Ethical Considerations

Question 1

Ethical Environment

Answer 1

Patient Centered Care, Patient Advocacy, Enabling patients to make their own decisions, ensuring that interventions are in the patients best interests as defined by the patients values and goals

Question 2

Autonomy

Answer 2

an individual who is informed and has decision making capacity to make certain choices and take certain actions based on personal values and beliefs.

Question 3

Beneficence

Answer 3

Actions done for the benefit of others. Doing good. Actions that enhance the patients well-being while reducing the risk of harm.

Question 4

Non-maleficence

Answer 4

a duty to avoid harm and reduce the risk of arm.

Weighing risk vs. benefit.

Question 5

Justice

Answer 5

Providing care that is equitable and fair to all and includes the fair distribution of scare resources. Care should be based on patient need regardless of socioeconomic or social status.

Question 6

Integrity

Answer 6

Consistently upholding and standing firm in ones values.

Question 7

Trust

Answer 7

Confidence and reliance in the ability and moral character of another person.

Question 8

Informed Consent

Answer 8

Patient cannot express autonomy unless it is informed and free from coercion. Both the disclosure of information and the active participation of the individual are components of the informed consent.

Question 9

Principle of double effect

Answer 9

When an act has 2 foreseen effects, one good and one harmful. The action is morally defensible if the harmful effect is not intended, the act itself is good or neutral and the bad effect does not lead to the good effect.
Sometimes used to justify the administration of analgesia in the context of end-of-life.

Question 10

Self-determination

Answer 10

Founded on autonomy, the patients preferences are known and supported as much as possible whether the patient is a child or an adult.

Question 11

Decision-making capacity

Answer 11

A healthcare term: can be assess by anyone on the team but confirmed by a psychiatrist or psychologist.

Question 12

Criteria for decision making capacity

Answer 12

The patient can make and communicate a decision.
The patient can articulate an understanding of the medical situation and prognosis, the nature of the recommended care and alternatives, the risks, benefits and consequences of each alternatives. Decisions are consistent with the patients known values and goals, the patient uses reasoning and analysis to make a choice.

Question 13

The ability to make decisions

Answer 13

depends on the patients ability understand the clinical facts of his/her health status. The focus is on the patients ability to interpret and integrate information, NOT on their values and preferences although these may influence decision making.

Question 14

Goal of patient self-Determination Act

Answer 14

Part of the Omnibus Budget Reconciliation act of 1990. Encourages americans to consider what they wound and would not want at the end of life.

Question 15

The Best Patient Advocate if the patient does not have decision making ability

Answer 15

The family

Question 16

How are decisions made if the patient does not have an advanced directive

Answer 16

Substituted judgement - judgement in the patients place based on previous conversations. Someone makes the decision that the patient would have made if he/she was here. Then after that it would be what is in the best interests of the patient.

Question 17

Medical Futility

Answer 17

Continuation or initiation of medical treatment may have the intended effect but have no benefit for the patient.

Question 18

Benefit

Answer 18

Any positive effect to the patients condition as perceived by the patient.

Question 19

If there is a dispute

Answer 19

Provide the care in dispute with support to the patient and family and agree on a time of reevaluation.

Question 20

T or F: Clinicians are not ethically or legally expected to provide interventions that, in their clinical judgement, are not expected to be effective.

Answer 20

True.

Question 21

What is needed to make a patient a DNR?

Answer 21

Patient and families need accurate information about the patients illness, his/her prognosis, and understanding of what resuscitation is and what outcomes it may or may not have.

Question 22

What is life-sustaining therapy

Answer 22

Focused on increasing the patients life span: nutrition, hydration, transfusions, mechanical ventilation, vasoactive medications, mechanical assist devices (VAD, IABP, ECMO, defies and pacemakers, renal replacement therapy.

Question 23

Withholding life-sustaining therapy

Answer 23

The considered decision not to institute a medically appropriate and potentially beneficial therapy with the understanding that the patient will probably die without the therapy in question.

Question 24

Withdrawal of life-sustaining therapy

Answer 24

the cessation and removal of an ongoing medical therapy with the explicit intent not to substitute an equivalent medical treatment. It is fully anticipated that the patient with die following the change in therapy.

Question 25

T or F: There is no ethical difference between deciding not to start a treatment and deciding to stop a treatment.

Answer 25

True.

Question 26

Why would we use a trial of treatment in ethical terms?

Answer 26

It is more ethical to err on the side of treatment than to err on the side of too little treatment or to discontinue treatment too quickly.

Question 27

What are the issues associated with artificial hydration and nutrition?

Answer 27

Feeding tubes are not associated with prolonged life. They do not protect from aspiration or increase strength. They may cause infection, pain, diarrhea, skin issues.

Question 28

What measures should the ARNP consider when hydration and nutrition are ceased?

Answer 28

Ice chips, sips of water, good oral hygiene as comfort when artificial nutrition is discontinued.

Question 29

Palliative sedation

Answer 29

Administration of sedative to reduce a terminal patient’s consciousness to adequately control one or more refractory symptoms. It promotes comfort and minimizes distress.

Question 30

What is the ANA and HPNA view on assisted suicide?

Answer 30

Nurses should not participate in assisted suicide or give any medication that would assist with death or the end of patients life.

Question 31

What should the nurse do if the patient asks for help with dying.

Answer 31

The nurse should explore the meaning underlying the request and should demonstrate his or her commitment to helping ease existential or physical suffering.

Question 32

What is the responsibility in regard to organ donation

Answer 32

Every death or imminent death in a U.S. hospital must be reported to an organ procurement organization.

Question 33

What happens if a palliative provider must remove themselves from a patient care?

Answer 33

They must inform the patient and family and delineate a provider who will take their place.