Ethical dilemmas Flashcards
physician is caught under the influence. who do you report to?
must report suspected physician impairment to appropriate state regulatory board - like a physician health program or state medical board
decision making capacity depends on:
communication of a choice, understands information provided appreciates consequences rational given for decision
communicates a choice is
pt can clearly indicate a preferred treatment option
understands information provided
pt understands having a condition and treatment options.
appreciates consequences
pt acknowledges having condition and likely consequences of treatment options including no treatment
rational given for decision
pt able to weigh risks and benefits and offer reasons for decisions
if patient is able to articulate reasons for decision and shows no signs of delirium psychosis and severe depression that could understand information then
he has right to refuse treatment and decision should be respected
what if pts has mild cognitive impairment (MOCA 24/30)
irrelevant to making decisions for oneself as long as no evidence of ability to understand consequences is affected
Risk factors for elderly abuse
advanced age>80 yrs depression, female hx of stroke or hip fracture dementia poor socioeconomic status suspicious care taker behavior indication of financial exploitation
physical signs of elderly abuse
skin tears, abrasions, and bruises lacking adequate explanation on trunk or other unusual locations fractures in sites not typical of osteoporotic fractures (long bones of arms or legs) dehydration or malnutrition pressure ulcers signs of sexual abuse (bruised breasts or anogenital trauma)
what to do for suspected elderly abuse?
call adult protective services
if physician friend wants a medication do you do it?
no, best to get a referral to independent physician who can perform a comprehensive clinical assessment in the pts best interest.
what to do in “near miss” events:
since pt was not harmed you don’t need to report to htem but rather you need to report to the hospital administration to identify weaknesses in the system of care that jeopardize pt safety. This is meant to help form corrective measures. Near misses are more common but root causes should be evaluated.
when an error is corrected before harming a patient a doctor should
use professional judgement when considering to inform the pts. IT can distress or confuse them unnecessarily. If the pt is aware of the near miss, then disclosure is recommended as not talking about it may increase anxiety and talking about it will improve trust and confidence.
Medical errors that impact patient care or causes harm to patient
should be disclosed promptly.
conflict of interest
must be appearance or even the conflict of interest of there’s a potential for financial incentives to influence medical judgement of physician (consciously or unconsciously) need to disclose it
SPIKES mneumonic for family meetings
if pt is an organ donar and it’s appropriate, who approaches the family and pt about organ donation?
Need to contact the organ donor network.
never appropriate for physician or any member of the medical team taking care of patient to approach family for consent for organ donation.
action can be misinterpreted as malicious and harmful to patient if family thinks that care is being withdrawn to harvest organs.
“res ipsa loquitur” situation in which someone gets sued
the thing speaks for itself
situation where persons suffer injury caused by an action of another party that would not have otherwise occurred.
it does not require expert witness testimony as it is a clear violation of standard practice even to a layperson.
Ex: tool left in someone after surgery. Wire left in person after CVC.
abandonment is
violation of principle that if a provider is unwilling to treat a patient provider must provide care until new provider is located.
can be cause for legal action.
seen in religious doctors who are dealing with someone who wants an abortion.
vicarious liability
this is you are held liable for the negligent actions of another person
(ie doctor held liable for actions of the RN or attending with a negligent resident)
“volenti non fit injuria” refers to
person who knowingly places himself at risk for danager cannot sue for any resulting injuries.
if someone is goding and there is a needle stick injury that happens, what to do next
employee should leave the code and go the ED for care.
HIV antiretroviral therapy can significantly reduce the risk for seroconversion if taken following an exposure.
how to effectively manage termination of a physician patient relationship?
if a doctor-patient relationship is irreparably compromised because of lack of trust, lack of mutual goals, failure to maintain an effective working relationship despite efforts to resolve differences then relationship can be terminated.
send pt a formal written warning informing him that patient physician relationship is to be terminated unless he is able to meaningfuly participate in plan of care.
Terminate relationship when pt is medically stable and alternative care is present.
if patient threatens a physician or staff member then
termination of doctor-patient relationship can be immediate.
