Ethics Flashcards
Beneficence
Physicians have a special ethical (fiduciary) duty to act in the pt’s best interest. May conflict with autonomy (an informed pt has the right to decide) or what is best for society (e.g. Mandatory TB treatment). Traditionally, pt interest supersedes.
Nonmaleficence
Do no harm. Must be balanced against beneficence, if the benefits outweigh the risks, a pt may make an informed decision to proceed (most surgeries and meds fall into this category)
Justice
To treat persons fairly and equitably. This does not always imply equally (e.g. Triage)
Informed consent
A process that requires
Disclosure: discussion of pertinent information
Understanding: ability to comprehend
Capacity: ability to reason and make one’s own decision
Voluntariness: freedom from coercion and manipulation
Pts must have an intelligent understanding of their diagnosis and the risks/benefits of proposed treatment and alternative options, including no treatment.
Exceptions of informed consent
Patient lacks decision-making capacity or is legally incompetent
Implied consent in an emergency
Therapeutic privilege - withholding information when disclosure would severely harm pt or undermine informed decision making capacity
Waiver - pt explicitly waives the right of informed consent
Consent for Minors
Minor =
Situations where parental consent not required
Sex: contraception a, STIs, pregnancy
Drugs: substance abuse, mental health
Rock & Roll: emergency/trauma
Decision making capacity
Pt is >18 years old or legally emancipated
Pt makes and communicates a choice
Pt is informed (knows and understands)
Decision remains stable over time
Decision is consistent with pt’s values and goals, not clouded by a mood disorder
Decision is not a result of altered mental status (e.g. Delirium, psychosis, intoxication)
Oral advance directive
Incapacitated pt’s prior oral statements commonly used as guide. Problems arise fro variance in interception. If pt was informed, directive was specific, pt made a choice, and decision was repeated over time to multiple people, then oral directive is more valid
Living Will (Written AD)
Describes Tx the pt wishes to receive or not if he/she loses decision making capacity. Pt directs physician to withhold or withdraw life-sustaining treatment if he/she develops a terminal disease or enters a persistent vegetative state
Medical power of attorney
Pt designates an agent to make medical decisions in the event that he/she loses decision making capacity. Pt may also specify decision in clinical situations. Can be revoked by pt if decision making capacity is intact. More flexible than a living will.
Surrogate decision-maker
If pt loses decision making capacity and has not prepared an AD, individuals who know the pt must determine what the pt would have done.
Priority of surrogates: spouse > adult children > parents > adult siblings >other relatives
Confidentiality
Respects pt privacy and autonomy. If pt is not present or is incapacitated, disclosing information to family and friends should be guided by professional judgment of pt’s best interest.
Pt may voluntarily waive the right to confidentiality (e.g. Insurance company request.
Exceptions to confidentiality
Potential physical harm to other is serious and imminent
Likelihood of harm to self is great
No alternative means exist to warm or to protect those at risk
Physician can take steps to prevent harm
Examples to Pt confidentiality
Reportable diseases (STIs, TB, hepatitis, food poisoning) - physicians may have duty to warn public officials, who will then notify the people at risk
The Tarasoff decision - require physician to directly inform and protect potential victim from harm
Child and/or elder abuse
Impaired automobile drivers (e.g. Epileptics)
Suicidal/homicidal pt’s
