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FDN2 > FDN2_Ethics > Flashcards

FDN2_Ethics Flashcards

1
Q

What 4 pieces of information are necessary for a patient to make an informed decision?

A
  1. Diagnosis and prognosis
  2. Recommended treatment*
  3. Alternative treatments*
  4. Consequences of no intervention*

*And associated risks, benefits, and consequences

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2
Q

What case resulted in the “duty to inform” ruling?

A

Martin Salgo

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3
Q

Describe the Martin Salgo case

A
  • Martin Salgo was permanently paralyzed following translumbar aortography.
  • The physician did not infrom him of the possible risk of paralysis
  • Martin Salgo sued
  • The court ruled that physicians had a duty to inform patients of “any facts which are necessary to form the basis of an intelligent consent by the patient to the proposed treatment”
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4
Q

What information should be provided to the patient under the “duty to inform” ruling?

A
  • Any facts necessary to provide informed consent
  • Basically, any side effects/consequences that are common or serious
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5
Q

Name 3 informed refusal cases

A
  • Dax Coward (Texas, 1972)
  • Elizabeth Bouvia (California, 1983)
  • William Bartling (California, 1984)
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6
Q

Describe the Dax Coward case

A

Dax Coward suffered severe burns all over his body and continually requested that treatmetn be stopped. Physicians refused, and Coward was treated against his will

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7
Q

Describe the Elizabeth Bouvia case

A
  • Elizabeth Bouvia had cerebral palsy
  • She admitted herself to the hospital, requesting that she be allowed to starve herself to death
  • Eventually, the hospital force fed Bouvia
  • The court determined that Bouvia (like any competent patient) had the right to refuse any medical treatment
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8
Q

Describe the William Bartling case

A
  • William Bartling was a patient with several medical conditions, but was not terminally ill
  • Bartling requested to be removed from the respirator, but the hospital refused
  • The supreme court of California sided with Bartling
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9
Q

Describe the idea of consent

A

Patients who have decision making capacity have the ability to agree to or refuse any medical treatment proposed by a physician

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10
Q

What is assent? How is it different from consent?

A

Patients who lack decision making capacity cannot consent to or refuse a treatment

Assent = these patients agreeing to/accepting the treatment for which their surrogate has given consent

Health care professionals have a moral oblication to ask for assent

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11
Q

Describe a patient who can give assent, but not consent, for a proposed treatment

A
  • A minor
  • A patient who lacks decision-making capacity
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12
Q

What are the 4 types of advance directives?

Which are written and which are oral?

A
  1. Living wills (written)
  2. Health care proxy (written)
  3. Oral statements to family members or friends
  4. Oral statements to physicians
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13
Q

What are the 3 criteria for evaluating the trustworthiness of an advance directive?

A

Advance directives are more trustworthy if they are…

  1. Specific - The directive should indicate what specific treatments the patient would want in various clinical situations
  2. Informed - The patient’s preferences must be informed
  3. Repeated - The directive is repeated over time, in different situations, to varous individuals
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14
Q

If a patient lacks decision making capacity and an advance directive is unavailable, how are decisions made about treatment?

A

A surrogate decision maker

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15
Q

What are the two standards for surrogate decision making for adults?

A
  1. Substituted Judgement: Surrogate attempts to make decisions based upon the known values of the patient
  2. Best Interest: Descisions are bade based upon what a “reasonable person” would wish done in the given case. One should consider reduced suffering, quality of life, and risks and benefits of proposed intervention
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16
Q

A surrogate decision maker who is using best interest standards should take into accout…

A
  • Reduced potential suffering
  • Quality of life
  • Risks and benefits of proposed treatment
17
Q

If a surrogate is using the patient’s values to make a decision about their treatment, they are using…

A

Substituted judgement

18
Q

If a surrogate is basing treatment desisions upon what a reasonable person would wish for, they are using…

A

Best interest standards

19
Q

Name 3 surrogate desision court cases

A
  1. Karen Anne Quinlan
  2. Nancy Cruzan
  3. Terri Schiavo
20
Q

Describe the Karen Anne Quinlan case

A

The first “right to die” case

  • Karen Anne Quinlan was a 22 year old woman in a persistent vegetative state
  • Physicians refused the family’s request to remove her ventilator
  • The court decided that family members can act as guardians and patients can be removed from ventilators
21
Q

Describe the Nancy Cruzan case

A
  • Nancy Cruzan was a 33 year old woman in a persistent vegetative state
  • Her family requested that her feeding tube be removed, but physicians refused
  • The court decided that states have the right to determine the level of evidence necessary for substituted judgement
22
Q

Describe the Terri Shiavo case

A
  • Terri Shaivo was a 27 year old woman in a persistent vegetative state
  • Terri’s husband requested that her feeding tube be removed
  • Terri’s parents challenged the decision
  • Extended/multiple court cases (lasting 15+ years!); Pro-life groups and governors (Jeb bush) got involved to affect the outcome (significant because of how much it blew up)
23
Q

How is a living will different from an advance directive?

A

A living will is a type of advance directive that is written down

24
Q

What is the difference between a healthcare proxy and a surrogate decision maker?

A

A healthcare proxy is a type of surrogate decision maker appointed by the patient while they still have decision-making capacity

25
Q

What is the order for determining a surrogate decision maker?

A

Highest to lowest priority:

  1. Court appointed
  2. Proxy appointed by the patient
  3. Family
    1. Spouse
    2. Adult children
    3. Adult siblings
  4. Friend
  5. Physician consulting with hospital ethics committee
26
Q

How shoudl physicians assist surrogates in making decisions for the patient?

A
  • Discuss the process
  • Give a recommendation (especially if the surrogate wants one)
  • Get help from other healthcare workers (ethics committee)
27
Q

When should “best interest” standards be used in surrogate decision making?

A
  • When it is unclear what decision the patient would have made
  • When a reliable surrogate is unavailable or doesn’t know what to do

FDN2 (14 decks)

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