Ethics Flashcards
Obligation to respect patients as individuals (truth telling, confidentiality), to create conditions necessary for informed consent, and to honor their preference in accepting or not accepting medical care.
Respect patient autonomy
Physicians have a special ethical (fiduciary) duty to act in the patient’s best interest. May conflict with autonomy (an informed patient has the right to decide) or what is best for society (traditionally patient interest supersedes).
Beneficence
“Do no harm.”
Must be balance against beneficence; if the benefits outweight the risks, a patient may make an informed decision to proceed (most surgeries and medications fall into this category).
Nonmaleficence
To treat persons failry and equitably.
This does not imply equally (eg. triage)
Justice
A process that legally (not just a document/signature) that legally requires:
Disclosure, Understanding, Mental capacity (unless compromised), Voluntariness (freeedom from coercion)
Exceptions: Patient lacks decision-making capacity or is legally incompetint, implied consent (emergency), therapeutic privilege, Waiver (patient expicitly waives right)
Informed consent
There are a few exceptions to the required consent for minors. What are they?
married
self-supporting
in military
What are the situations in which parental consent is usually not required: parents can’t stop kids from getting treatment for…
sex (contraception, STDs, pregnancy)
drugs (addiction)
Rock and roll (emergency/trauma)
Decision-making capacity
I must determine whether the patient is psychologically and legally capable of making a particular health care decision.
Components: >/= 18 years of age (exceptions), patient makes choice, patient is informed, decision remains stable over time, decision is consistent with patient’s values and goals (not clouded by mood disorder), decisions are not result of delusions or hallucinations
Patient is not adherent
attempt to identify the reason for nonadherence and determine his/her willingness to change;
do not coerce the patient into adhering or refer him/her to another physician
Patient desires an unnecessary procedure
attempt to understand why the patient wants the procedure and address underlying concerns.
Do not refuse to see the patient or refer him/her to another physician. Avoid performing unnessesary procedures
Patient has difficulty taking medications
provide written instructuions; attempt to simplify treatment regimens; use teach-back method (ask patient to repeat medication regimen back to physician) to **ensure patient comprehension **
Family members ask for information about patient’s prognosis
Avoid discussing issues with relatives without the permission of the patient.
A patient’s family member asks you not to disclose the results of a test if the prognosis is poor because the patienet will be “unable to handle it.”
Attempt to identify why the family ember believes such information would be detrimental to the patient’s condition. Explain that as long as the patient has decision-making capacity and does not indicate otherwise, communication of information concerning his/her care will not be withheld.
A child wishes to know more about his/her illness
Ask what the parents have told the child about his/her illness. Parents of a child decide what information can be relayed about the illness.
A 17-year-old girl is pregnant and requests an abortion.
Many states require parental notification or consent for minors for an abortion.
Unless she is at medical resk, do not advise a patient to have an abortion regarless of her age or the condition of hte fetus.
