Ethics Flashcards
Principles of Bioethics (4)
Autonomy
Justice
Beneficence
Non-maleficence
Identify what Principle of Bioethics:
This is compromised when members of an indigenous tribe with no formal education should they agree to participate study.
Autonomy
Instances when a patient autonomy is taken into consideration
All patients should be evaluated as to their capacity to make autonomous decisions, regardless of the condition.
Eg. psychiatric patients, Severely Intoxicated , Pediatric
Ethical principle rooted in society’s respect for the individuals ability to make rational, uninfluenced decisions.
Autonomy
It includes the right of the patient to agree to a medical procedure and the right to refuse treatment.
The capacity of a patient to make an informed , rational, and uninfluenced decision regarding his medical treatment.
Autonomy
A 70yo woman, of sound mind , was diagnosed with stage 4 endometrial cancer. Feeling fulfilled with her life already. She decided not to undergo any treatment and opted for palliative care. The Physician respected her decision and complied. What ethical principle was applied?
Autonomy
The culture and sensitivity result of a 60year old man with CAP-MR revealed that the organism is highly sensitive to Ampicillin- Sulbactam, however, the patient experienced anaphylactic reaction with this drug decades ago. The physician opted to use other antibiotics.
What ethical principle is applied?
Non-maleficence
This means performance or doing of an act.
Feasance
Performance of an act that is solely unfair and unlawful.
Malefeasance
Wrong performance of a lawful act, negligently or contrary to the accepted standards.
Misfeasance
Omission of an act that should have been done
Nonfeasance
Ethical principle involved in a doctor spending more time and attention to a patient as warranted by the condition but not necessarily ask for an additional fee.
Equity
US Public Health Service Syphilis Study at Tuskegee (1932-72). (5)
- Study was unjustically unjustified, and the results were disproportionately meager compared with known risk to human subjects involved.
- Participants informed consent was not collected
- Researchers told the men they are treated for “bad blood” ( Syphilis, anemia, fatigue)
- Penicillin was not offered as treatment in the study
- The men received free medical exams , free meals, and burial insurance
This focuses on the obligations of the physician-investigator
Declaration of Helsinki
This focuses on the human rights of the human subject
Numberg Code
The creation of Belmont report is prompted by the inhumane study of this disease.
Syphilis
Fundamental principles included in 1979 announcement of the Belmont Report
- Respect for Persons
- Beneficence
- Justice
Set of research ethics principles for human experimentation because of the experimentation at the end of WWII
Nuremberg Code (1947)
Preventing inconsistencies in making decisions under Medical Bioethics (3)
- Defer to extend help by deferring to the existing laws of land
- Do the publicity test: ask the question “would I decide this way if the decision is publicly known in social media”.
- Do not decide in haste . Discuss with colleagues.
Not a positive step for criticism to foster a healthy criticism scenario.
Superiority of Senior consultants during discussions.
The aim of health criticism is to better the healthcare system.
Methods used in Bioethics.
- Analysis
- Findings
- Reasoning
If the patient has no advanced directives, what can the family do?
Consult the hospital’s ethics review board
Principle of double effect is regarded as a combination of which bioethical principles.
Beneficence & Non-maleficence
Ethical requisites for informed consent? (3)
- Patient has the capacity to make decisions
- Decision is voluntary and free from duress or coercion
- Patient is adequately informed of all relevant information
**Does not require that the patient is capable of paying medical dues after treatment **
Transferance and Countertransference in ethics in doctor-patient relationships.
**Transference **
Unconscious displacement of earlier relationship experiences and expectations onto the physician.
Countertransference
Corresponding unconscious emotional reaction of the physician to the patient.
Questions to justifiably balance benefit and harm.
- What is expected actual benefit or harm for the patient and the evidence that supports the benefit and harm?
- How often will harm occur and can it be preventable?
- Are there any other treatable options available and what are the harm expected if condition is not treated?
Required contents of an informed consent document for medical research.
- Use first person, especially in the certificate of consent
- Statement of agreement at the conclusion of the document
- Signed by the adult patient, attending physician , and two adult witnesses.
Purpose of informed consent before surgery?
- Protects the patient’s status as a human being
- Prevents coercion and deception
- Asserts patients autonomy
** does not assure the physician will be paid of their services**
Small tribe of indigenous people still living in a very traditional way with limited contact to the modern world.
- Vulnerable population
- They may lack understanding as to what is being done with them during the study.
Vulnerable populations for research
Include but are not limited to:
- Children, Minors , Pregnant women, Fetuses, Human in vitro fertilization, prisoners, employees, military personnels and students in hierarchical organizations, terminally ill, comatose, physically and intellectually ill, comatose, physically and intellectually challenged, institutionalized, elderly, visual or hearing impaired, ethnic minorities, refugees, international research, economically and educationally disabled and healthy volunteers.
Obligations of a physician in the currently accepted standard of medical practice.
- Fully inform the patient of their condition and risk of treatment
- Continue to provide medical care once consent is secured and relationship started
- Refer the patient to a specialist if necessary
