Ethics

Question 1

What is the difference between decision making capacity (decisionality) and competency?

Answer 1

Decision making capacity - physician’s determination, based on examination, or patient’s ability to make decisions

Competency - legal term refers to a decision made by a judge (physicians opinion carries weight through competency hearing)

Question 2

What 3 tasks must a person be able to do, in order to have decision making capacity?

Answer 2

1) Receive information
2) Evaluate, deliberate, and mentally manipulate information
3) Communicate a preference

Question 3

3 things physicians should look for when assessing decision making capacity

Answer 3

1) Understanding - understand what they are being told even if they do not agree

2) Logic - is it a rational thought process?

3) Consistency - if changing mind, can they explain why (change in values etc.)

Question 4

What is decision making contingent on?

Answer 4

1) Task specific (some require higher level of capacity)
2) Time specific (depending on acute issues affecting cognition)

Question 5

Conditions that need to be met for informed consent:

Answer 5

1) Patient can make voluntary choice
2) Informed
3) Has capacity

Question 6

What should be discussed to meet the spirit of the informed consent doctrine?

Answer 6

• diagnosis
• nature, purpose, benefits/risks of proposed intervention/treatment
• nature, purpose, benefits/risks of alternative intervention/treatment
• risks/benefits of not undergoing the intervention/treatment

Question 7

What is therapeutic privilege?

Answer 7

Principle that physicians may withhold information that may do harm to the patient

Question 8

List 5-7 steps to managing family requests for non-disclosure

Answer 8

1) Be calm
2) Explore / understand the family’s viewpoint
- Including - are they afraid of the information, or how it is given
3) Clarify how much the patient knows
4) Respond empathetically
5) Express your own views / perspectives
6) Be willing to brainstorm solutions
- Meet in the middle
- No “one size fits all” solution
7) Negotiate a solution

Question 9

What is one potentially legal option for someone interested in hastening death, but not wishing to have MAID / euthanasia?

Answer 9

VSED - voluntary stopping of eating and drinking

Question 10

what kinds of problems can mask as ethical ones?

Answer 10

communication
relational
biotechnical

Question 11

What factors does the 4 quadrant approach to ethical decision making take into account?

Answer 11

medical indications
patient preferences
quality of life
contextual / external factors

Question 12

What 2 aspects are most commonly in conflict in ethical dilemmas?

Answer 12

autonomy and beneficience

Question 13

what is moral distress

Answer 13

negative self directed emotions or attitudes arising in response to one’s involvement in a situation that one perceives to be morally challenging / undesirable

i.e when actions may be required of us that conflict with our personal opinion of what should be morally just or right

Question 14

what skills can help address moral distress?

Answer 14

ethical competence - constructively process the dilemma
self-regulation - appreciate what is / isn’t in your control
self-awareness - what is causing the distress? why?