Ethical Considerations Flashcards
Ethical Environment
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
Autonomy
an individual who is informed and has decision making capacity to make certain choices and take certain actions based on personal values and beliefs.
Beneficence
Actions done for the benefit of others. Doing good. Actions that enhance the patients well-being while reducing the risk of harm.
Non-maleficence
a duty to avoid harm and reduce the risk of arm.
Weighing risk vs. benefit.
Justice
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.
Integrity
Consistently upholding and standing firm in ones values.
Trust
Confidence and reliance in the ability and moral character of another person.
Informed Consent
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.
Principle of double effect
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.
Self-determination
Founded on autonomy, the patients preferences are known and supported as much as possible whether the patient is a child or an adult.
Decision-making capacity
A healthcare term: can be assess by anyone on the team but confirmed by a psychiatrist or psychologist.
Criteria for decision making capacity
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.
The ability to make decisions
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.
Goal of patient self-Determination Act
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.
The Best Patient Advocate if the patient does not have decision making ability
The family
How are decisions made if the patient does not have an advanced directive
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.
Medical Futility
Continuation or initiation of medical treatment may have the intended effect but have no benefit for the patient.
Benefit
Any positive effect to the patients condition as perceived by the patient.
If there is a dispute
Provide the care in dispute with support to the patient and family and agree on a time of reevaluation.
T or F: Clinicians are not ethically or legally expected to provide interventions that, in their clinical judgement, are not expected to be effective.
True.
What is needed to make a patient a DNR?
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.
What is life-sustaining therapy
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.
Withholding life-sustaining therapy
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.
Withdrawal of life-sustaining therapy
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.
T or F: There is no ethical difference between deciding not to start a treatment and deciding to stop a treatment.
True.
Why would we use a trial of treatment in ethical terms?
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.
What are the issues associated with artificial hydration and nutrition?
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.
What measures should the ARNP consider when hydration and nutrition are ceased?
Ice chips, sips of water, good oral hygiene as comfort when artificial nutrition is discontinued.
Palliative sedation
Administration of sedative to reduce a terminal patient’s consciousness to adequately control one or more refractory symptoms. It promotes comfort and minimizes distress.
What is the ANA and HPNA view on assisted suicide?
Nurses should not participate in assisted suicide or give any medication that would assist with death or the end of patients life.
What should the nurse do if the patient asks for help with dying.
The nurse should explore the meaning underlying the request and should demonstrate his or her commitment to helping ease existential or physical suffering.
What is the responsibility in regard to organ donation
Every death or imminent death in a U.S. hospital must be reported to an organ procurement organization.
What happens if a palliative provider must remove themselves from a patient care?
They must inform the patient and family and delineate a provider who will take their place.
