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rc: specialties woo hoo > Ethics > Flashcards

Ethics Flashcards

1
Q

T or F: Withdrawal of care must always be proven brain death.

A

False

  • i.e. 7 y.o. CP with MVA presents GCS 4. ICU x 1 week with no change. if parents certain to withdraw they can.
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2
Q

Jehovah’s witness need emergent blood. What do you do?

A

Transfuse now without parental consent.

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3
Q

What are exceptions to general duty to provide life-sustaining tx?

A
  • No Tx.
  • Tx harmful.
  • Going to die fast.
  • Withdrawal better palliation.

Details:

  • distress or suffering cannot be prevented or alleviated
  • tx clearly ineffective or harmful
  • irreversible progression to imminent death
  • life to be severely shortened regardless of tx; withdrawal or limited care provide better palliation
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4
Q

T or F: withhold or withdraw life-sustaining tx ethically appropriate if tx will not benefit child or adolescent.

A

True

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5
Q

Tips with withdrawal or withholding care:

A
  • interdisciplinary team involved +/- ethics committee or consultant
  • recognize cultural, religious, spiritual, moral bkgrd of families
  • document + review well decision well
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6
Q

Management decisions should ALWAYS be based on:

A

best interest of child

NOT:

  • cost to society
  • burden to fam
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7
Q

T or F: Autonomy may be superseded with CAS if child apprehended.

A

True.

  • CAS authority can supersede wishes of parent + child if apprehended.
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8
Q

T or F: tx decision from proxy decision makers cannot change once made.

A

False.

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9
Q

What is a substitute decision maker?

A
  • guardian respect child’s previously expressed wishes
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10
Q

What is a proxy decision maker?

A

= decision makers if pt incapable

  • two types:
    > substitute= know well and already discussed what they want done
    >surrogate= don’t know but decide in best interest
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11
Q

List 3 Hallmarks of Informed Choice

A

“VIC”

  1. VOLUNTARIness (no manipulation or coercion)
  2. Appropriate INFO
  3. CAPACITY
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12
Q

What is assent?

A

Info they can understand and appropriate choice of tx.

  • i.e. which arm to poke for BW
  • best for kids w/ partial skills to make decision
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13
Q

What’s the difference between emancipated versus mature minors?

A

Emancipated: no longer dependent on parent.

Mature= irregardless of age can understand health condition and tx

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14
Q

If you think parental decision not in best interest of child- what do you do?

A
  • explore decision w/ multi-D
  • 2nd opinion.
  • ethics committee or consultant
  • or if all consultants agree contrary then legal opinion
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15
Q

T or F: there is minimum age for decision making?

A

False.

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16
Q

Brain death =

A

irreversible cessation of entire brain (inclding brainstem)

AKA determination of death using neuro criteria

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17
Q

Brain death is most commonly after:

A
  1. TBI

2. Asphyxia injury

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18
Q

What are the 3 clinical components of brain death:

A
  1. Irreversible coma with known cause
    - not metabolic, toxin, drugs, T, lytes etc.
  2. Absence of brainstem reflexes
    - pupillary light, oculocephalic, corneal, oculovestibular, gag + cough
  3. Apnea
    - no resp effort after adequate stimulus

+ observation period x 2 examinations (12-24h)

19
Q

T or F: spinal reflexes may occur in brain death

A

True.

  • subtle, semi-rhythmic movement of facial nerve, finger flexion, tonic neck etc.
20
Q

What is the apnea test in brain death?

A

Goal: assess function of medulla in driving vent

1- ensure no other reason for apnea (i.e. sedative drugs, metabolic)
2- pre-O2 100%
3- vent adjusted to get PCO2 40
4- baseline gas
5- repeated blood gas till target PCO2 suppressed (60) or unstable

21
Q

Are EEG and Cerebral blood flow required for brain death dx?

A

No.

Ancillary test.
- may do if can’t do apnea test well
+ help shorten observation period

22
Q

Most kids on peds organ donation waiting for:

A

liver
kidney
small bowel

23
Q

T or F: anyone can approach families about organ donation

A

False.

  • AAP: approach in systematic person trained in psych, social, medial part of dx
24
Q

Who can be considered for organ donation?

A
  • declared brain death

- cardiocirculatory death

25
Q

T or F: consent is all or nothin (no organ specific)

A

False.

Organ specific

26
Q

Contraindicatons to Organ Donation:

A

“PIMM”

Prematurity

Infection (septicemia, TB, Creutzfeldt-Jakob dx, HIV, west nile, Hep B, Hep C)

Malignancy

Mets (disseminated)

27
Q

Child with severe head injury. Father suspected of abuse. What do you do about withdrawal of care?
Court, Parents both decide, Police need to be aware?

A

Parents both decide

AAP: decision re: life-sustaining tx for kids injured by suspected abuse should be determined by same send as other kids.

28
Q

T or F: patient does not need to be brain dead to consent to be obtained for organ donation?

A

True.

  • pt suffered devastating or irreversible brain injury
  • near death but does not meet formal criteria
  • fam may withdraw and when heart stops organs recovered in OR
  • can recover up to 1hr after withdrawal of support
29
Q

T or F: parent’s wishes are more imp than MD fiduciary obligation to act in best interest?

A

False.

30
Q

What is reasonableness when someone makes SDM decision?

A

Best option= one most rational people would choose after all factors considered?

31
Q

Define autonomy

A

Right of individual to make decision and act freely without interference.

32
Q

Define beneficence

A

Responsibility of physician to act in patient’s best interest

33
Q

Old theory of parental authority=

A

right of parent to make decision for child because considered property of parent= BAD

34
Q

Define non-maleficence

A

Do not harm

35
Q

Clinical tip: what guideline can you refer to if ensure if parental decision oppose best interest for child?

A

Does it fit….

“All children are entitled to medical tx that is likely to

  1. prevent serious harm
  2. prevent suffering
  3. prevent death”
36
Q

What are high risk sexual assaults traits for transmission of STI?

A
  • pt has STI signs
  • suspected perpetrator has known STI
  • genital, oral, anal penetration or ejaculation
  • someone living in household has STI
  • pt or parent requesting test
37
Q

What do you disclose to police re: a pt?

A
  • refrain from patient info unless patient consent or warrant/ court order/ subpoena
38
Q

Is it appropriate to donate organs from anencephalic baby?

A

No.

  • do not usually satisfy brain death b/c adequate brainstem f’n
  • once death occur usually organ have irreparable ischemic damage (which occurs due to gradual brainstem deterioration even on life support)
39
Q

What special consideration may you keep in mind for teenager who hung herself?

A
  • high cervical spine injury= confounding factor to clinical assessment for neurologic brain death
  • R/O cervical spine injury before full assessment for brain death
  • if can’t do clinical test due to injury= ancillary tests!
40
Q

Which withdrawal consideration must you make for child submersed in cold water?

A
  • rewarm to min. 34C before resus stopped
  • if survive + CVS stable serial neuro exam x 48-72h (as can see significant gains)
  • consider withdrawal if no neurologic recovery after this.
41
Q

Which is true for kids in foster care:

a. in older kids occasional visit warranted if pvx strong attachment
b. disruption in continuity of care potentially harmful
c. if loving in foster home in 1st year of life- will do well.
d. child should be placed with grandparents for best long term oucome

A

B. Disruption of continuity of care may be potentially detrimental to all kids.

42
Q

List common medical issues that arise with foster care admission?

A
  • poor hygiene
  • under immunization
  • dental neglect
  • contraception
43
Q

T or F: mental health problems + behavioural found in 1/2 of foster care kids

A

True

rc: specialties woo hoo (31 decks)

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