Ethics Flashcards
Healthcare Quality
Comanagment team model:
- Automatic involvement of co-managing physicians (not only when consulted) –> who proactively identifies medial conditions and manages them.
- Defining clinical proceses through systemic review and continous cycles of testing and assessment.
Informed Consent
Genetic Information Nondiscrimination Act: aims to eliminate discrimination by private employers and health insurance companies based on genetic information. Exclusion of employees at higher risk for genetic disease using results from genetic test is illegal.
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Diagnosis:
Proposed treatment or procedure
Alternative treatment options
Risk/benefits of proposed tx, common complications, rare but major complications
Risk of refusing
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Just as patients have the right to refuse trainee involvement in their care, physicians have the right to refuse to care for patients who declined the involvement of medical trainees in elective procedures. For elective procedures, patients have time to find another physician. For emergency medical conditions, physicians cannot refuse care to patients.
Professional conduct
Sexual/Romantic relationship with parent of patient:
The larger the role the individual plays in medical decision-making for the patient, the more problematic a sexual relationship between that individual and the physician becomes.
Physicians should refrain from sexual or romantic interactions with key third parties (parents, guardians, spouse, or partner)
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Accepting gifts:
Consideration includes the gift’s cost, the meaning of the gift to the patient, and the patient’s probable motivation and expectation for giving the gift. The potential impact on the physician - patient relationship of refusing the gift should also be considered.
- Can accept the gift if not excessive
- If uncertain or cannot assess the motivation –> decline
There is no specific guidelines regarding social contact outside of professional relationships. Invitation to major events (wedding) are more ambiguous. Physicians should use through clinical judgment.
Root Cause
- Collect data
- Create causal factor flow chart
- Identify root causes of each contributor
- Generate rec’s and implement change
- Measure success
QI tool used to identify what, how and why an undesirable outcome occurred.
Decision Making Capacity
All patients, including those with intellectual disabilities, must freely consent to sterilization and are allowed to refuse a procedure.
Patient Safety
Helps QI interventions achieve their desired change.
- Plan: collect background info, identify specific goal & intervention
- Do: implements plan and collect data
- Study: analyze data, assess whether intervention met goal
- Act: determined lesson learned, modify plan for next cycle
Proportionality
Considers whether a treatment goal is sufficiently worthwhile and also considers weather a proposed medical intervention for achieving the goal is proportional in terms of potential harm and achievable benefit.
Patient confidentiality
Adult patients have the right to authorize release of their medical records to other entities or themselves. Such request should be honored, even if patient has outstanding balances. However, healthcare facilities may assess a reasonable record fee.
Handoffs
- Patient demographic (age, name, MRN, allergies)
- Clinical status: current medical problems, vitals signs
- Care plan: brief summary of hospitalization, current treatment, anticipated discharge
- Anticipated problems & course of action
- Pending action and follow-up
Patient autonomy
Poor prognosis is not the same as medical futility.
Medical futility: treatment that can have no beneficial physiological effect.
Physicians are not ethically obligated to provide treatment that is futile (ex. Dialysis in an unconscious patient expected to die in a few days.)
Physicians can withdraw futile treatment irrespective of the proxy’s wishes. However, there should be a discussion beforehand. If the proxy refuses comfort care, the ethics committee would be the next step, then court order.
Physical patient communication
When communication with a large family system, it often helps to establish a primary point of contact who is able to concisely communicate with family’s questions and concerns.
This point of contact may not be the surrogate decision maker, however the surrogate is the person making the medical decisions.
Research ethics
Institutional review board (IRB) is a committee with the authority to review, approve, disapprove, or require modifications in research activities involving human participants.
Projects must be approved before a study begins.
Any and all modifications require re-submission and approval before implementing the change.
IRB is allowed to waive consent if minimal risk is present, or if there is risk in emergency situations.
