Ethics/Research Flashcards
- Boy with CP was in a motor vehicle accident and has had a GCS of 4 for the last week. Parents want to withdraw. What do you do?
a) Consult ethics
b) Call CAS
c) Withdraw if the parents are reasonable and understand the situation
- ———————— - A 7-year-old with CP is involved in an MVA and presents with a GCS of 4. He has been in the ICU for 1 week with no improvement despite aggressive management. Parents approach you regarding the withdrawal of treatment because of his underlying disability. Which of the following is true:
a) If two EEGs done 24 hours apart show isoelectric background, then withdraw
b) Do cerebral angiography to document no blood flow to confirm brain death
c) Obtain a neurology consult to substantiate brain death
d) Discuss the options again with the parents, and if they remain certain about the decision then proceed with withdrawal
Discuss the options again with the parents, and if they remain certain about the decision then proceed with withdrawal
- What size does a child need to be to switch from a booster seat to a normal seat belt?
a. 18 kg, 120 cm
b. 36 kg, 120 cm
c. 36kg, 145 cm
d. 45 kg, 150 cm
36kg, 145cm
- A 14y boy presents with his third relapse of ALL. An experimental form of chemotherapy is proposed as a potential treatment. He refuses the treatment. Which is true?
a. He can refuse the treatment if he is deemed capable
b. Treatment must proceed
c. Parents should decide if treatment should proceed
d. An ethics committee should decide if treatment should proceed
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14 year old with ALL, his 3rd relapse. Parents want to try experimental therapy, but the kid does not. Which of the following statements is true?
a) He has a right to not be treated if he understands the consequences of this
b) Must continue with treatment as the parents consented at the outset of therapy
c) Consult an ethics committee
d) The parents get to decide for him
He can refuse the treatment if he is deemed capable
Informed consent requires that a decision maker:
- Has the capacity to make the decision
- Is adequately informed, that is, given all relevant information that a reasonable person would require to make a decision
- The resultant decision must be voluntary and free of coercion
- Regarding consent for organ donation, which is true:
a) It is possible to consent only to donation of specific organs
b) can consent to donation of organs despite the absence of full brain death criteria
c) there are no absolute contraindications to organ donation
d) some tissue donations do not require consent
- ———————————– - Young child is in PICU with a brain tumor; terminal. Which is true? a) Organ donation does not need consent for all the organs
b) Patient need not be brain dead for consent to be obtained for organ donation
c) There are no absolute contraindications for organ donation
d) Do not need consent for tissue donation
Patient need not be brain dead for consent to be obtained for organ donation
Organ donor
- Nonreversible injury + mechanically ventilated
- Donation after NDD: Any pt who has been pronounced dead by neurological death criteria
- Donation after cardiac death (DCD): Any pt who has sustained non-recoverable injury, who is on life sustaining therapy and who does not meet the criteria for neurological death, may be a potential organ + tissue donor with DCD
- Parents of a 15y boy suspect he is using drugs. They ask you to obtain a urine sample and “add this test on” after the sample is collected. What to do you do?
a. Refer the boy to psychology
b. Ask social work consult
c. Do as the parents ask
d. Ask to speak with the boy
Ask to speak with the boy
- 15 y/o girl sexually assaulted 5 days ago by a 32 year old man for whom she babysits. All of the following are true except.
a) Forensics are not indicated
b) CAS must be informed
c) Give post coital contraceptive now
d) Low risk for STD
e) She is competent to refuse further treatment and investigations
Low risk for STD
- overall rates of STIs low, but postpubertal girl more likely to get STIs than prepubertal
A. Forensics not indicated if >72H after sexual contact
B. CAS should be informed
C. Give post-coital contraception. Plan B may be effective up to 5d, copper IUD up to 7d
E. Should be competent if she understand benefits, risks, alternatives
- Which of these patients can give a valid consent:
a) A teenager who is currently drunk who was sexually assaulted 36 hours ago
b) Down’s syndrome with femur fracture
c) 14 y/o who wants an abortion
d) A patient who is hallucinating
e) Person who is unconscious who needs surgery
14 y/o who wants an abortion (unless in Quebec)
Down’s syndrome with femur fracture - also possible
- All are needed to declare brain death except:
a) EEG
b) 2 physicians are required to declare brain death
c) No spontaneous respiration despite hypercarbia
d) Absent corneal reflex
e) Absence of hypothermia
EEG
- An 8 year old male with Down syndrome is admitted to the PICU with his 5th episode of pericarditis. Which is true:
a) It is time to discuss DNR
b) When parents and physicians disagree on management, the ethics committee must be consulted
c) the choice is up to the patient
d) Once parents have decided to treat the child, they may change their minds at a later stage
Once parents have decided to treat the child, they may change their minds at a later stage.
- Should always re-evaluate advance care plans as the disease progresses
Should discuss DNR b/c should be starting palliative care/advance care planning discussions early in children with reduced life expectancy
- Which of the following statements regarding autonomy is true in pediatrics:
a) The wishes of the parents supersede the wishes of the child -
b) If there is a psychiatric problem, the wishes of the parent and child are not valid -
c) CAS authority can supersede the wishes of the parent and the child -
d) The right to autonomy can be used to force the MD to take medical action that they feel is inappropriate -
e) If conflict exists, the physicians opinion takes precedence over that of the parent of child -
CAS authority can supersede the wishes of the parent and the child -
A: if child is capable, wishes of parents does not necessarily supercede (except for if <14 in Quebec)
B: nope
D: Principle of beneficence & pt’s best interest
E: nope
- A 7-year-old child has been in an MVA. He is unstable with a HR 160. Hb 50. The parents are Jehovah’s witnesses. How should you proceed:
a) Transfuse blood now without parental consent
b) Await for a court order before transfusing blood
c) Respect the parents decision to refuse transfusion
d) Transfuse with albumin instead of blood
e) Spend time with the parents in hopes of changing their decision about transfusion
Transfuse blood now without parental consent
CMPA: When the patient or substitute decision maker is unable to consent and there is demonstrable severe suffering or an imminent threat to the life or health of the patient, a doctor has the duty to do what is immediately necessary without consent. Emergency treatments should be limited to those necessary to prevent prolonged suffering or to deal with imminent threats to life, limb or health. Even when he/she is unable to communicate, the known wishes of the patient must be respected.
- Management decisions in the treatment of a critically-ill newborn should be based on:
a) cost to society
b) burden to parents
c) best interests of the child
d) ventilate at all costs regardless of neurologic outcome
Best interests of the child
- A 15-month-old child presents with diarrhea and FTT. The mother has a history of IV drug use. She doesn’t know who the father of the child is. You suspect HIV as a cause of the child’s presentation. You would do all of the following EXCEPT:
a) discuss the benefits and harms of knowing about one’s HIV status
b) discuss the issues and services available for those with HIV
c) discuss the confidentiality of the test
d) explore the risk factors
e) explain that you will follow-up by telephone as soon as the test results are available
explain that you will follow-up by telephone as soon as the test results are available
- Child with a severe head injury. The father is suspected of abuse. What do you do about the decision to withdraw care?
a) the court decides
b) the decision must involve both parents, including the father
c) police need to be informed before care is withdrawn
the decision must involve both parents, including the father
Parents may NOT be the appropriate decision makers for child:
- when parents lack decision-making capacity
- when there are irresolvable differences between parents regarding child/adol’s care
- when parents have clearly relinquished responsibility for the child or adol
- when a legal guardian has been appointed
- *Does not mention suspected abuse cases
- Boy involved in MVA intubated. Pedestrian killed. EtOH smell. Police asked you for alcohol levels report (Ethics)
a) give it to them
b) ask for a warrant
c) Call CMPA
d) Call CAS
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Similar Questions:
Alcohol-related MVC. Police want a blood EtOH level. You:
a) give it
b) ask for warrant
c) call CMPA
d) wait for patient to wake up for consent
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Boy involved in MVA intubated. Pedestrian killed. EtOH smell. Police asked you for alcohol levels report
a) give it to them
b) ask for a warrant
c) Call CMPA
d) Call CAS
Ask for warrant
Unless required by law (including a legislative provision, search warrant, or other court order) or given consent by the pt, physician cannot be required to perform an invasive service on a pt (such as taking blood from a suspected impaired driver for the purpose of confirming his or her blood alcohol content ) or to provide any other information or evidence about a pt
Subpoena alone is not sufficient reason for a physician to breach pt confidentiality.
