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Peds > Ethics > Flashcards

Ethics Flashcards

1
Q

True or False: There is no ethical difference between withholding or later withdrawing treatment

A

True

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2
Q

True or False: The opinion and guidelines of the family prevail over your opinion as the physician

A

True

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3
Q

What should be done in cases where there is conflict between you and family (interests of the child in your opinion differ from the parent/guardian’s opinion)?

A

Get ethics committee involved

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4
Q

True or False: It can be appropriate for a “mature minor” (>14) to have a say in their treatment

A

True

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5
Q

What happens in terms of parents wishes in cases where they are perpetrators of child abuse?

A

Alternate guardian is assigned and hospital ethics committee must be involved to determine who makes decisions

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6
Q

What determines when and how to implement DNR orders?

A

Family values and decisions

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7
Q

What are beneficial interventions or required reconsiderations in terms of DNR?

A

Temporary revisions to standing DNR orders (for instance, what is allowed in the OR if a child with a DNR is having a surgical procedure)… these need to be planned in advance and very specific

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8
Q

What do beneficial interventions or required reconsiderations allow parents to do?

A

Distinguish between interventions they feel comfortable with and the resuscitative efforts they wish to avoid (guidelines should try to encompass any possible occurance).

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9
Q

Whose responsibility is it to meet with and educate everyone (parents, school providers, ect) about what is and is not considered resuscitation and what interventions are allowed within the DNR context for a child?

A

The PCP

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10
Q

Any question dealing with cost containment (AKA conflict of interest between insurance companies and needs of patients) should be answered with what?

A

Advocating for the patient

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11
Q

What is cost sharing?

A

Insurance companies provide financial incentive for limiting the use of consultants and resources

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12
Q

What is the most common and most challenging conflict of interest in terms of health care costs?

A

Cost sharing

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13
Q

What are loyalty conflicts?

A

When you need to refer outside your ongoing network of specialists and affiliated institutions

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14
Q

What is paperwork burden?

A

Time consumed getting prior authorization and appeals for rejected services (this time isn’t reimbursed and represents a financial disincentive)

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15
Q

Loyalty conflicts and paperwork burden are examples of what in pediatrics?

A

Conflicts of interest (pediatricians financial interests are in conflict with child’s needs)

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16
Q

In the NICU, all decisions are based on what?

A

Newborn’s best interest, factoring in parental wishes (in the end, newborn’s best interest overrides parental wishes)

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17
Q

What happens in the NICU if parents wishes aren’t in the best interest of the newborn?

A

Get ethics involved

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18
Q

What should you do in the NICU if treatment is clearly futile and parents want to continue?

A

Override parents with ethics committee help

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19
Q

What should you do in the NICU if the best interests aren’t clear, but parents wish to withdraw care?

A

Defer to parent’s authority

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20
Q

Withdrawal must be based on what?

A

Best long term interests of the infant

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21
Q

True or False: In terms of extreme prematurity, the gold standard is the % survival with maximal care rather than gestational age alone

A

True

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22
Q

True or False: Taking cost into consideration is unethical

A

False- on a global level, this is very ethical

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23
Q

Which unit typically has costs that are disproportionately high?

A

NICU

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24
Q

True or False: If there is no chance of survival, don’t code

A

True

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25
Q

What rules if there is a good prognosis for a child?

A

Parental preference

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26
Q

What must be implemented if a good outcome is likely?

A

Resuscitation and treatment

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27
Q

True or False: Withdrawing and witholding support are inappropriate terms to be used around a family

A

True

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28
Q

True or False: Good outcome is a subjective term

A

True

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29
Q

What is the dead donor rule?

A

Removal of both paired/vital organs and a non-paired organ cannot precede or cause death

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30
Q

What is considered to be a controversial definition of death?

A

Cardiorespiratory death

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31
Q

What cannot factor into the donor status of a patient?

A

DNR order

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32
Q

True or False: Children can be stem cell donors for siblings

A

True

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33
Q

True or False: Parents who decide to conceive another child so the new child can become a savior sibling is unethical

A

False- this is not considered to be unethical in and of itself

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34
Q

Name 5 conditions that have to be met when siblings are considered as stem cell donors

A
  1. No adult or other donor options are available
  2. A strong positive relationship between siblings
  3. Both the donor and recipient are to benefit
  4. Risk to donor is minimal
  5. In addition to parental permission, the child, if old enough must also agree (assent)
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35
Q

What involves wakefulness and awareness of self and environment?

A

Consciousness

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36
Q

Patients with what state lake wakefulness and also lack awareness of self and environment?

A

Coma

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37
Q

Patients in what state lack awareness, but do have wakefulness?

A

Vegetative

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38
Q

In order to declare brain death what must be done?

A

Conditions that can mimic brain death must be treated or excluded (metabolic derangements, intoxication, hypothermia)

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39
Q

What 6 factors must be considered for a child who could be a solid organ donor?

A
  1. No adult or other donor options are available
  2. A strong positive relationship between siblings
  3. Both the donor and recipient are to benefit (benefit to donor is largely psychological)
  4. Risk to donor is minimal (surgical risk)
  5. In addition to parental permission, the child, if old enough must also agree (assent)
  6. The absence of coercion must be verified by a 3rd party
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40
Q

Why would a sibling with severe cognitive disabilities not serve as a solid organ donor for a sibling?

A

Sibling with disabilities wouldn’t likely benefit psychologically from this (needs to have mutual benefit)

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41
Q

Why do children <11 get priority on kidney donor waiting lists?

A

Due to the impact of renal disease on growth and development

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42
Q

True or False: Autonomy and bodily integrity of the mother is critical and must be honored

A

True

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43
Q

True or False: Pregnant women have the same rights to make medical decisions as those who are not pregnant

A

True

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44
Q

For anything questions regarding conflict of maternal-fetal interest, what is the key thing to do?

A

Discussion of all aspects of the conflict and respect Mom’s decision

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45
Q

What is assent?

A

Willingness to accept treatment

46
Q

True or False: Assent is mandatory before treatment begins

A

False- it is preferred, but not mandatory (consent is mandatory)

47
Q

True or False: Immunizations aren’t considered to be life saving

A

True

48
Q

True or False: In situations where the treatment is likely to prevent substantial harm, the child’s right to treatment outweighs parental religious freedom

A

True

49
Q

True or False: In situations where treatment will happen regardless of the child agreeing to it (assent), the child should be told this

A

True

50
Q

True or False: Newborn screening is mandatory

A

False

*Parents give passive permission by doing nothing…they must sign a waiver to opt out of newborn screening

51
Q

What 3 things should be considered when deciding if a disease should be included in newborn screening?

A
  1. Does it have significant deleterious effect on the child
  2. Does it have effective treatment available if diagnosed early
  3. Is there a screen that is acceptable to the population
52
Q

True or False: Newborn screens are diagnostic

A

False

*False positives are common…this triggers need for more definitive testing

53
Q

True or False: Some cases of disease get missed by newborn screening

A

True- If presentation is classic, workup the child for the disorder in question

54
Q

True or False: If the newborn screen comes back positive, you should refer for genetic counseling

A

False

55
Q

What do you need to do in cases of testing for carrier status of a disease or fetal testing of certain diseases?

A

Make sure parents have all the information needed to make a decision and you have not pressured them in any way

56
Q

Name 1 example of a condition for which ethics committees will refuse genetic testing in siblings until they are 18

A

X-linked adrenoleukodystrophy

57
Q

Who should be involved in determining which gender to raise a child with a disorder of sex development?

A

Multidisciplinary approach

58
Q

What are two important factors to consider in the management of a child with a disorder of sex development?

A
  1. Any genital surgery as a child should be potentially reversible if the patient would want to change gender in adulthood
  2. Fertility should be preserved if possible
59
Q

How should you tell a child about a disorder of sex development?

A

Gradually and based on developmental level (don’t surprise them with this when they are older)

60
Q

What type of medicine is intended to be based on knowledge of safety and efficacy obtained from randomized, controlled trials?

A

Conventional

*This excludes all treatments that aren’t supported by such studies/evidence

61
Q

What are treatments that are outside of conventional treatments and include chiropractic treatments, herbs, bioelectronics remedies, and nutritional therapy?

A

Alternative medicine

62
Q

What type of medicine uses both alternative treatments and conventional treatments?

A

Complementary medicine

63
Q

What form of medicine blends conventional medicine and alternative therapies (has some evidence of safety and effectiveness)?

A

Integrative medicine

64
Q

What is the difference between complementary and integrative medicine?

A

Integrative includes things that were initially alternative, but now are evidence based (probiotics, omega 3’s, ect)

65
Q

True or False: Some herbs and vitamins can interfere with metabolism and elimination of medications

A

True (think about this if there is a medication that isn’t as effective as it was in the past)

66
Q

What basic rule applies whether you are discussing conventional or non-conventional treatment?

A

Risk-Benefit

67
Q

True or False: Courts won’t interfere with the use of alternative treatment unless it’s life-threatening or coupled with refusal to use conventional treatment

A

True

68
Q

True or False: Meds that are less effective than proven conventional treatments shouldn’t be used instead of these proven conventional treatments

A

True

69
Q

If a doctor isn’t comfortable with an alternative therapy, is transfer to another physician who is comfortable appropriate?

A

No

70
Q

What should you counsel parents on in situations regarding enhancement therapies?

A
  • Importance of individualism

- Happiness is independent of extrinsic factors

71
Q

What are 4 conditions for which growth hormone is FDA approved?

A
  1. Turner
  2. Chronic renal insufficiency
  3. Prader-Willi
  4. Non-growth hormone deficient idiopathic short stature
72
Q

True or False: It is okay to accept small gifts from pharmaceutical reps

A

False

73
Q

True or False: A gift textbook is appropriate

A

True- but only if it helps to improve treatment

74
Q

When is a sponsored CME lecture beneficial?

A

If the speaker has complete and unbiased control of what is presented

75
Q

True or False: Are samples to a patient appropriate

A

Yes, it helps the patient

76
Q

When are patient samples not appropriate?

A

If this leads to the prescription of a costly medication when a less expensive alternative is available

77
Q

What is an important thing to remember for patients in terms of cost of healthcare?

A

Anything leading to increased cost when less expensive and equally effective treatments are available means the patients needs aren’t being met

78
Q

What are 3 things to remember regarding ethics committees?

A
  1. Members should be from different backgrounds and perspectives
  2. Subcommittees should answer to main ethics board
  3. CME on ethics topics are needed to keep members qualified
79
Q

How should you tell a child that they are HIV positive?

A

Slowly over time and consistent with the developmental stage of the child

80
Q

What is really important for HIV positive teens and helps to ensure treatment compliance?

A

Support

81
Q

What activity modifications should you recommend for HIV + patients?

A

Against close contact sports where bloody/bodily fluid transmission is likely (boxing, wrestling, ect.)

82
Q

True or False: Parents are required to disclose a child’s positive HIV status to school

A

FALSE

*Schools need to handle every situation with universal precautions

83
Q

What measure should teens with HIV do in terms of decisions regarding health care?

A

Identify a health proxy to make decisions for them if they become incapacitated

84
Q

Children who are exposed to what are at risk for physical injury, likely to be aggressive with their peers, prone to separation anxiety as toddlers, at risk for school failure as adolescents, and at risk for risky sexual behavior?

A

Intimate partner violence

85
Q

True or False: Children exposed to intimate partner violence are more likely to be shy and withdrawn

A

FALSE

*More likely to be agressive

86
Q

What behavior might you see from an infant exposed to intimate partner violence?

A

A lot of crying, resistant to comforting

87
Q

What behavior might you see from a toddler exposed to intimate partner violence?

A

Extreme separation anxiety

88
Q

What needs to be done within 72 hours of placement in foster care?

A

Health care screen

89
Q

What should be done within 30 days of entry into foster care?

A

A comprehensive health assessment

90
Q

Who represents children at court hearings for child abuse?

A

A law guardian (may be a trained volunteer- Court Appointed Special Advocate/CASA or and actual attorney

91
Q

True or False: Screening for intimate partner violence is recommended as part of routine encounters

A

True

92
Q

When is screening for intimate partner violence particularly crucial?

A

Cases of children with frequent non-specific symptoms (stomach aches and headaches)

93
Q

True or False: You only need to screen Mom’s for intimate partner violence of they are depressed or anxious

A

False

94
Q

True or False: Only mothers are victims of intimate partner violence

A

False

95
Q

In screening for intimate partner violence, should the questions be specific or general?

A

Specific

96
Q

True or False: You have to report suspicion of intimate parter violence even if there is no evidence or suspicion of child abuse?

A

True- As mandated reporter because children are likely being exposed to violence too

97
Q

At what age should you ask guardians about intimate partner violence with children not present?

A

If the child is over 3 and verbal

98
Q

True or False: In any cases of suspected abuse it isn’t a good idea for you to interview the child

A

True- Authorities should do this

99
Q

What is the preferred place for foster placement?

A

With relatives (versus a non-relative home)

100
Q

What is always the primary goal of Child Protective services?

A

Reunification of the family (as long as the child is in a safe environment)

101
Q

True or False: Healthy children cannot participate in studies that involve more than minimal risk

A

True

102
Q

When can children with a condition or disorder participate in a study that poses more than minimal risk?

A

If there is potential benefit to them from the study

Ex: Experimental treatments when no other proven-effective treatments exist

103
Q

When is a study that poses more than minimal risk for patients if there is no direct benefit?

A

Only is there is a “minor” increase over the minimal risk

104
Q

What is a deviation from standard practice?

A

Malpractice

105
Q

What action results in a breach of the physician’s duty to act reasonably, and results in injury to the patient?

A

Malpractice

106
Q

Who helps to prove breaches in a physician’s duty in court?

A

Expert witnesses

107
Q

What 4 things do pediatricians serving as expert witnesses have to be?

A
  1. Thorough
  2. Fair
  3. Objective
  4. Impartial
108
Q

True or False: An expert witness’s compensation cannot be contingent on the outcome of the case

A

True

109
Q

True or False: Situation in practice that might lead to litigation should be reported to the malpractice carrier as early as possible

A

True

110
Q

True or False: Disclosing errors to families is legally and ethically mandated

A

True

Peds (35 decks)

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