Ethics_Brain death_Organ donation Flashcards
<p>Brain death, <strong>Clinical prerequisites prior to consideration: </strong></p>
<ul> <li>Compatible neuroimaging</li> <li>Exclusion of confounding medical conditions</li> <li>No intoxication, poisoning</li> <li>Normal temperature</li> <li>Normal systolic BP</li> </ul>
<p><strong>List 5 exam findings compatible with brain death</strong></p>
<p><strong>Exam must demonstrate </strong><strong>all of</strong><strong> the following:</strong></p>
<ul> <li>Coma</li> <li>Absent pupillary light reflex</li> <li>Absent corneal reflex</li> <li>Absent oculovestibular reflex</li> <li>Absent jaw jerk</li> <li>Absent gag, sucking or rooting reflex</li> <li>Absent cough with tracheal suctioning</li> <li>Apnea (demonstrated by apnea test)</li> </ul>
<p>List 2 potential contraindications to organ donation</p>
<ul> <li>Cancer in specific organ</li> <li>Transmissible infectious disease that will adversely affect recipient</li> <li>No consent from SDM</li> </ul>
<p><strong>Organs/tissues that can be harvested for transplantation (9): </strong></p>
<ul> <li>Organs: heart, lungs, liver, kidney, pancreas/pancreatic islets, intestines</li> <li>Tissue: corneas, sclera, skin, bone, tendon, heart valves</li> </ul>
<ul> <li>Outline 5 critical steps in delivering effective notification of death to surviving family members</li> </ul>
<p><strong>S - </strong>Set up, setting</p>
<p><strong>P -</strong> Perception</p>
<p><strong>I - </strong>Invitation</p>
<p><strong>K - </strong>Knowledge</p>
<p><strong>E - </strong>Emotions, Empathy</p>
<p><strong>S - </strong>Strategy, Summary</p>
<p>What ethical principles may be used in ethical decision making?</p>
<p><strong>Define these ethical principles:</strong></p>
<ul> <li><strong>Beneficence</strong> (Moral obligation to act for the <strong>benefit</strong> of others)</li> <li><strong>Nonmaleficence </strong>(do not harm)</li> <li><strong>Autonomy</strong> <ul> <li>Self-directing freedom</li> <li>Free from controlling interferences by others</li> <li>Implies decision making based on personal values</li> </ul> </li> <li><strong>Confidentiality </strong>(Privacy of physical person and personal information)</li> <li><strong>Medical futility</strong> <ul> <li>Interventions with possible beneficial effect, but that experience suggests is highly improbable (very low likelihood of success)</li> <li>Benefit must <strong>appreciably improve the </strong><strong>person as a whole, </strong>otherwise = futile</li> </ul> </li> </ul>
<ul> <li><strong>List 3 basic elements of informed consent</strong></li> </ul>
<ul> <li><strong>Informed</strong></li> <li><strong>Voluntary</strong></li> <li><strong>Capacity</strong></li> </ul>
<p>When is informed consent not required?</p>
<ul> <li><strong>Implied Consent </strong></li> <li>Life-threatening emergencies with inadequate time to obtain consent</li> </ul>
<p>What important elements of capacity must be assessed?</p>
<p>The patient must be able to:</p>
<ul> <li><strong>Understand</strong> (and express) the nature, risks, benefits, alternatives and consequences of the proposed medical treatment <strong>and</strong> alternatives</li> <li><strong>Appreciate</strong> how the information applies to the particular situation</li> <li><strong>Reason </strong>through the choices to make a decision</li> <li><strong>Communicate</strong> a consistent choice</li> </ul>
<p>Identify the parties who may be considered appropriate substitute decision makers when a patient lacks capacity: (5)</p>
<p>(Order varies by province)</p>
<ul> <li>Advance directive/POA</li> <li>Legal guardians</li> <li>Spouse</li> <li>Children by age</li> <li>Parents</li> <li>Siblings</li> <li>Physician panel/legal counsel</li> </ul>
<p><strong>What special considerations exist in the assessment of capacity of minors? </strong></p>
<ul> <li>No specific age (except Quebec) <ul> <li>Emancipated minor?</li> </ul> </li> <li>Based on the minor’s maturity and ability to understand and appreciate the treatment and consequences, etc</li> <li>If minor lacks capacity – parents or guardian can consent on their behalf <ul> <li>Must be guided by what is in the best interests of the minor</li> <li><em>If parents refuse treatment that a physician regards is medically necessary, </em><strong>physicians are obligated to report to child protection authorities </strong></li> </ul> </li> </ul>
<p>When can physicians disclose health information without consent?</p>
<ul> <li><strong>Testimony</strong>: In court, medical information is not legally privileged</li> <li><strong>Statute</strong>: Child or elder protection acts; infectious disease reporting; weapons injury statutes</li> <li><strong>Public Interest</strong>: Violent acts/ threats to persons at risk; infectious disease; violence by psychiatric patients; public safety (seizure or other disorder and driving, etc)</li> <li><strong>Express or Implied Consent</strong>: Implied in normal consultation with other physicians or nurses involved with direct care</li> </ul>
