Everything *Confirmed Flashcards
1
Q
Preconditions associated with brain death
A
- Depressant drugs
- Hypothermia
- Metabolic/endocrine causes
2
Q
Depressant drugs associated with brain death
A
- alcohol
- barbiturates
- muscle relaxants
- “Dormicum” in 20min from resus
Administer Naloxone and Flumazenil if opioids and benzos suspected
3
Q
Metabolic/Endocrine conditions associated with brain death
A
- renal failure
- hepatic failure
- ketotic hyperglycaemia
4
Q
Clinical examination of the brain dead patient
A
“Deep Coma”
- GCS of 3
- no spontaneous movements to verbal or painful stimuli
- if spinal injury don’t do painful stimuli on sternum - do it supraorbital, limb responses could be dt spinal reflexes
5
Q
Brainstem tests
A
- pupil response CN 2,3 (No response, Midposition pupil)
- corneal reflex CN 5, 7
- vestibulo-occular reflex CN 3, 8
- gag reflex / cough CN 9, 10
- occulocephalic (doll’s eye)
6
Q
Approach to the brain dead patient
A
- per conditions
- clinical examination = deep coma
- brainstem tests
- apnea
- time period = confirmatory tests
7
Q
Confirmatory test for brain death
A
- Angiography = no cranial flow but patent external carotids
- EEG = 8 scalp electrodes, electrocerebral silence present 6hrs after clinical brain death
- Isotope study = no flow 6hrs after clinical testing
8
Q
Declaration of brain death
A
2 Clinicians on practicing at least 5 yrs
Certification of death is issued when the apnea tests is confirmed
9
Q
A
10
Q
What is the definition of ethics according to the WMA?
A
The study of morality, careful and systematic reflection on moral decisions.
Distinction: Ethics = Knowing; Morality = Doing.
11
Q
Who are the philosophers associated with the foundations of medical ethics?
A
- Socrates: Ethical questioning
- Plato: Concept of justice
- Aristotle: Virtue ethics
- African Philosophy: Ubuntu and communal well-being
12
Q
What historical case marked the birth of modern bioethics in dialysis rationing?
A
Scribner Shunt (1960s)
This case set a precedent for ethical discussions in medical resource allocation.
13
Q
What ethical principle emphasizes informed consent and patient self-determination?
A
Respect for Autonomy
This principle is crucial in medical ethics and patient care.
14
Q
What are the core ethical principles in medical ethics?
A
- Respect for Autonomy
- Beneficence
- Non-Maleficence
- Justice
15
Q
Fill in the blank: _______ focuses on maximizing good outcomes in ethical decision-making.
A
Utilitarianism
16
Q
Kantianism
A
Duty-based ethics.
17
Q
- Liberal Individualism
A
Rights-based ethics
18
Q
- Communitarianism
A
Community-focused decision-making.
19
Q
- Casuistry
A
Case-based ethical reasoning
20
Q
- Virtue Ethics
A
Emphasizing character and moral virtues.
21
Q
True or False: Public health ethics prioritizes individual autonomy over population well-being.
A
False
Public health ethics emphasizes the well-being of the community.
22
Q
Accountability for Reasonableness (A4R) Framework
A
Ensuring fair allocation of healthcare resources.
23
Q
What is the principle of proportionality in public health ethics?
A
Ensuring that public health measures are justified by the level of risk.
24
Q
o Least Infringement public health ethics
A
Choosing interventions that impose the fewest restrictions necessary.
25
o Triage systems
1. SOFA (Sequential Organ Failure Assessment)
2. CFS (Clinical Frailty Scale)
3. likelihood of survival
26
Free-rider problem
When individuals refuse vaccination but still benefit from herd immunity.
27
Doctor-Patient Ratios SA
1 doctor per 3,198 patients.
28
o MPS Ethics Debate (2023):
Should hospitals be penalized for not reducing their carbon footprint?
29
Ethics of Pandemics
o Proportionality – Actions must be justified and limited.
o Least Infringement – Restrictions should be minimal.
o Social Justice – Fair allocation of resources.
o Alcohol bans, lockdowns, and ethical debates.
30
Vaccination Ethics Key Ethical Issues:
o Autonomy vs. Public Health.
o Parental refusal and child welfare.
o Herd immunity and free-rider problems.
31
Justifications for Vaccine Mandates:
o The Harm Principle – Restricting autonomy to prevent harm.
o Justice and reciprocity in public health.
32
What is the focus of neuroethics in healthcare?
Ethical dilemmas in neuroscience, such as mental privacy and neuroenhancement.
33
Ethical dilemmas in neuroscience
1. Mental privacy
2. Neuroenhancement
3. Neurodeterminism
4. Deep brain stimulation autonomy concerns
34
What does the POPI Act regulate?
How personal and health information is collected, stored, and shared.
Ensures patient confidentiality and data security.
35
Ethical concerns with POPI
Balancing patient privacy with public health eg. during pandemics
36
What is the ethical consideration when balancing patient privacy with public health needs?
Ensuring confidentiality while addressing health crises.
37
Core human rights
Right to health, autonomy, dignity.
38
What is the ethical decision-making process?
* Identify the ethical dilemma
* Gather relevant information
* Analyze ethical principles
* Develop possible solutions
* Implement and evaluate policy decisions
39
What are the categories of eligibility in the A4R framework for dialysis allocation?
* Category 1 – Must receive renal replacement therapy (RRT)
* Category 2 – Eligible if resources allow
* Category 3 – Not eligible due to poor prognosis, age, or exclusion criteria
40
What is the ethical significance of the Charlie Gard case in medical ethics?
Conflict between parental autonomy and the best interests of the child.
1. Best Interests of the Child
2. Parental Autonomy
3. Distributive Justice & Futility
41
What is the role of surrogate decision-making in healthcare?
Appointing an individual to make healthcare decisions on behalf of a patient lacking decision-making capacity.
42
Fill in the blank: The ethical principle of _______ involves doing good and prioritizing patient welfare.
Beneficence
43
* Definition of an Argument:
o "A reason or set of reasons given in support of an idea, action, or theory."
44
* Facts vs. Values:
o Factual claims are justified through empirical observation.
o Ethical judgments are justified through rational argumentation.
45
What are the ethical challenges in resource allocation during pandemics?
* Triage systems
* Fair distribution of resources
* Addressing health inequities
46
What is the main ethical concern with vaccine mandates?
Balancing autonomy with public health objectives.
47
What are common logical fallacies in ethical arguments?
1. Appeal to Nature: Assuming what is natural is inherently good.
2. Naturalistic Fallacy: Equating what is pleasant or unpleasant with moral rightness or wrongness.
3. Is/Ought Fallacy: Drawing normative conclusions from descriptive facts.
48
Toulmin’s Model of Argumentation:
1. Claim – The assertion being made.
2. Grounds – Evidence supporting the claim.
3. Warrant – The logical connection between the grounds and claim.
4. Backing – Additional support for the warrant.
5. Rebuttal – Anticipating counterarguments.
6. Qualifier – Conditions limiting the claim’s strength.
49
What does the term 'dual loyalty conflicts' refer to in healthcare?
Healthcare professionals balancing state vs. patient interests.
50
What is the ethical principle of least infringement in public health?
Choosing interventions that impose the fewest restrictions necessary.
51
What is the significance of the Accountability for Reasonableness (A4R) framework?
Ensures fair allocation of healthcare resources.
52
What are the medical factors considered in patient selection for dialysis?
* Age Limits
* BMI Restrictions
* HIV, Hepatitis B & C Status
* Psychological Factors
53
What does the term 'common morality theory' refer to?
Universal moral norms that guide ethical behavior.
54
What is the ethical principle of non-maleficence?
Do no harm.
55
Fill in the blank: The _______ framework in public health ethics seeks to balance individual rights with community health benefits.
A4R (Accountability for Reasonableness)
56
What are the ethical implications of climate change on public health?
Healthcare institutions' responsibility to minimize environmental impact.
57
What is the role of arguments in ethical decision-making?
To justify beliefs, opinions, actions, and persuade others.
58
What is the focus of virtue ethics in healthcare?
Emphasizing character and moral virtues.
59
What does the term 'moral obligations' refer to in public health interventions?
Responsibilities to prevent harm while respecting individual choices.
60
What is social weighting?
A method to evaluate the priority of patients for treatment based on various factors.
61
Surrogate Decision-Making
Surrogate decision-making involves appointing an individual to make healthcare decisions on behalf of a patient who lacks decision-making capacity.
62
National Health Act No. 61 of 2003 in terms of surrogate decision making.
A health service may not be provided without informed consent unless:
1. The patient has mandated a surrogate in writing.
2. A person is legally authorized to provide consent (court order, law).
3. If no legally designated surrogate exists, the decision follows a specific order:
Spouse or partner
Parent or grandparent
Adult child
Sibling
4. Treatment is necessary to prevent serious risk to public health.
5. Delays in treatment would result in death or irreversible harm.
63
What considerations are there for emergency dialysis in late-presenting cases?
Assessment of urgency, patient condition, and resource availability.
64
Advanced Directives regarding surrogate decision making
Neither the living will nor durable power of health care attorney is recognized under South African law.
However, a competent patient can appoint someone to make medical decisions if they later become incapacitated.
Must be in writing
65
What are the provisions for living donor transplants?
Options for waitlisting and eligibility assessments.
66
What are the criteria for Category 3 in renal transplantation eligibility?
* Age >60
* Obesity BMI>35
* HBeAg pos/high viral load/cirrhosis
* AIDS
* Substance abuse
* Uncontrollable malignancy
* Irreversible organ disease
* Mental illness prohibiting responsibility
* Non-SA citizen
67
What factors are considered in Category 2 for renal transplantation?
* Comorbid disease
* DM
* Smoking
* HBsAg pos
* No cirrhosis
* BMI 30-35
* Previous kidney transplant
* Good home circumstances
* Well motivated
* Good support
68
What are the criteria for Category 1 in renal transplantation eligibility?
* Age <50
* BMI <30
* HIV/HBsAg negative
* Employed
69
What is brain death?
Complete and irreversible cessation of all brain activity including the cerebrum, cerebellum, and brainstem.
70
What are the preconditions for brain death diagnosis?
* Deep coma
* Absence of depressant drugs
* No hypothermia
* Exclusion of metabolic/endocrine causes
* Identifiable cause
71
What is the Glasgow Coma Score for deep coma?
3
72
What are the brainstem tests used in brain death diagnosis?
* Pupil response
* Corneal reflex
* Vestibulo-ocular reflex
* Gag reflex
* Oculocephalic test
73
What is the Apnoea Test?
Patient disconnected from ventilator to check for respiratory movements. Oxygen provided at 6L/min via ET tube
74
What signifies a positive Apnoea Test?
No respiratory movements when PaCO2 > 6.65 kPa.
75
What are confirmatory tests for brain death?
* Angiography
* EEG
* Isotope study
76
What additional tests are required for neonates <36 weeks corrected gestation?
Specific tests beyond standard brain death criteria.
77
What is required for legal certification of brain death in South Africa?
Two clinicians, one with at least five years of experience.
Death is officially certified at the moment the apnoea test confirms brain death
78
What ethical concerns arise in doctor-patient social media interactions?
* Blurring of professional boundaries
* Providing online medical advice
* Crowdsourcing medical advice
* Conflicts of interest
* Defamation risks
79
What does HPCSA discourage regarding online medical advice?
Giving advice unless in emergencies or life-threatening situations. There is a duty to protect others from harm
80
What are the five elements of defamation?
* Publication of defamatory co ntent
* Identification of the person
* Negative impact on reputation
* Falsehood of the statement
* Fault or intent behind the defamation
81
What does the Children's Act No. 38 of 2005 govern?
Children's rights and decision-making in healthcare. Supports families to ensure children's well-being, prevent abuse/neglect, and provide care for children in need.
82
What is the paramount consideration in decisions concerning children?
Best interests of the child.
Child participation.
83
Consent to Medical Treatment in children
o Children aged 12+ can consent to medical treatment if they have sufficient maturity.
o Children aged 12+ can consent to surgical treatment if assisted by a parent/guardian.
o Parental Consent Required for children under 12.
84
What is mandatory reporting under Section 110?
Reporting sexual abuse, physical abuse causing injury, and deliberate neglect.
Reports must be made to the Department of Social Development (DSD), SAPS, or a Child Protection Organisation.
85
What age can children access contraceptives without parental consent?
Children aged 12+.
86
The legal standing around circumcision and children
o Female circumcision is prohibited.
o Religious circumcision for boys is allowed with parental consent.
o Social or cultural circumcision is prohibited for boys under 16 years.
87
What are applications of AI in healthcare?
* Diagnostics
* Predictive analytics
* Robotic-assisted surgery
* Chatbots
88
What ethical concerns are associated with AI in healthcare?
* Bias in AI models
* Patient privacy
* Accountability and liability
* Informed consent
89
FATE principles
In terms of AI development:
Fairness
Accountability
Transparency
Ethics
90
Ethical Theories Applied to Psychiatry
o Consequentialism (Utilitarianism): The right action is the one that produces the most overall good.
o Deontology (Kantianism): Ethical rules should be followed universally, emphasizing rational decision-making.
o Virtue Ethics (Aristotelianism): Encourages practitioners to cultivate wisdom and moral character.
91
Elements of Informed Consent
o Competence
o Voluntariness
o Disclosure
o Understanding
o Decision
o Authorization
92
Components of Competence
1. Ability to communicate a choice.
2. Understanding the current situation and consequences.
3. Understanding relevant medical information.
4. Ability to reason rationally about risks and benefits.
5. Making a decision a reasonable person would make.
93
What does the Mental Health Care Act (MHCA) of 2002 regulate?
Regulates the care, treatment, and rehabilitation of people with mental illnesses. Due to potential impaired decision making capacity
94
What are the categories of patient admission under the MHCA?
* Voluntary Admission
* Assisted Admission
* Involuntary Admission
* Emergency Admission
95
Voluntary Admission
o Competent patient requests admission for treatment.
o Can leave when they wish.
96
Assisted Admission
o Patient is not fully competent but does not refuse treatment.
o Requires a family member or caregiver’s application.
97
Involuntary Admission
o Patient is not competent and refuses treatment.
o May pose a danger to themselves or others.
o Requires medical and legal assessment before admission.
98
Emergency Admission
o Patient needs urgent psychiatric care.
o Can be admitted for up to 24 hours without formal assessments.
99
What is the role of the HPCSA?
Regulation of professional conduct, education, and training of health professionals.
- regulation of education and training
- monitoring professional conduct
- registration and licensing
- determination of fees & practise standards
100
Ethical frameworks covered by HPCSA
o Informed Consent
o HIV Management
o Telemedicine
o Research Ethics
o Social Media Usage
o Withholding & Withdrawing Treatment
101
What are common complaints filed against health practitioners?
* Unethical advertising
* Breach of confidentiality
* Professional incompetence
* Sexual misconduct
* Fraudulent medical certificates
102
What is over-servicing?
Providing medically unnecessary tests or treatments or procedures
103
Perverse Incentives
Accepting or offering financial benefits for referrals, research participation, or product endorsements.
104
Social Media Misconduct
o Breach of patient confidentiality.
o Defamation of colleagues or institutions.
o Making racist, sexist, homophobic, or derogatory remarks online.
105
What is the legal framework for medical professionals in South Africa?
* HPCSA guidelines
* SAMA responsibilities
* Court proceedings
106
What are the common reasons doctors get sued?
Patient dissatisfaction, perceived negligence, or medical errors:
* Failure to provide proper care
* Misdiagnosis
* Lack of informed consent
* Surgical errors
* Unprofessional behavior
107
What must be prioritized in medical practice?
Patients' interests and well-being must be prioritized.
108
What does the South African Medical Association (SAMA) define?
It defines the rights and responsibilities of doctors and patients.
109
Court Proceedings Involving Doctors
o Inquests: Investigating deaths due to unnatural causes.
o HPCSA Inquiries: Professional misconduct cases.
o Criminal Cases: Charges such as fraud, culpable homicide, or gross negligence.
o Civil Suits: Patients suing for perceived negligence.
o Witness Testimony: Doctors may be called to testify.
110
What is the purpose of the inquest process?
Judicial inquiry into unnatural deaths.
Determines the cause, date, and potential responsibility for the death.
May lead to HPCSA or criminal charges.
Doctors must report unnatural deaths and provide a detailed report.
111
What is a core element of doctor-patient relationships?
Trust is a core element of doctor-patient relationships.
112
What are the types of court proceedings involving doctors?
* Inquests
* HPCSA Inquiries
* Criminal Cases
* Civil Suits
* Witness Testimony
113
What is the purpose of an inquest?
Investigating deaths due to unnatural causes.
114
What must doctors report in the inquest process?
Unnatural deaths and provide a detailed report.
115
What triggers an HPCSA inquiry?
Patient complaints or an inquest outcome.
116
What can be the outcomes of an HPCSA inquiry?
* Warnings
* Fines
* Suspension
* Deregistration
117
What is the burden of proof in criminal cases?
"Beyond reasonable doubt."
118
What is the burden of proof in civil suits?
"Balance of probabilities" (51% likelihood of negligence).
119
What are the components of Duty of Care?
* Duty to assess the patient properly
* Duty to ensure informed consent for treatment
* Duty to meet reasonable medical standards
120
What must patients be fully informed of?
* The procedure
* Risks and benefits
* Alternative options
121
What are strategies for risk management for doctors?
* Maintain strong doctor-patient relationships
* Keep good medical records
* Adhere to medical guidelines
* Respond to incidents appropriately
122
What should doctors avoid in reporting adverse events?
Speculation, blame, or omissions.
123
What is defensive medicine?
Practicing with extra caution to reduce legal risks. Documenting every step of patient care.
124
What is the importance of documentation in medical practice?
If it’s not documented, it didn’t happen.
125
What is the burden of proof in civil cases?
"Balance of probabilities" (51% likelihood of negligence).
126
What should be gathered when analyzing an ethical dilemma?
Medical information
Legal information
Ethical considerations
Patient’s Preferences
Family's Preferences
Doctors Personal Value system
Socio-Political Norms
127
Consequentialism
How to achieve the greatest good for the greatest number?
128
Deontology
Doctors' duty to do good while considering justice in resource allocation.
129
What is the objective of establishing ethical guidelines for ICU stays?
To address prolonged stays in cases of poor prognosis.
130
What are the four principles of medical ethics?
* Autonomy
* Beneficence
* Non-maleficence
* Justice
131
