Ethics

Question 1

Explain the fiduciary relationship b/w patient and physician.

Answer 1

this involves the physician’s willingness to put the patient’s interests ahead of their profit interests
it also involves a willingness to make some personal sacrifice and assume some personal risk

Question 2

What principle is the main guiding force in the fiduciary relationship?

Answer 2

beneficence

Question 3

What are the 3 reasons that a doctor can refuse to see a patient?

Answer 3

adversarial doctor patient relationship
threat to personal safety
personal moral objections

Question 4

What is an example of an adversarial doctor patient relationship?

Answer 4

when a father of a patient kicks a hole in the office wall

or when a patient spits in the doctor’s face

Question 5

What is an example when physicians treated patients despite the threat to personal safety?

Answer 5

during war…physicians are on the battle field caring for wounded soldiers

Question 6

What are some examples of when physicians refused to treat patients b/c of the threat to their personal safety?

Answer 6

1980s: some docs refused to see gay male patients out of fear of HIV
2002-2003: some docs didn’t see patients they thought were involved in the SARS epidemic
H1N1–some docs refused to see these patients.

Question 7

What is conscientious objection?

Answer 7

when a healthcare provider has a personal or moral objection to treating a patient.

Question 8

What are conscience clauses? What is another name for them?

Answer 8

aka refusal clauses

• *these laws allow medical providers to refuse to provide medically necessary services when they have a moral or religious objection
• *just b/c you receive public funds as a hospital & you’re a doc who refuses to perform an abortion–can’t be fired

Question 9

How many states don’t have conscience clauses?

Answer 9

only 3 states don’t have them

Question 10

Can you discriminate against docs who are willing to perform abortions b/c of conscience clauses?

Answer 10

No. Can’t discriminate against either.

Question 11

When was the first conscience clause enacted into law?

Answer 11

1973 called the church amendment. Right after the 1973 Roe v. Wade decision.

Question 12

By which year had all states enacted conscience clause legislation?

Answer 12

by 1978

Question 13

What is the significance of this piece of law: Omnibus Consolidated Rescissions and Appropriations Act of 1996?

Answer 13

it said that you can’t discriminate against physician training programs that don’t provide training for abortions

Question 14

There was an interesting addition to this piece of legislation. What was it? 1997 New Medicaid requirements on providing family planning services.

Answer 14

In here, they added that if you were religiously opposed to counseling on abortion you didn’t have to.

Question 15

Can you have health plans that don’t include coverage for abortions or controversial things?

Answer 15

Yes, 1998 – Exemption for religiously affiliated health plans.

Question 16

Weldon Amendment of 2004

What is the significance of this?

Answer 16

this amendment excused health care providers for not providing abortion referrals

Question 17

T/F there is sometimes a difference b/w what professionals consider ethical to do & what the law says.

Answer 17

True.

Question 18

In 1996, the law more clearly defined what a health care entity is in terms of the conscience clauses. What did this say?

Answer 18

Defined as: Individual physicians, post-graduate physician training programs, and participants in health professional training programs.
**some legislation has been proposed to expand that definition to cover nurses, therapists etc.

Question 19

What is the question that comes up w/ conscientious objection in terms of the balance b/w rights & obligations?

Answer 19

Right of Physicians: to not engage in medical practices that they have moral objections to
Obligation of Physicians: to get patients access to legal treatments even when they feel a moral implication against that treatment.

Question 20

What is Plan B?

Answer 20

a pill that must be taken w/i 72 hours of sex. it has high doses of levonorgestrel.
it delays ovulation, prevents sperm penetration, prevents fertilization, if already fertilized prevents implantation.
if already implanted, doesn’t do anything.

Question 21

What is the availability of Plan B?

Answer 21

It is available over the counter to patients 15 years old & above. Sometimes it is behind the desk of the pharmacy or in a locked box. It costs 50 dollars OTC b/c there is only one brand available. If you have a prescription, it is about half that price w/ insurance.

Question 22

If you are a health care provider in a rural area…what additional ethical questions arise w/ conscientious objection?

Answer 22

if you feel a moral obligation to not provide a number of procedures & you are the only doc around for hours…should you be practicing in this area? Should you allow someone else to practice there? Is it even possible for patients to access a provider who will perform their legally desired treatment?

Question 23

What are the rights of teenage girls when it comes to pregnancy, STDs, contraception?

Answer 23

STDs & contraception–>don’t need to inform parents. (Although they may see it on the insurance bill)
Pregnancy–>girl has all of the rights over her medical decisions EXCEPT abortion.
Abortion–>must get permission of the parents.

Question 24

Is a physician’s autonomy to not provide care they morally object to absolute?

Answer 24

No. 2 requirements.

1. they must provide info to the patient on how they can seek out that care from another HCP
2. only applies if lack of treatment doesn’t endanger the patient’s safety immediately (fired scrub nurse who wouldn’t help w/ an emergency C-section)

Question 25

What are the laws in terms of pharmacists’ rights of conscientious objection?

Answer 25

no federal regulations about this
some state regulations
Illinois: despite personal objection, pharmacists must provide contraception
CA: if personal objection, pharmacists must refer out in a timely manner

Question 26

What is a right to privacy issue w/ pharmacists & their conscientious objections?

Answer 26

Can a pharmacist ask why a medication is being prescribed?
**Ex: are you taking this oral contraceptive for the purpose of contraception or acne control? Oh, contraception? I will not fill it.

Question 27

What is an extreme view of doctors’ conscientious objections?

Answer 27

**Declaration of Geneva: basically, doctors’ opinions shouldn’t matter as much as patients’ rights. If you have a problem with that, you shouldn’t be a doctor.

Question 28

What is an ethical response to patients if you are an ObGyn doc who doesn’t perform abortions?

Answer 28

Inform your patients that that isn’t something that you do…but that that is something that other docs do. Here are their names. Be upfront from the beginning.