce it with his weapon) that will maximize the number of passengers likely to survive. Since rescue is unlikely to arrive prior to the storm, selecting the best rowers carries with it the greatest probability of increasing the total number of survivors compared to the other options listed. Were the captain to give up his place to one of the other passengers, the lives of the remaining survivors would be further imperiled having lost their leader.

Question 39

You dx viral infection, but mom of pt wants abx for child despite your discussion of why that would be ineffective… rx abx?

Answer 39

You have fulfilled your beneficent obligation by correctly diagnosing your patients and recommend appropriate tx. The addition of abx, which have no clinical utility, may actually cause harm (e.g., acute diarrhea, allergic reaction). Exposing the child to unnecessary risk would, therefore, violate the principle of non-maleficence.

Question 40

You are seeing a patient referred to your surgical practice. She has a large uterine fibroid (a benign condition) causing abnormal vaginal bleeding. While some fibroids respond to medical management, many require surgical excision for symptom resolution. Pt demands surgery even though, in her case, its risks outweigh its benefits…

Answer 40

The principles of non-maleficence and beneficence prohibit surgeons from actively and unnecessarily placing patients at risk even if they choose to place themselves at risk.