Ethics

Question 1

Autonomy

Answer 1

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

Question 2

what is beneficence

Answer 2

trying to do good for others

Question 3

you must follow the last known wishes of

Answer 3

the pt

you with whatever the last clear wishes are

Question 4

Advance directives

Answer 4

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

Question 5

when does the healthcare proxy take effect

Answer 5

when the pt has lost the capacity to make decisions

Question 6

Order of decision making

Answer 6

1. a pt with capacity supersedes all else
2. healthcare proxy that includes an agens (person) to carry out wishes
3. living will )advance directive that are a matter of documentation)
4. 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

Question 7

Ethics committee

Answer 7

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

Question 8

court order

Answer 8

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

Question 9

Psychiatric evaluation of the patient

Answer 9

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.

Question 10

Minors

Answer 10

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

Question 11

Abortion

Answer 11

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”

Question 12

Brain Death

Answer 12

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.

Question 13

USMLE will want you to do what

Answer 13

discuss, educate, explain, and confer before everything else

Question 14

Consent

Answer 14

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

Question 15

a pt signs consent for an ovarian biopsy on the left side at surgyer you find cancer on the right sid

Answer 15

wake the pt up and obtain consent to remove ovary ont he right side

Question 16

Do not resuscitate orders

Answer 16

do not resuscitate orders refer only to witholding cardiopulmonary resuscitation. they do not refer to withholding any other form of therapy

Question 17

Pysician assisted suicide

Answer 17

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

Question 18

Euthanasia

Answer 18

is the physicisan administering treatment intended to end or shorten the life of the patient

Question 19

Physician ehtics come before

Answer 19

legal requirements. you cannot do something unethical even if it is legal at the moment

Question 20

Terminal sedation and law of double effect

Answer 20

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

Question 21

the question is of intent

Answer 21

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.

Question 22

Futile care

Answer 22

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

Question 23

organ and tissue donation

Answer 23

paymetn for organ donations is unacceptable; however, payment for renewable tissues such as sperm and aeggs is acceptable

Question 24

consent for organ donation

Answer 24

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.

Question 25

confidentiality

Answer 25

the pts rigth to confidentiality can be borken whent here is danger to others. examplys of ethically acceptable circumstances in which confidentiality can be broken are STDs, HIV/AIDS, airborne communicalbe disease such as tb and court orders demanding information.

Question 26

the pts right to confidentiality cannot be broken for

Answer 26

employers, coworkers, government agencies, or family and friends

Question 27

confidentiality is improtant but not as

Answer 27

important as protecting others from harm

Question 28

Notifying for HIV

Answer 28

you have the right to notify the partner or to disclose the pts hiv status to the health department so taht they can notify the partner

Question 29

Do HIV positive healchare workers need to disclose their status to teh pts or their employers

Answer 29

no

Question 30

when do you have to provied health-related protected records to government.

Answer 30

only if htey have a volid warrant or subpoena from the courts

Question 31

Doctor/Patient Relationship

Answer 31

a physician is not obligated to accept everyone coming to him or her as a patient. the physician has the right to end the doctor/patient relationship but must give the patient sufficient time to obtain another caregiver. small gifts from patients are acceptable as long as they are not tied to a specific treamtent request. romantic or sexual contact between patients and their current physicians is never acceptable

Question 32

Gifts from industry

Answer 32

unlie a small gift from a patient, gifts from industry such as drug companies are never acceptable. even samll items from industry such as pens, penlights, pads, and cups are unacceptable. eals in direct association with education activites are not considered gifts

Question 33

Elder abuse

Answer 33

you can report elder abuse againste the consent of the pt. this is base don the conept that abused older adults may be too weak, fragile, or vuleraable to protects themselves or remove themselves from an environment of potential harm, elder abuse is treated ethically like child abuse.

Question 34

domestic violence ans spousal abuse

Answer 34

unlike hcild abuse, domestic abuse cannot be reported against the pts wishes, you can report and intervene only with the consent of the patient.

Question 35

Impaired Drivers (seizure disorders and driving)

Answer 35

this is one of the least clear areas nationally, and the states have no unifomrity of laws. you must answer “suggest that the ptfind another means of transportation

Question 36

wrong answers for impaired drivers

Answer 36

confiscating car keys and reporting to law enforcement

hospitalizing the pt

refusing to let the pt get in her car

Question 37

Execution of prisoners

Answer 37

it is never ethical for a physician to participated in executions at any level. you cannot ethically formulate a lethal injection or even do so much as pronounce a prisnoer dead. even if state law makes execution legal, you as a physician are not to participate at any level

Question 38

torture

Answer 38

physicians are never to participate in the torture of prisoners or detainees. even if the question states that you are in the military, your ethical obligation as a physician supersedes you obligation to the military.this would include

refusing orders from military superiors to participate in torture
keeping the torure safe so taht it is not fatal or damaging

tjust answer no

Question 39

are you obligated to report torture

Answer 39

yes