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Health Care Ethics > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

What is relativism?

A

Belief that there are no universally valid moral principles, the truth of all moral claims is relative to the beliefs of the individual or their culture

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2
Q

What is the problem with relativism?

A

-Makes it so that any behavior could be justified as morally right

-Can’t have inter-societal
judgements (going against cultural norms)

  • Revolutionaries can’t be right (stood up against majority)
  • It makes moral progress impossible (no subjective standard)
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3
Q

What is the definition of consequentialism?

A

morality based on outcome (consequences), weigh likely positive and negative consequences to determine the right action to take

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4
Q

What is the definition of deontology?

A

reasoning from principles, morality is based on duties/obligations/principles NOT consequences

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5
Q

What is Natural Law?

A

Idea that everything is inherit in human nature, thus right actions can be determined by examining this nature

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6
Q

How can human nature be defined?

A

how people normally act, universal between humans

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7
Q

What is the main idea behind Natural Law?

A

Idea that all laws can be determined through reason, natural laws are objective and knowable by all

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8
Q

What is the key feature behind Virtue Ethics?

A

focus on individuals character rather than actions

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9
Q

What are virtues?

A

dispositions/habits– you have to work on them

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10
Q

How is virtue ethics distinct from other theoretical approaches?

A

it focuses on how to be a good person instead of what is right and wrong

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11
Q

What is ethics of care?

A
  • criticizes traditional theories for being ‘cold’
  • recognizes that human relations aren’t cold and abstract
  • suggests that moral emotions (care and empathy) should be included in consideration about right action
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12
Q

How is ethics of care different from traditions theories?

A

doesn’t separate reasons and emotion, realizes that emotion can be closely tied to reason and theory. Emotion has a role

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13
Q

How is ethics of care applied?

A

applied by acknowledging emotions and allowing them to play a role in ethical decision making

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14
Q

How is ‘following your feelings’ a decision-making shortcut?

A
  • Good motivator but can’t ALONE justify morality
  • feelings could be based on prejudice/personal bias
  • Can feel guilty even if you do the right thing
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15
Q

How is ‘obeying the law’ a decision-making shortcut?

A
  • Law is often based on ethics, but there is much divergence
    ex) no law about cheating on a spouse, however it’s unmoral
  • Civil Rights Movement was started to stop unjust/unmoral laws
  • Have to consider consequences of breaking law, but sometimes morality requires it
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16
Q

How is ‘following your religious beliefs’ a decision-making shortcut?

A
  • isn’t enough to just say, “I believe this because my religion says so” YOU NEED JUSTIFICATION
  • Could easily slip into relativism (idea that you believe what you believe)
  • Must find underlying justification for a moral claim
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17
Q

How is ‘following your professional code of ethics’ a decision-making shortcut?

A

-As a matter of personal responsibility, you must be able to justify what dictates your code of ethics

  • Many codes are incomplete and internally inconsistent
  • There’s not much specific guidance, must more general
  • Code of ethics strive for consensus and sometimes do not really mirror morality
  • Conflicting advice, must look for underlying ethical considerations
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18
Q

How is ‘doing what everyone else is doing’ a decision-making shortcut?

A
  • sometimes people get into the habit of not doing what is the right thing
  • “everyone is doing it” does NOT justify it
  • sometimes you must decide to ‘go with the flow’ or do what’s right and risk losing your job for new employment
  • personal responsibility requires you to critically evaluate normal practices to ensure that they are morally justified
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19
Q

How is ‘avoiding the “unnatural”’ a decision-making shortcut?

A
  • doesn’t give you a good moral assessment

- used as a crutch when things are unfamiliar or new to us

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20
Q

What is considered ‘unnatural’?

A

something that is wrong by itself, means different things to different people, VERY AMBIGUOUS

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21
Q

Define: respect for persons

A

doing what’s best for others rather than what’s best for you (looking at the big picture)

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22
Q

Define: autonomy

A
  • people (at 19 in NE) have the right to make their own REASONED choices and choose their own path
  • must be able to accept consequences that come with their choices
  • children and people with disabilities do not have FULL autonomy
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23
Q

Define: fidelity

A

promise keeping, doing what you say you’ll do

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24
Q

Define: veracity

A

honestly, telling the truth

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25
Q

Define: confidentiality

A

obligation to keep private information private, not to pass info on unless to people who must know (in the medical field that includes: doctors, nurses, etc)

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26
Q

Define: privacy

A

right of an individual to determine what information about them is shared and what is not

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27
Q

Define: beneficence

A

duty to help/act/intervene

ex) preventative care for patients such as vaccines

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28
Q

Define: nonmaleficence

A

duty to not harm

ex) if someone is asking for a fully functional limb to be removed, the doctor will most likely say no because it will cause more harm than good to remove it

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29
Q

Define: justice

A

fair distribution (fair doesn’t always mean equal)

ex) the grade that you get is fair due to the amount of studying and work you did for the exam

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30
Q

Conflicts in healthcare when it comes to justice

A
  • distribution of limited resources
  • access (to doctors, therapists, tests, technologies, etc)
  • organ transplants: who get the organs?
  • not enough organs for everyone on the list to receive a donation
31
Q

Explain the ethical considerations that underlie the focus on informed consent in healthcare

A
  • Making sure people’s autonomy is being taken into account and allowing them to make the choice
  • Making sure people have the correct information to make an informed choice
32
Q

What led to the shift in healthcare from a focus on beneficent paternalism to a focus on individual rights?

A

-Cultural change
60-70’s focus on individual’s rights
*Women’s Movement
*Civil Rights Movement

-Medical Advances
People were surviving things that they wouldn’t have survived beforehand
*Life support
(People and their families were forced to continue treatment because the doctors saw discontinued treatment as killing them, were not allowed to discontinue treatment)

-Patient’s Health Determination Act
*Made it so that patients had the right to determine treatment
• 1990 and 1991

33
Q

Explain some problems with informed consent in health care as it is currently practiced

A

-There’s a lot of variation between healthcare providers on whether they are more worried about actually informing the patient or just trying to get the form signed
*Jumping through legal hoops to keep lawyers happy
_Can’t be sure that you are ACTUALLY and TRULY informed

-Have gone from a process of trying to understand the procedure over a period of time (weeks and months) to a one time sit down meeting where you are informed and sign the paper

34
Q

What is the role of shared decision-making in informed consent? What are the contributions of each party in shared medical decision-making?

A

Role is to make sure both parties have their voice heard and that the best medical choice can be made for the patient

  • Physicians offer medical training, knowledge, and expertise
  • Patients offer knowledge of own aims and values (can weight risks and benefits)
35
Q

What is the difference, as explained in class, between decision-making capacity and competence?

A
  • Competence is a legal term used by the courts

- Decision-Making Capacity is the ability of the person to make reasoned decisions/choices

36
Q

What conflicting principles lead to the types of ethical conflicts in medical decision-making discussed in the section ‘Patient Autonomy the Central Value in Medical Decision-Making’?

A
  • Autonomy vs. Beneficence

- their choice vs. helping them (doing what’s best for them)

37
Q

-In “When Competent Patients Make Irrational Choices,” Brock and Wartman give two definitions of irrational (p16) – what are they? Which one do they believe is more important in the discussion of the role of patient autonomy in decision-making? Why?

A
  • One that satisfies those aims and values less completely than another available choice
  • If it fails to promote a set of basic aims and values that belong to the physician or to standard guidelines of medical practice
  • They believe that the first one is more important because it takes into account the patient’s own aims and values
38
Q

-What was Brock and Wartman’s purpose in identifying common forms of irrational decision-making?

A

-Helps the doctor get a clearer image of what new information may be presented to the patient to help give them a clearer picture of the procedure and the benefits that it could have for them

39
Q

-Ultimately, according to Brock and Wartman, what should a provider do if they recognize that a patient/client’s health care decision is irrational? What principle supports this approach?

A
  • Give them more information to help ensure that their choice is truly informed. Try to lead them toward a more rational decision.
  • Supported individualistic autonomy because they are responsible for their own decision making, even though it may be irrational.
40
Q

According to Stirrat and Gill (in “Autonomy in Medical Ethics After O’Neill”) what is the difference between “principled autonomy” and “individualistic autonomy”? (pp20-21) Which of these do they endorse as appropriate in medical decision-making?

A
  • Principled: respect autonomy if person considers the effects on others (account for how your choices affect others) adds requirement that patient be beneficent
  • Individualistic: regular autonomy (right to make your own choices for whatever reason you want)
  • They endorse principled autonomy because it accounts for the feelings and opinions of others as well as the patient
41
Q

Stirrat and Gill imply that “principled autonomy” requires that patients choose “responsibly in a manner considerate to others” – should these considerations be required for autonomy? How does this differ from the position of Brock and Wartman?

A

-Stirrat and Gills take a more communal (ethical) approach to autonomy, whereas Brock and Wartman take a more patient bound approach to autonomy.

42
Q

Explain what you take to be the strongest reasons for the claim that autonomy ought to be the central value in medical decision-making. (Be sure to identify which definition of autonomy you are applying.)

A
  • Physicians are fallible
  • They make mistakes
  • May frame things according to personal bias
  • May not know relevant patient information
  • Systemic factors may cause underlying influence (extra testing, quotas, time, insurance)
  • No two people are exactly the same
  • Different values and goals
  • Different pain thresholds
  • Shouldn’t be forced to endure treatment against their will (Violation of nonmaleficence)
43
Q

Explain what you take to be the strongest reasons for the claim that autonomy should not be the central value in medical decision-making. (Be sure to identify what other principles are appealed to and which definition of autonomy you are applying.)

A
  • Physician expertise should override patient’s choice
  • Beneficence: trying to help/do what’s best
  • Individual choice can determine community health
  • Immunizations, outbreaks (EBOLA)
44
Q

Define: advance directive

A

Generally inform others of your choices in various healthcare situations

45
Q

Define: living will

A

Instructions regarding medical care for principal in certain specific situations, applies only while the principal is still LIVING

46
Q

Define: last will and testament

A

Instructions regarding what happens to the principal’s estate, minor children, etc. applies AFTER principal’s death

47
Q

Define: attorney-in-fact

A
  • Person elected by you to be in charge

- same thing as the durable power of attorney

48
Q

Define: power of attorney

A
  • useless once person becomes incapacitated

* terminated by disability, incompetence, or death of principal

49
Q

Define: durable power of attorney

A

can be used when incapacitated, terminated by death

50
Q

Define: durable power of attorney for health care

A

goes into effect when principal is no longer capable of making his/her own healthcare decisions

51
Q

Define: DNR

A

Do Not Resuscitate

52
Q

Define: DNI

A

Do Not Intubate

53
Q

Define: POLST

A

Physicians orders for life-sustaining treatment

  • Uses communication between patient and physician regarding decision-making
  • Applies only during serious illness
  • Once decisions are made, they are written as physician orders
  • Believed to hold more power than just regular wishes/will
54
Q

What are three differences between a living will and a durable power of attorney for healthcare?

A

Living Will:
is a living document where you in the document list what your wishes are (specific instructions)
-Only applies when living (no longer able to make their own decisions, terminal illness, PVS)

Durable Power of Attorney:
you just pick the person and appoint them to speak your wishes when you are unable due to health reasons
-Applies ANY TIME that you are incapacitated
• Applies in a much wider range of cases
• More flexibility since it’s an actual person making the decisions instead of a piece of paper that can’t change

55
Q

What special provision is included in the Nebraska law regarding the right of a DPOA for health care to decide to withdraw life sustaining treatment?

A

If your power of attorney for healthcare… if you want them to be able to withdraw life sustaining treatment… you have to explicitly appoint them to do that/make that choice in the legal documents or they won’t legally be able to make that choice

56
Q

What ethical principles support the push for advance directives?

A

Autonomy (right for the person to be able to make their own justified decisions) and nonmaleficence (if you are providing care that they wouldn’t want you are creating more harm than good)

57
Q

Explain how the concept of surrogate decision-making is related to patient autonomy.

A

The patient has hand-picked this person and believed that this person would know them well enough to act in their favor, therefore, it plays into patient autonomy because it’s still allowing the patient to have a choice even after capacitation.

58
Q

Why are cases like Terri Schiavo’s difficult?

A

Many factual questions cannot be answered with absolute certainty

59
Q

What factual instances pertaining to Terri Schiavo’s case make it challenging?

A
  • the patient cannot directly express her/his wishes, so, in the absence of a clear advance directive, the decision-makers cannot be certain about what she/he would want
  • the diagnosis of PVS can be tricky and could be mistaken, which leads to uncertainty about patient suffering and the possibility of improvement or recovery
  • the surrogate is faced with a difficult, emotional (and possibly financial choice), so there can be uncertainty regarding whether they are adequately representing the patient’s will
60
Q

What evidence does Wolfson use in “A Report to the Governor Jeb Bush… in the Matter of Theresa Marie Schiavo” to support his conclusion that the decision to remove all life support should be carried out?

A

-Medical evidence
o Tons of independent researchers who watched her and saw no proof of reaction to stimuli
o Researchers and doctors alike saw no improvement over the 15 years that she was kept alive

-Encounters with her friends who had said that based on what she said when she was alive that she would not want to be kept alive

61
Q

Explain three reasons Koch gives in “The Challenge of Terri Schiavo: Lessons for Bioethics,” in support of the claim that the lives of severely disabled persons (including those diagnosed to be in a PVS) should not be ended by the discontinuation of nutrition and hydration.

A
  • Personhood: more broadly in relationship with others, need to respect relationship that she had with her parents and not discount it
  • Sanctity of Life: All life is valued regardless of limitations and we shouldn’t be ending them, need to continue her life because discounting one life could create a slippery slope of deciding who should die and who should live, could lead to disrespect for life for people with disabilities
  • Suffering: if the diagnosis is correct, then she’s not suffering so why not let it continue? If the diagnosis is incorrect, then stopping her treatment would cause harm, so why would we do it?
62
Q

Based on the reading and class discussion, develop the strongest argument you can in favor of allowing a surrogate to terminate life sustaining care including artificial nutrition and hydration.

A

-Allows for patient autonomy
• if the patient would not like to live like this, then we need to respect their wishes

-Quality of Life
• forcing someone to remain alive against their will violates it
• if there’s no chance for advancement, then what’s the purpose of holding off death? Especially when it’ll happen anyways

-Cost of unwanted care
• We could be wasting resources that could be used elsewhere
• It’s an unfair burden on the caretakers

-Violation of
nonmaleficence
• Forcing care that is unwanted
o Causes more harm than help

63
Q

Based on the reading and class discussion, develop the strongest argument you can against allowing a surrogate to terminate life sustaining care including artificial nutrition and hydration.

A

-Undermines familial relationship and personhood
• Idea of autonomy as a means of relationships with community

-Sanctity of Life
• Idea that ending a life is wrong
o Undermines respect for life

-Uncertainty of Diagnosis
• Removal may cause suffering
o violation of nonmaleficence
o If there is no cerebral function, there is no suffering so what’s the hurt in allowing her to stay alive
o If there is ANY cerebral function, taking away food and water would cause suffering

  • Surrogate may make decision for wrong reason
  • Surrogate may have lack of knowledge
64
Q

According to “How to Teach Doctors Empathy,” what are some of the characteristics of clinical empathy?

A

Ability to stand in patients shoes and convey an understanding of the patients situation as well as the desire to help

65
Q

What is “shared decision making”? (see Brock and Wartman, p15)

A

Both physician and patient make active and essential contributions, makes deciding the best treatment option much easier and more consistent with the wishes of both parties

66
Q

Based on information in the article “How to Teach Doctors Empathy,” explain how clinical empathy could affect the shared decision making process.

A

Helps doctors to alleviate underlying worry that may be in patients. Makes the process go smoother because the patient is able to put their trust in the physician and the physician is able to better understand more aspects of the patients dimensions

67
Q

Based on information in the article “How to Teach Doctors Empathy,” explain at least three ways applying clinical empathy can be good for healthcare.

A
  • Higher patient satisfaction
  • Better outcomes
  • Decreased physician burnout
  • Lower risk of malpractice suits and errors
68
Q

Define: Voluntary passive euthanasia

A

-Comes directly from the patient

Passive requires stopping something (ex) cancer treatment, dialysis, etc)

69
Q

Define: Non-voluntary Passive Euthanasia

A
  • surrogate makes choice for patient

- acts on what they think the patient would want

70
Q

Define: voluntary active euthanasia

A

-intentionally administering medications to cause the patient’s death at the patient’s request with full, informed consent

71
Q

Define: non-voluntary active euthanasia

A

euthanasia conducted when the explicit consent of the individual concerned is unavailable, such as when the person is in a persistent vegetative state, or in the case of young children

-still acting in accordance to patient’s will/wants

72
Q

Define: Physician Aid in Dying

A

refers to a practice in which a physician provides a competent, terminally ill patient with a prescription for a lethal dose of medication, upon the patient’s request, which the patient intends to use to end his or her own life

73
Q

Define: principle of double effect

A

-Tries to account for cases where you have one action that has two consequences (one which is good and one is bad) and sees how you can apply the principle

Morphine: used in hospice to take away pain, can also lead to death (Must act on good intents )

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