Ethics Flashcards
If an adult patient who is mentally intact desires to refuse a treatment or test, what is the next step in management?
Discuss the reasons before honoring his/her wishes
Who determines Capacity?
Doctors
Who determines Competence?
Courts/Judges
Is capacity sufficient to make a medical decision?
Yes
When is a Psych consult indicated for ethical matters?
If the patient’s capacity to understand is not clear
When should a psych consult NOT be done?
When pt competence/Capcity is Clearly present
When pt is comatose/clearly does not hv capacity
Which minors can be considered Emancipated?
Those who :
Live independent of their parents and are self-supported
Married
In Military
When is a minor considered partially emancipated?
In terms of sexual/reproductive related issues and substance abuse –> these minors can mk decisions w/o parental notification/consent
What condition is an exception to Partial Emancipation and requires parental consent/knowledge ?
Abortion (Recommend that parents be notified or initially discuss why the pt does not feel she can share this with her parent(s)
Are parents allowed to refuse lifesaving therapy for minors?
No, regardless of parental belief/lifestyle. A minor MUST receive life-saving therapy. If they refuse–>considered child abuse!
What is required for informed consent to be granted by a patient?
Pt must have capacity and be fully informed?
What are the 5 prinicples of Informed Consent?
1) Pt. must be informed of the benefits
2) Pt. must be informed of the risks
3) Pt. must be given alternatives
4) Information must be in a language pt can understand
5) Informed consent must be given for each intervention/procedure
What is the rule for a woman’s right to refuse life-saving treatment for her fetus?
A pregnant woman CAN refuse life-saving treatment for her unborn child.
The fetus is considered a part of her body until it is born
A parent cannot refuse treatment for a child that is living outside of the womb!!
What medical conditions allows a physician to inform close contacts/associates at risk about a pt without their consent?
Transmissible Diseases, such as: HIV Tb Syphilis Gonorrhea
Psychiatric pt who may be planning to harm others
What is required for an advanced directive to be valid?
The patient must have capacity
What is considered the strongest advanced directive?
Health Care Proxy
What can be used as an alternative if a pt does not have a health care proxy?
Living Will
What is required of the living will in order for it to be useful/valid?
It must be clear and concise; no generalizations
ex: “No heroic measures” cannot be used to determine the type of care a pt should/should not receive
What should/should not be done when a DNR is in place?
No endotracheal intubation and no CPR if one cannot breathe independently or one’s heart stops.
Testing and medical treatment can still be done
When should an ethics committee be used?(3)
If pt is an adult who lack capacity
If there are no clear wishes/instructions from the pt
If the caregivers/family are divided regarding what the pt’s wishes are
When is a court order necessary?
When all other attempts at determining pt wishes (including ethics committee) prove futile
What should be done regarding fluids and nutrition to a pt?
Adult with Capacity: Whatever they decide
Adult w/o capacity and proxy/clear wishes: as pt stated prior to losing capacity
Adult w/o capacity and NO proxy/clear wishes: provide nutrition/fluids
What is the rule regarding pain meds that can end life?
It is ok to give pain medication for the purpose of relieving pain/suffering even though that medication/dose may shorten the pts life.
It is NOT ok to give the pt the medication or for the physician to administer it thesole purpose of ending the pts life, this is Physician-assisted Suicide/Euthanasia, both are illegal.
What are the criteria to declare someone Brain Dead?
Loss of consciousness
Absence of motor response to painful stimulus
Absent Brainstem reflexes
(Pupillay, Oculocephalic, Oculovestibular, Corneal,
Facial grimacing to noxious stimuli, Gag, or Cough)
Apnea
Acute CNS catastrophe
Absence of elctrolyte/acid-base imbalance
Absence of poisoning/drug intoxication
Requires exam by a neurologist/neuro-related subspecialty physician
