Elliot: Medical Ethics, Limits and Boundaries Flashcards
Lab tests indicate that your patient has developed Hep C. What do you say?
h
What are professional values?
First, do no harm (nonmaleficence) Respect the pt (autonomy) Benefit the pt (beneficence Use scarce resources wisely (justice) Be honest
What makes the execution of professional values complicated?
DR-Pt relationship:
How do I tell her so she will hear?
If she is difficult to care for–can I fire her?
What are Dr Pt Relationships based on?
ethics of personal and professional values
reflect a locus of POWER in a decision
- paternalistic
- informative
- deliverative
When can I DECLINE to tx?
- scope of practice (legal and ethical)
- clinical skills (legal and ethical)
- exposure to infection (legal; not ethical)
- torture/execution (legal and ethical?)
- Can’t refuse to refer (not legal or ethical)
- reproductive health (conscience clause) (legal and ethical)
What are conscience clause for reproductive health?
legally permits professionals to NOT provide certain medical services, based on MD’s personal beliefs (abortion, BC, Stem cell rx)
Guardian or conservator
appointed by the court—trumps proxy/surrogate
What is substituted judgement?
decisions based on pt preferences
sources of guidance for SJ (written documents, discussion, life story, biographic knowledge)
What does best interests mean?
decision based on what is best for the patient
What are sources of guidance for BI?
- pain and suffering
- functionality, prognosis
What is EMTALA?
Legal obligation to treat and stabilize
-you are not obliged to do everything possible, but if they present unstable, then you are obliged to stabilize
When do you not need informed consent?
- EMTALA
- children
- good samaritan (ethical and legal)
- best interests criteria vs default of full care
Where is the death with dignity act (PAS) legal?
oregon washington montana vermont new mexico
Is euthanasia legal in the US?
NO
What are hte ethical issues surrounding PAS?
Intent–> counter air hunger (ok)
double effect
autonomy
beneficence
What is double effect?
Cancer tx + kill fetus
What is futility?
NON-beneficial care
- professionals are NOT obliged to provide care they judge to be non-beneficial
- limits pt autonomy: pt cannot demand care/can refuse care
How do you assess futility?
Look at the goals of care
- clinical prognosis (MD assessment)
- social, spiritual, personal, family goals
- costs and benfits ratio
What are ethical issues associated w/ futility?
- high cost outliers
- use expensive options selectively
- monitor benfits
*HCV, CRC
What is disproportionate or extra-ordinary care?
Disproportionate to benefit
- can be declined
When can you forgo medical interventions?
When an intervention is likely to offer little benefit to a pt
-cpr, feeding tube, ventilation
What are the ethical issues are associated w/ forgoing medical interventions?
- first, align autonomy and beneficence
- understand/explain w/ non-maleficence (do no harm)
*facilitated by dr-pt relationship
How do you resolve conflicts in clinical medicine?
ethics committees
How can request an ethics committee for a case?
ANYONE
- no cost
- findings are advisory (more than one)
- multidisciplinary
How do you cope with competing issues?
can arrange to do BOTH
-have assistand do informed consent to avoid coercion
How do you cope w/ conflicting interests?
doing ONE impacts other
- financially: investment in drug under investigation
- intellectually: interest in publication
Is the government involved wtih privacy?
NO
is government involved with confidentiality?
NO
What are exceptions to confidentiality?
Public health reporting
Tarasoff (known risk to others–> POLICE)
impaired professionals
emancipated minors
patients/others at risk (incl. driving)
Child and vulnerable adult abuse
domestic abuse (ethical, depends on state)
Impaired pts (unsafe drivers, public safety)
infectious conditions (legal)
genetic conditions (legal)
When should you report impaired professionals?
- illness
- drugs, alcohol
- chronic infectious conditions (HIV, hepatitis)
HPSP- public safety, rehabilitation
What are exceptions for legal statuses and minors?
- specific care issues (BC,STI, mental health concerns, drug abuse)
- legal marriage
- consenting as parent
- military
- court ordered emancipation
What are sources of legal liability?
- risk management–keep hospital protected
- scope of practice/competence
- informed consent
- negligence
- medical errors
- harm
