Ethical Issues and RisksAssociated with Catheterizationand Interventional Procedures Flashcards
What must physicians prioritize when caring for patients?
The patient’s welfare must be paramount.
On what basis should physicians prescribe drugs and treatments?
Based solely on medical considerations and patients’ preferences.
What should physicians disclose to patients regarding conflicts of interest?
Any conflicts of interest related to their relationships with or investments in companies.
What steps should a physician take if they face an unresolved conflict of interest?
Consult with disinterested colleagues or an institutional ethics committee.
Are physicians allowed to accept financial inducements from industry?
No, they must not accept direct or indirect financial inducements.
What constitutes unacceptable inducements for physicians?
Payments over and above the actual cost of completing postmarketing surveys.
What should clinicians disclose when presenting clinical research or experience?
Their own or their institution’s financial relationship with the manufacturer.
What is the role of peer review in medical practice according to ethical standards?
It is a critical component of continuous quality improvement and appropriateness review.
What is the ethical stance on performing inappropriate procedures on patients?
It is profoundly unethical and may result in permanent loss of membership in the society.
What should be explained to patients prior to performing a procedure?
Details of the procedure, potential risks and benefits, and all reasonable alternatives.
What is the ethical choice for managing a patient with unstable coronary lesions?
Ameliorate the unstable coronary lesion and address other relevant interventions.
What is the ethical dilemma faced by interventional cardiologists regarding sedation?
Lack of authority to administer propofol despite it being the most medically optimal approach.
What is the Federal Physician Self-Referral Law also known as?
The Stark Law.
What does the Stark Law prohibit?
Referrals for designated health services to entities with which the physician has a financial relationship.
What is the purpose of the Medicare–Medicaid Anti-Kickback Statute?
To prohibit remuneration to induce referrals of items or services covered by Medicare or Medicaid.
What are the Belmont principles that guide ethical practices?
Beneficence, respect for persons, and justice.
What should a laboratory director do in response to sexual harassment complaints?
Review policies and ensure a professional, non-hostile working environment.
What defines sexual harassment according to the EEOC?
Unwelcome sexual advances and other verbal or physical conduct of a sexual nature.
What is the ethical guideline regarding CPR for patients in cardiac arrest?
All patients should receive resuscitation unless there is a valid DNR order or signs of irreversible death.
What criteria may justify withholding attempts to resuscitate newborns?
Gestation <23 weeks, birth weight <400 g, or confirmed anencephaly.
What does a valid DNR order indicate about a patient?
The patient has expressed a desire not to receive resuscitative measures.
What are signs of irreversible death?
- Rigor mortis
- Decapitation
- Dependent lividity
In which scenarios is withholding resuscitation appropriate for newborns?
- Confirmed gestation <23 weeks
- Birth weight <400 g
- Anencephaly—confirmed trisomy 13 or 18
What do current guidelines say about medical therapies for patients with DNR/DNI orders?
There is no contraindication to medical therapies unless prompted by decisions for comfort care.
What is the classification rating for primary PCI at hospitals without on-site cardiac surgery?
Class IIa recommendation (Level of Evidence B)
What does the Class IIb recommendation for elective PCI indicate?
It might be considered with proper planning and rigorous patient selection.
What are the primary ethical principles in resource allocation?
- Equity
- Justice
- Utility
Define distributive justice.
The fair distribution of resources to a given population.
What is compensatory justice?
The belief that an injured person should receive a benefit proportional to their loss.
What should be prioritized in managing acute hypotension post-catheterization?
Normalization and stabilization of blood pressure.
What may bradycardia and vagal symptoms indicate in a hypotensive patient?
Possibility of vasovagal hypotension or anaphylactoid reaction.
What is a key management step for hypotension after intervention?
Consider IV pressors for blood pressure support.
What should be discussed with a terminally ill patient regarding an ICD?
- Potential benefits and burdens of the device
- Pain from defibrillation shocks
- Turning off the ICD will not cause death or increased pain
What is the role of a substitute decision-maker?
To approximate the patient’s wishes when they cannot make competent decisions.
What principles guide therapy regarding advance directives?
- Patient autonomy
- Respect for the patient’s wishes
- Ethical decision-making
What must interventional cardiologists do if they find a procedure is not indicated?
They must cancel the procedure or reassess the hemodynamic significance.
What are essential elements of informed consent?
- Full disclosure of risks and benefits
- Patient understanding of the procedure
- Patient competence to make decisions
- Autonomy free from undue influence
- Documentation of consent
What is an anaphylactoid reaction?
A non-immune mediated reaction resembling anaphylaxis, often triggered by contrast material.
What should be done for a patient experiencing an anaphylactoid reaction?
Administer volume expansion, IV diphenhydramine, and IV glucocorticoids.
What is the best practice for patients with a history of contrast reaction?
Pretreatment with preventive agents starting 24 hours before the procedure.
What is the recommended approach for disclosing medical errors?
Full and honest disclosure to maintain trust and responsibility.
