Ethical and Legal Issues in the Treatment of Older Adults

Question 1

autonomy

Answer 1

patient is able to make own decisions

Question 2

beneficence

Answer 2

is treatment in the best interest of the patient

Question 3

nonmaleficence

Answer 3

do no harm

Question 4

tort

Answer 4

a civil wrong, other than a breach of contract including negligence, false imprisonment, assault and battery

Question 5

informed consent was conceived from what?

Answer 5

the intentional tort of “battery”

Question 6

intentional tort

Answer 6

no standard of care involved

Question 7

informed consent

Answer 7

standard of care may apply

Question 8

informed consent is usually treated as what?

Answer 8

negligent tort

Question 9

types of torts

Answer 9

1. negligence
2. vicarious
3. intentional
4. strict

Question 10

elements of informed consent

Answer 10

1. describe procedure/treatment
2. explain risks/benefits
3. discuss alternative treatments

Question 11

adequate consent requires that the patient has what?

Answer 11

capacity

Question 12

capacity is determined by who?

Answer 12

a physician

Question 13

competency is determined by who?

Answer 13

the courts

Question 14

two standards for disclosure of informed consent

Answer 14

1. physician-based

2. patient-based

Question 15

physician-based standard for disclosure of informed consent

Answer 15

amount of disclosure based on what physicians would disclose given the same circumstances

Question 16

problems with physician-based standard for disclosure of informed consent

Answer 16

1. plaintiff has to produce expert testimony

2. based solely on physician discretion

Question 17

patient-based standard for disclosure of informed consent

Answer 17

amount of disclosure determined by what the “reasonable patient” would want to know about the treatment

Question 18

T/F: patient-based standard for disclosure of informed consent doesn’t require an expert testimony and by focusing on the patient, court believed that autonomy/self-determination preserved

Answer 18

true

Question 19

T/F: states have used case law/statutes to pick one of the standards of informed consent or a hybrid of them

Answer 19

true

Question 20

modalities to present information to patient

Answer 20

1. verbal presentation
2. discussion with physician
3. written information
4. pamphlets
5. video/internet
6. diagrams/charts

Question 21

what is the preferred modality to present information to patients?

Answer 21

discussion with physician

Question 22

what should be disclosed to patients?

Answer 22

1. severe risk, low probability
2. less severe, higher incidence
3. risk specific to procedure

Question 23

rule of thumb when it comes to disclosing risks to patients

Answer 23

1. death
2. serious injury
3. limb/organ damage
4. minor events that happen >5% of the time

Question 24

what are the general risk that should be disclosed to patients?

Answer 24

1. infection
2. vascular/neurological injury
3. death

Question 25

Do Not Resuscitate (DNR) orders

Answer 25

order given by a physician to not attempt resuscitative protocol for someone in cardiopulmonary distress (no ACLS protocol)

Question 26

when can a DNR be written?

Answer 26

after a physician discusses it with the patient or, if they lack capacity, a patient surrogate

Question 27

types of DNR orders

Answer 27

1. DNR
2. DNI
3. chemical code
4. full code

Question 28

DNI (do not intubate)

Answer 28

no invasive airway establishment

Question 29

chemical code type of DNR

Answer 29

meds only

Question 30

full code tyoe of DNR

Answer 30

all supportive measures

Question 31

criteria for capacity

Answer 31

1. ability to communicate a choice
2. understanding relevant information
3. appreciate the situation/consequences
4. ability to reason about treatment

Question 32

types of advance directives

Answer 32

1. living will

2. durable power of attorney for health care

Question 33

when does the living will take effect?

Answer 33

when patient lacks capacity

Question 34

what does the living will outline?

Answer 34

the type of care the patient would like

Question 35

problems with living wills

Answer 35

1. it may not address the therapy that needs to be instituted
2. language can be vague
3. may not clearly indicate code status

Question 36

legal definition of “terminal condition”

Answer 36

will result in death regardless of treatment

Question 37

T/F: “terminal condition” usually requires 2 physicians to agree

Answer 37

true

Question 38

durable power of attorney for health care provides what?

Answer 38

a surrogate to make active decisions

Question 39

T/F: with durable power of attorney for health care, patient can still outline what they prefer as far as treatment modalities

Answer 39

true

Question 40

regular durable POA controls what?

Answer 40

only finances

Question 41

guardianship

Answer 41

a person is stripped of all their rights and declared incompetent by the court

Question 42

emergency exception to informed consent can only be used when?

Answer 42

in the preservation of life… no more, no less

Question 43

when can the “extension doctrine” be applied?

Answer 43

should be a life-threatening risk

Question 44

when does the “extension doctrine” not apply?

Answer 44

1. elective cases

2. when “extension” should be anticipated

Question 45

therapeutic privilege

Answer 45

can only be obtained if it can be proved that an individual patient could not handle that disclosure

Question 46

T/F: therapeutic privilege is very hard to prove

Answer 46

true

Question 47

waiver of consent

Answer 47

should provide at least enough information, so that the general nature of the treatment is expressed so patient can understand what they are forgoing

Question 48

informed refusal

Answer 48

patient should be told the risks/consequences of refusing treatment