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Bioethics > Ethical Issues and Problems > Flashcards

Ethical Issues and Problems Flashcards

1
Q

a situation in which one or more moral norms or principles are present but do not create a problem.

A

Ethical Issue

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2
Q

a situation in which two or more moral norms or principles create a challenge about what to do

A

Ethical Problem

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3
Q

there are 4 basic types of ethical problems:

A

ethical distress
ethical dilemma
ethical dillemma of justice
locus of authority issue

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4
Q

3 types of ethical problem that is focused on what to do

A

ethical distress
ethical dilemma
ethical dilemma of justice

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5
Q

type of ethical problems that focus on who should do it

A

locus of authority issue

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6
Q

3 basic concepts of ethical problem

A

moral agent
course of action
desired outcome

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7
Q

anyone who is in a situation in which he must (and can) assure responsibility for the outcome of his actions

A

moral agent

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8
Q

capable of thinking, deciding and acting in accordance with moral standards and rules

A

moral agent

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9
Q

may not always fulfill the requirements of a moral standard or rule i.e. he need not be morally perfect but must have the capacity to judge himself

A

moral agent

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10
Q

the agent’s judgments process and final decision about what will happen if one or more paths are chosen

A

course of action

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11
Q

also called the process of applying ethics

A

course of action

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12
Q

the projected positive result/s of having taken the course of action

A

desired outcome

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13
Q

a kind of ethical problem a health professional faces when ho knows exactly what course of action is right but there is a barrier keeping the person from doing it 

A

ethical distress

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14
Q

arises when one knows the right thing to do but institutional constraints make it nearly impossible to pursue the right course of action

A

ethical distress

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15
Q

the most common type of ethical problem

A

ethical dilemma

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16
Q

involves 2 (or more) morally correct courses of action but you cannot do both (or all)

A

ethical dilemma

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17
Q

sometimes considered as a problem in which there is no right or wrong solution 

A

ethical dilemma

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18
Q

there is more than one right thing to do but to act on one necessarily prohibits you from acting on the others

A

ethical dilemma

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19
Q

as a result, you (the agent) necessarily are doing something right and also wrong (by not doing the other right thing)

A

ethical dilemma

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20
Q

may be presented in special case of paternalism or parentalism

A

ethical dilemma

21
Q

the patient’s autonomy conflicts with the health professional’s judgment of what is best for the patient

A

paternalism

22
Q

when a physician or other healthcare professional makes decisions for a patient without the explicit consent of the patient

A

paternalism

23
Q

the health professional is acting as a parent to the patient

A

paternalism

24
Q

a dilemma that arises in regard to distributing societal benefits and burdens

A

dilemmas of justice

25
Q

the scarce supply of these resources requires difficult decisions by the agent

A

dilemmas of justice

26
Q

because to choose to provide the good to one group may necessarily mean there are no resources available for others

A

dilemmas of justice

27
Q

these situations arise as problems when roles or other institutional policy or societal arrangements create a confusion about who is in charge

A

locus of authority issue

28
Q

in the diagram, the 2 agents, each of whom assumes himself to be the legitimate authority for making a particular decision, they may come to different conclusions about how to achieve the best outcome for a patient

A

locus of authority issues

29
Q

they may disagree on the course of action and benefit, or they agree on the course of action and desired outcome, disagreeing solely on who is the proper authority to effect that outcome

A

locus of authority issues

30
Q

there are several aspects that may consider in deciding who is in charge

A

difference in professional expertise
traditional arrangements
institutional arrangements and mechanisms
the weight of experience

31
Q

five steps of process of ethical decision making

A

Gather relevant information
identify type of ethical problem
determine ethics approach to be used
explore practical alternatives
complete the action

32
Q

relevant facts include (4)

A

clinical indications
patient preferences
quality of life
external factors

33
Q

Is the illness or condition reversible?
Is the life saving treatment medically useless?
What is the usual treatment for this type of condition in the community?
What is needed to relieve suffering and provide comfort?
Is the patient brain dead or in persistent vegetative state?

what kind of relevant facts

A

clinical indications

34
Q

Is the patient informed?
Is the patient competent?
If the patient is not competent, how can I discern what this patient would want? (substituted or surrogate judgment)
If the patient is not competent, how can I discern what this type person would want? (best interest)

what kind of relevant facts

A

patient preferences

35
Q

What is the patient’s judgment?
What is the health professional’s judgment?
Is there any hope for improvement from present quality of life?

what kind of relevant facts

A

quality of life

36
Q

Costs? Reimbursement issues?
What policies are there? Hospital, judicial opinions, professional societies, etc.
What are the legal implications? (court cases, statutes)
Is allocation of beds, other resources an issue?

what kind of relevant facts

A

external factors

37
Q

simultaneous with the initial fact-finding and sorting of information, the health professional can begin to determine the type of ethical problem he is facing

as he observes, asks questions, and reflects, he can begin to decipher where his initial observations were correct and where they were not until he arrives at a point where he has as clear a picture of the situation as he is able to put together

what step

A

identify the type of ethical problem

38
Q

if the moral agent is a ____his thinking will be guided by the duties and/or rights that are in conflict

A

deontologist

39
Q

he will spend a lot of time weighing the two duties in dilemma and will probably decide that the weightier or more compelling duty is to the patient

what type of moral agent

A

deontologist

40
Q

if the moral agent is a ___, he will spend less time thinking about the duties and will be guided by his desire to bring about the over-all best consequences in the situation

A

utilitarian

41
Q

the over-all best consequences might well be to leave well enough alone, not to make waves with the patient

what kind of moral agent

A

utilitarian

42
Q

the health professional has to explore the actual strategies and options open to him
these alternatives should be duty-bound and would produce the desired outcome

what step

A

explore practical alternatives

43
Q

the final and necessary step in moral judgment and action
without the necessary attention to a strategy for carrying out the plan, the entire process, steps 1 to 4, is just an intellectual exercise
the health professional must assume that he is prepared to accept the consequences of his actions, and that he has the motivation to go beyond mere identification of the problem
in order to see the benefits of his own struggle he must now proceed to action
to do this, he needs the character traits of compassion, a sense of responsibility, and the courage to go ahead

what step

A

complete the action

44
Q

read doctor patient relationship

beginning and ending the relationship

A

a voluntary relationship entered freely by both sides

a patient cannot be compelled to accept a particular doctor as his/her physician; a physician cannot be compelled to accept a patient without his/her agreement

there is no legal obligation on the part of the physician to accept a patient; this is true no matter what need the patient has and whatever expertise the doctor may possess

this is different from a hospital’s mandate to provide emergency treatment to anyone who comes to the emergency department; hospital cannot turn anyone away at the door of the emergency room

once a patient and a physician have entered into a care relationship, there is far greater complexity in ending the relationship

the doctor cannot suddenly end the relationship; he/she must maintain the care of the patient until the patient can find an appropriate alternate source of care and the doctor must give reasonable notice

45
Q

read doctor patient relationship

gifts from patients (or from pharmaceutical industry)

A

small gifts from patients of nominal or modest value are acceptable

provided that there is no expectation of a different form of therapy or a higher level of care based on the value of the gift

rules on gifts from patients are less rigorous, precise or clear than the rules on gifts from pharmaceutical industry

there is an automatic presumption that gifts from pharmaceutical industry always carry an influence toward a product, service or prescribing practice

gifts from industry are viewed differently because there can only be no other intention behind them except to buy influences

46
Q

read

doctor/patient sexual contract

A

sexual contact between a physician and a patient is always inappropriate

at the very least, the physician and the patient must mutually agree to end the formal professional relationship of a doctor and a patient

not clear how much time must elapse between the ending of the formal relationship and the start of the personal relationship

the American Psychiatric Association guidelines specifically state that there can never be a sexual or personally intimate private relationship between doctor and patient even after the professional relationship

these guidelines apply no matter who initiates the relationship; it is not more acceptable for a doctor and patient to have sexual relations if the patient initiates the relationship

no account is given on gender or sexual orientation
it is always unacceptable for a physician of any kind to have sexual relationship with a current patient

47
Q

If the patient is not competent, how can I discern what this patient would want?

A

(substituted or surrogate judgment)

48
Q

If the patient is not competent, how can I discern what this type person would want?

A

best interest

Bioethics (8 decks)

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