Ethics Flashcards
Autonomy
pts have the sole right to determine what treatents they shall and shall not accept. autonomy, ethically, is more important than beneficence. trying to help someone is not as iimportant as following her wishes
what is beneficence
trying to do good for others
you must follow the last known wishes of
the pt
you with whatever the last clear wishes are
Advance directives
tell the caregivers the parameters of care that the pt wanted. the agent is the person designated by the pt to carry out the pts wishes. this term is sometimes used interchangeable with healhcare proxy. the healthcrae proxy is the written document outlining the parameters of care. the major problem with the proxy is that the details of care are often not clear. it is not helpful to just say, no heroic measures. in order to be useful, the document must specifically state, no intubation, no cpr, no che, no dialysis. the proxy can also specifically state wishes about fluid and nutrition. if the proxy says, no nasogastric tube, no artificial feeding, then it is useful
when does the healthcare proxy take effect
when the pt has lost the capacity to make decisions
Order of decision making
- a pt with capacity supersedes all else
- healthcare proxy that includes an agens (person) to carry out wishes
- living will )advance directive that are a matter of documentation)
- persons clearly familiar eith the pts wishes, can be a friend if they can clearly proves they knew what the pt wanted more than the family
5 family the order of decision making starts with a spouse, if no spouse it goes to children, then parents, then siblings
Ethics committee
importants when a pt has lost capacity to make decisions and the advance directive is missing or unclear. the ethics comittee is also important on issues of medical futility. this is when the pt of healthcare proxy is asking for tests and treatments taht may have no benefit
court order
improtant when the pt has no capacity to understand and the family is in diagreement
right answer when:
pt has no capacity and no proxy;family is split about whether to continue care
caregivers want to withdraw care and the ethics committee cannot reach a conclusion
Psychiatric evaluation of the patient
a psychiatric consult is improtant when it is not clear if the patients has capacity to understand. if the question clearly states that the pt has capacity to understand, a psychiatric evaluation is not necessary. if the patient is clearly delirious or psychotic, psychiatric evaluation is not necessary.
Minors
minors do not have dexision-making capacity. they cannot consent to or refuse medical treatments. only the parents or legal guardian can consent and refuse. exceptions are contraception, prenatal care, substance abuse treatment, and sexually transmitted diseases (STDs) including HIV/AIDS
Abortion
the states are split on parental notification laws. some require it, and some dont. your answer will be something like “tell the minor patient sto notify her parents”
Brain Death
brain death is considered death in our legal system. if the pt is brain dead, you do not need consent to stop therapy such as mechanical ventilation or antibiotics. court order and ehtics committee are not correct answers.
USMLE will want you to do what
discuss, educate, explain, and confer before everything else
Consent
only an adult can consent to procedures, and each procedure needs individual consent. consent is implied in an emergency. the person doing the proceduremust obtain consent. adverse effects of a proceudre must be xplained to make the consent valid and the consequences of refusing a procedure must be explained to make the consent valid. prengnat women can refuse procedures and treamtents for their unborn children. telephone consent is valid
a pt signs consent for an ovarian biopsy on the left side at surgyer you find cancer on the right sid
wake the pt up and obtain consent to remove ovary ont he right side
Do not resuscitate orders
do not resuscitate orders refer only to witholding cardiopulmonary resuscitation. they do not refer to withholding any other form of therapy
Pysician assisted suicide
always a wrong answer, even in states whihc it is legal to do so. ethical requireemients for physicians supersed legality. this is administered by the pt but it is still unethical
Euthanasia
is the physicisan administering treatment intended to end or shorten the life of the patient
Physician ehtics come before
legal requirements. you cannot do something unethical even if it is legal at the moment
Terminal sedation and law of double effect
it is acceptable to administer pain medication even if there is the possibility of the treatment shortening the pts life. for example, it is acceptable to give pain medications to a persone with copd who has metastatic cancer even if the only wy to relieve pain is to give enough opiates that breathing may be impaired, causing the pt to die earlier
the question is of intent
if the medications are given with the intent to relieve pain, and as an adverse effect they shorten life, it is ethical. if the primary intent is to shorten life, it is unethical.
Futile care
a physician is not obligated to render care that is futile even if they family or pt wants it. if a pt is brian dead and the family insists that you continue mechanical ventilation, you are under no obligation to do so. you are under no obligation to perform tests and treatments you consider worthless
organ and tissue donation
paymetn for organ donations is unacceptable; however, payment for renewable tissues such as sperm and aeggs is acceptable
consent for organ donation
only the organ donor network should ask for consent for organ
it is an ethical conflict of interest for the physician to ask for consent for organ donation. the organ donor network also has fewer refusals thna thephysician. organ donor cards give an indication of the patients wihses, but the famimly can refuse organ donation even if the pt has an organ donor card.
