Ethics Flashcards
What are teh core ethical principles?
- Patient autonomy
- Beneficence
- Nonmaleficence
- Justice
What is Patient autonomy?
Obligation to respect pts as individuals & to honor their preferences in medical care
What is Beneficence?
Physicians have a special ethical (fiduciary) duty to act in the pt’s best interest. If the pt can make an informed decision ultimately the pt has the right to decide
What may beneficence conflict w/?
Pt autonomy
What is Nonmaleficence?
“Do no harm”
What is Justice?
To tx persons fairly
What does informed consent legally require?
- Discussion of pertinent info
- Pt’s voluntary agreement to the plan of care
- Freedom from coercion
What are the exceptions to informed consent?
- Pt lacks decision-making capcity or is legally incompetent
- Implied consent in an emergency
- Therapeutic privilege
- Waiver
What is Therapeutic privilege?
With holding info when disclosure would severely harm the pt or undermine info decision-making capacity
What is Waiver?
Pt waives the right of informed consent
What must pts have an intelligent understanding of?
- Risks
- Benefits
- Alternavtives
- No intervention
When can a written consent be revoked by the pt?
Any time, even orally
Who is considered a minor?
Any pt <18yo
When does parental consent need to be obtained?
Any minor unless the pt is emancipated
When is parental consent NOT required?
- Emergency situations
- Prescribing contraceptives
- Treating STDs
- Medical care of pregancy
- Treatment of drug addiction
What is Decision-making capacity?
Physician must determine whether the pt is psychologically & legally capable of making at particular health care decision
What are the components of decision-making capacity?
- Pt makes & communicates a choice
- Pt is informed
- Decision remains stable over time
- Decision is consisten w/ pt’s values & goals, not clouded by a mood disorder
- Decision is not a result of delusions or hallucinations
What are advanced directives?
Instructions given by a pt in anticipation of the need for a medical decisions
State specific
What is an Oral advanced directive?
Incapacitated pt’s prior oral statements commonly used as guide
Where do problems arise from in oral advanced directives?
Variance in interpretation
What makes an oral advanced directive more valid?
- Pt informed
- Directive was specific
- Pt made a choice
- Decision was repeated over time to multiple people
What is a Living will (written advance directive)?
Describes tx the pt wishes to receive or not receive if he/she loses decision-making capacity
What do pts direct physicians to do w/ Living wills?
W/hold or w/draw life-sustaining tx if he/she dev a terminal dz or enters a persistent vegetative state
What is a medical power of attorney?
Pt designates an agent to make medical decisions in the event that he/she loses decision-making capacity & specify decisions in clinical situations
When can a medical power of attorney be revoked?
Anytime pt wishes (regardless of competence)
A medical power of attorney is more flexible than a ____ ____.
What is a Surrogate decision-maker?
If an incompetent pt has not prepared an advanced directive, individuals who know the pt must determine what the pt would have done if he/she were competent
What are the priorty of surrogates?
- Spouse
- Adult children
- Parents
- Adult siblings
- Other relatives
____ respects pt privary & autonomy.
Confidentiality
What are the general principles for exceptions to confidentiality?
- Potential harm to others is serious
- Likelihood of harm to self is great
- No alternative means exists to warn or to protect those at risk
- Physicians cna take steps to prevent harm
What are some examples of exceptions to confientiality?
- Reportable dz (STD, TB, hepatitis, food poisoning)
- The Tarasoff decision
- Children &/or elder abuse
- Impaired automobile drivers
- Suicidal/homicidal pts
What is the Tarasoff decision?
California Supreme Court decision requiring physicians to directly inform & protect victim from harm
