Famous Cases Flashcards
What did the Nuremberg code establish, in terms of research? (3)
- Voluntary consent
- Benefits have to outweigh the risks
- Ability of subject to terminate participation
What are the three Belmont principles?
- Respect for pt autonomy
- Beneficence
- Justice (equitable distribution of harm / benefits)
What is the relation between group size and the groupthink concept?
Bigger groups = more groupthink
What was the Tarasoff v Regents case?
Former girlfriend killed by Podder, who was not held appropriately held after stating homicidal intention
What were the two things that came out of the Tarasoff and Regents case?
- Duty to warn
- Duty to protect
What did we learn from the Dax Cowart case?
-Pt should maintain ability to make a decision that you deem is incorrect
What did we learn from Larry McAfee case?
Resources make a huge difference
What did we learn from the Janet Adkins/Dr. Kevorkian case?
Don’t be a renegade
What did we learn from Elizabeth Bouvia?
(cerebral palsy wishes to die)
- Every human should maintain the right to die
- Public opinion is substantial
What was learned from the Karen Quinlan case?
(Vegetative state pt, with parents wanting to withdraw life support)
- Standard of care is fluid
- State recommended hospitals enact ethics committees
What are the three standards of legal evidence?
- Preponderance of evidence
- Clear and convincing evidence
- Most rigorous standard (beyond a reasonable doubt)
What did the US supreme court rule in the Nancy Cruzan case? (3)
(Vegetative state pt with state saying it had an interest in preserving life)
- Made the standard that patients have the right to refuse life sustaining measures
- Finding it was acceptable to require “clear and convincing evidence” of a patient’s wishes for removal of life support
- Huge push for advanced directive
What was learned from the Schiavo case?
(severe hypokalemia 2/2 eating disorder lead to cardiac arrest and severe hypoxic-ischemic encephalopathy. EEGs were flat)
The court is not the best place to mediate issues in the family
What was the main issue with the Schiavo case?
No societal consensus about whether a feeding tube is in the best interest of a patient in PVS
What was involved in the Karen Quinlan case? (court, impact)
- New Jersey Supreme court
- Motivated hospitals to develop process for addressing ethical issues
What was involved in the Nancy Cruzan case? (court, impact)
- US SC
- Sparked state and federal legislation to facilitate use of advanced directives (danforth self determination act)
What was involved in the Terri Schiavo case? (court, impact)
- Florida SC
- Heightened importance of surrogate decision maker
True or false: Coma = Vegetative state
False–Vegetative state is a potential outcome of a coma, but not the only outcome
What is coma AND vegetative state?
Pts are unresponsive and unarousable
When is vegetative state persistent? Permanent?
-1 month = persistent
Permanent:
- 3 month if anoxia
- 12 month if traumatic brain injury
What is a coma? (eyes open or closed) Vegetative state?
Eyes-closed state = coma
Eyes open = vegetative state
What is a coma?
initial presentation to severe brain injury and is self limited, usually lasting a few weeks. Can progress to brain death or complete recovery
What is a minimally conscious state? What is the prognosis?
- A vegetative state that has yet to become permanent
- Has fluctuating consciousness level, and uncertain prognosis
True or false: a minimally conscious state is still a state of consciousness
True
What is the appropriate language when describing persistent/permanent vegetative state?
Type of injury (traumatic anoxic etc) and its duration
When was Roe v Wave ruled? What was ruled?
1973
-Overturned all state laws limiting women’s access to abortions during the first trimester, limited access during the second, and gave states the right to forbid abortion in the third trimester
When do the rights of the fetus begin to supercede those of the mother?
24-28 weeks
True or false: Roe v Wade forbade states from deciding what could be done in the third trimester with an abortion
False– gave them the right to choose, but with the exception that if there was serious health to the mother, then abortions were legal
What occurred with the baby jane doe case?
Down baby born with Meningomyelocele, hydrocephalus, and other anomalies
- Parents elected symptomatic treatment
- Right-to-life activists sued to force parents to consent to treatment to close a meningomyelocele, with the Fed hopping in as well
What was the child abuse law of 1984?
-In order for states to receive federal money, hospitals need to develop procedures to report medical neglect of children/babies
What happens to the child abuse law of 1984?
1986–regulations were struck down by the US supreme court on the grounds that the autonomy of the states had been violated, and the rehabilitation act did not apply to the medical care of handicapped patients
Who was Saul Krugman?
Guy who performed the Willowbrook study–purposeful infection with Hepatitis to study disease course
What was the Willowbrook school?
Staten island institution for mentally ill or developmentally delayed children
What was the Willowbrook case?
Children intentionally exposed to hepatitis to track the development of the infection, and test the effectiveness of gamma globulin injections
What was born out of the willowbrook case? (2)
- Need for IRBs
- Improve the residential facilities
What was the Elizabeth Stern case?
Stern paid woman to have another woman be a surrogate–surrogate took the baby
What was borne of the Elizabeth Stern case?
-Babies can have multiple parents
What was Baby fae?
Baby fae born with hypoplastic left heart syndrome–baboon heart replaced it, but baby died d/t immunological rejection
What was the ethical dilemma with Baby fae?
Ethicists faulted loma linda clinicians since no attempt was made to find a human heart, and made the baby into an experiment
What was the baby K case?
- Baby with anencephaly but mother refused to take off of ventilation
- Diagnosed prenatally, but mother refused abortion
What was the importance of the baby K case? (5)
- Defining death
- Nature or personhood
- Moral standing
- Medical futility concerns
- Resource allocation
What is the major moral crisis currently in medicine?
Our failure as a society to have a sufficient sense of physical and moral limits
What is the shift in thinking in regards to end of life care?
From what’s in the best interest, to patient’s wishes
Who leaked the Tuskegee case?
Peter Buxton
What were the principals that arose d/t Tuskegee?
Belmont principles
What were the two cases in which the pt won the right to die, but decided against it?
Mcafee
Elizabeth Bouvia
What is the significance of the baby doe laws?
We need to be more active in the formation of laws that affect our care
How is the standard of care shifting in neonatal care?
To “substituted judgement” from “best interest”
