Ethics Flashcards
When having an end of life conversation with a family, what should be asked about the patient?
- Establish who is MPOA
- Known wishes regarding serious illness/advanced care directive
- Current quality of life
- Co-morbidities
- What did they enjoy doing in life (ie gardening, driving etc)
How should you approach the patient who wishes to leave but medically should be admitted?
- Calm and empathetic, determine why they want to go
- Attempt to address any issues (ie give food, support person etc)
- Explain why they should stay
- Establish competency
- Involve NOK/friends/support worker
What are some of the features of culturally competent patient centred care?
- Take a cultural history, may involve caregivers as well
- Incorporate diverse health beliefs into ED care
- Give access to appropriate support people (ie AHLO’s)
- Get a professional interpreter
- Give opportunity to speak to cultural or religious representative
- Ensure the patient feels safe
- Knowledge of different ethnicities and their health status and predispositions
What should be considered before stopping CPR?
- Presence of irreversible pathology (ie massive ICH, refractory hyper K, refractory hypothermia)
- Personnel, equipment and specialties available (ie in rural centre without ecmo may terminate earlier)
- QOL and functional status
- Co-morbidities and life expectancy
- Previous documented ceiling of care or wishes
- POCUS showing no cardiac activity
How should an adverse outcome from a procedure be handled in an emergency department?
- Open disclosure to the patient and/or family
- Clear documentation of events
- M&M referral for case review
- If due to faulty equipment then remove from workplace and notify equipment team for audit and repair or replacment
- Review the hospital guideline or process and consider updating
What factors would make you consider active management in patient with very morbid pathology?
When considering using duty of care to keep someone against there will, what must be considered?
What issues need to be considered when a patient requests to be “DNR”?
What are the differences between collectivist and idividualist cultures when it comes to healthcare?
How should you approach history taking and consent with individuals from collectivist and individualist cultures?
How should history taking and consent be approached in people of aboriginal background?
How should you approach end of life conversations with family members?
- Private environment
- Include patient if possible
- Explain the change of focus from resuscitation to comfort care
- Engage treating teams
- Engage stakeholders, family, priests or other cultural representatives
- Consider including social workers
What is cultural competency in healthcare practice?
- a set of attitudes, skills and knowledge
- allow effective interaction in cross cultural situations
What factors would potentially lead you to pursue active management in a potentially endstage patient (ie nursing home patients)?
- Lack of significant co-morbidities
- Good pre-morbid quality of life
- Potential criminal cause of the deterioration (ie physical abuse with head injury)
- Advanced care directives
- Patients wishes/preferences
- MPOA preference
- Advice from hospital legal team or medical superintendant
If a patient wishes to discharge against medical advice, what questions need to be answered before they can go?
- Is the assessment/management complete
- Is the patient capable/competent?
- Can someone else legally determine their consent?
- What is the risk of DAMA?
- What is the risk of patient restraint?
