ethics

Question 1

what are the 5 ethical principles? (think: nutritionists don’t recommend eating Just BRAN)

Answer 1

Justice
Beneficence
Respect for persons
Autonomy
Nonmaleficence

Question 2

autonomy means what and includes what two aspects of a patient?

Answer 2

patient’s right to make their own medical decisions, according to those dictated by their:

• religion
• culture

Question 3

t/f: according to the principle of autonomy, patients have the right to forgo medical txt of any kind

Answer 3

true– regardless of prognosis or condition state AND if they are competent

Question 4

if a patient is incompetent, the principle of autonomy dictates they should be txted how?

Answer 4

according to their previously expressed wishes

Question 5

t/f: it is always ethically mandatory to provide food and fluid by artificial means

Answer 5

false…

Question 6

what is mandatory that all patients receive?

Answer 6

comfort–> ask would administering therapy promote comfort? or simply prolong suffering?

Question 7

what does Dr Kane consider one of the most important goals of medicine?

Answer 7

relieving suffering

Question 8

what 2 ethical principles must be balanced? what do each of these mean in translation?

Answer 8

beneficence (duty to improve health and QOL) and nonmaleficence (duty to do no harm)

Question 9

which ethical principle should be employed with advanced dementia patient who at risk of aspiration because they must be restrained to keep their nasogastric tube in place, otherwise they will rip it out? what should be done?

Answer 9

nonmaleficence–> pull tube feed

Question 10

what is the hierarchy of choice for making decision if patient is incompetent?

Answer 10

1. advanced directives/living wills (written choices by patient prior to becoming incompetent–> EX. DNR)
2. proxy directives( power of attorney given to someone for HC choices by patient before becoming incompetent)
3. health proxy/substituted judgment (selecting choices that patients themselves would have made, based on best knowledge of patient)
4. courts

Question 11

what is the proxy hierarchy if a patient did not have an advanced or proxy directive?

Answer 11

guardian (if child) or spouse, adult children (if applicable), parents, adult siblings

Question 12

what happens if a family and clinicians disagree on the course of txt (ex. a child’s family refuses to get the child cancer care based on religious beliefs)?

Answer 12

case will go to an ethics committee for review and in the mean time, patient will undergo txt