Ethics Flashcards
What are the four principles of bioethics?
Respect for autonomy, beneficence, nonmaleficence, and justice
What is autonomy?
Self determination that is free from both controlling interferences by others and personal limitations preventing meaningful choice
Personal limitations that prevent meaningful choice are things like what?
Inadequate understanding, faulty reasoning
How do we as physicians demonstrate respect for autonomy?
Sharing information with the patient about their condition and options for therapy, obtaining informed consent, and accepting delegated authority
Physicians have a responsibility to provide information and help their patients understand what?
Their medical condition and options for treatment
Consent occurs when?
A patient gives permission to avail themselves of various medical services
What are the requirements for consent to qualify as informed?
Competence, disclosure, understanding, voluntariness
What are varieties of consent?
Express, implied, tacit, presumed
What is considered future-oriented consent?
Personal identity and advance directives
What are examples of circumstances where the ability of the patient to exercise autonomy and/or provide informed consent can be complicated?
Emergency conditions, when information is not or not fully disclosed, when there are conflicting priorities or necessities, when patients are incapacitated, when patients are minors
In emergency conditions, how should the physician proceed?
As medically indicated even without consent, or with “presumed consent”
Physicians should always provide information about a patient (including errors in care) to the patient, unless…
The patient doesn’t want it and/or preferentially wants someone else to receive it on their behalf
When can you pace the release of information to a patient?
If the patient is simply not able to comprehend the totality of the information at one time
When can physicians decline to follow a patient’s directives?
When they endanger public health, have the potential to harm others, or they require a scarce resource
When a patient lacks decision-making capability, what is the ethical responsibility of the physician?
To identify an appropriate surrogate to make the decisions, to provide advice, guidance, and support to the surrogate, and to assist the surrogate to make decisions in keeping with the standard of substituted judgement and the patient’s best interest
What is substituted judgement?
The patient’s preferences as expressed in an advanced directive or as documented in the medical record, the patient’s views about life and how it should be lived, how the patient constructed their life story, and the patient’s attitude toward sickness, suffering, and certain medical procedures
Decisions regarding the patient’s best interest should include consideration of what?
The pain and suffering associated with the intervention, the degree of and potential for benefit, the impairments that may result from the intervention, and the quality of life as experienced by the patient
When should you consult an ethics committee or other institutional resource?
When no surrogate is available, when ongoing disagreement about a treatment decision can’t be resolved, or when the physician judges that the surrogate’s decision is “off”
Why might a physician judge a surrogate’s decision to be “off”?
It is clearly not what the patient would have decided, it could not reasonably be judged to be in the patient’s best interest, or it primarily serves the interests of the surrogate rather than the patient
Who can legally provide informed consent?
Those 18 or older, emancipated minors, minors with specific conditions/requirements, and mature minors
What specific conditions/requirements make a minor able to legally provide informed consent?
Sexually transmitted infections, birth control, pregnancy, assault victims, substance abuse, psychiatric illness
What are emancipated minors?
Minors taking on commitments and responsibilities typical of an adult
Decisions for pediatric patients usually involve what?
A three-way relationship between the minor patient, the patient’s parents (or guardian), and the physician
Since consent implies a decision for self, parents provide what instead of consent for their child?
Permission for care
When there is a legitimate inability to reach a consensus about what is in the best interest of the child, what should receive preference?
Generally, the wishes of the parents/guardian should receive preference
When dealing with consent related to minors, when should you consult an ethics committee?
When there is a reversible life-threatening condition and the patient (if capable) or parents/guardian refuse treatment that the physician believes is in the patient’s best interest or when there is a disagreement about what the patient’s best interests are
What is beneficence in medicine?
Promoting the welfare of patients, not just avoiding harm. It is medicine’s goal, rationale, and justification
What is nonmaleficence?
Avoiding harming or inflicting the least harm possible to reach a beneficial outcome
Beneficence is the primary goal of medicine, but what is the limiting factor on how far a physician can go to achieve that goal?
Autonomy
What is paternalism?
When a physician intentionally overrides a patient’s preferences regarding an intervention in pursuit of a benefit
What is the Principle of Double Effect?
A single act, which has one good effect and one harmful effect, is not always morally prohibited
According to the principle of double effect, when is could make an act not morally prohibited?
The act must be good or at least morally neutral, the agent intends only the good effect not the bad effect, the bad effect must not be a means to the good effect, and the good effect must outweigh the bad effect
What are other requirements of beneficence and nonmaleficence?
Confidentiality, duty, and non-abandoment
What does the AOA code of ethics state about confidentiality?
The physician shall keep in confidence whatever he/she may learn about a patient in the discharge of professional duties
In regards to alcohol and drug abuse, what do confidentiality requirements include?
Alcohol and drug abuse records may not be disclosed unless authorized, and a minor who voluntarily seeks treatment for alcoholism, alcohol abuse, or drug abuse may receive treatment without notification or consent of the parents
It is unnecessary to obtain patient authorization for release of information when disclosure is related to what?
Treatment, payment and operations, serious contagious disease, child abuse, serious and immediate threat or harm to identifiable persons, and legal search warrant
What is HIPAA?
A privacy rule that requires health care providers to obtain patient authorization to use or disclose individually identifiable health information, with broad exceptions
What are examples of reportable health conditions?
AIDS, HIV, hep B, chlamydia, gonorrhea, syphilis, latent tuberculosis, animal bites, varicella, measles, mumps, etc
What are examples of reportable abuse or neglect?
Duty to report child abuse or neglect, or that of endangered adults
Who is considered an endangered adult?
An individual who is at least 18 years of age and incapable of managing or directing the management of the individual’s property or providing care and is harmed or threatened with harm
In most cases, what is a therapist required to do if a patient poses an imminent threat to themself, the therapist, or a third party?
They are required to breach confidentiality, with the necessary information being divulged to someone who is capable of taking action to reduce the threat. In most cases, the person in danger and law enforcement would be notified
What is duty as state by the Hippocratic Oath?
Help the sick according to my ability and judgement
What is an example of a legal requirement for duty?
EMTALA - emergency medical treatment and labor act
What is abandonment?
Not helping the sick according to a physician’s ability and judgement. A physician is never justified in abandoning a patient
What are reasons to deviate from typical responsibilities of duty?
Conscientious objection, abuse of staff, non-compliance, drug diversion, must be non-discriminatory
How can you deviate from typical responsibilities while avoiding abandonment?
Give reasonable written notice to a patient when the physician withdraws from the case, in order to allow the patient to find another physician
With circumstances not considered, justice requires the distribution of resources how?
To each person an equal share
With circumstances considered, how does justice require the distribution of resources?
To each person according to merit, to effort, to contribution, to need, to free-market exchanges
What is express consent?
Consent directly given by voice or in writing
What is implied consent?
Consent made evident by signs, actions, or facts, or by inaction or silence
What is tacit consent?
Consent given due to lack of identifiable objection in someone capable of doing so
What is presumed consent?
Consent given merely by virtue of what is typically done. Patient does not need to even be aware of circumstances. Assumed in emergencies.
When obligations of nonmaleficence and beneficence conflict, what should generally be given priority?
Generally, obligations of nonmaleficence override obligations of beneficence
