final Flashcards
1
Q
the consent form establishes a person’s ——–
A
autonomy
2
Q
in order for the patient to provide valid consent they must be fully informed about 6 things
A
- nature of ttt (investigation being proposed)
- why its needed
- how the procedure will be performed
- risks and benefits (SE)
- alternative ttts available
- likely success
3
Q
when a dr requests consent from a patient, what are the 3 types of consent, and what are their legal substantiations
A
- written consent (MOST legally substantiated)
- oral consent (LESS legally substantiated) it ensures verbal consent is documented in notes
- implied consent (LEAST legally substantiated) best avoided where possible and may be misinterpreted by doctor.
4
Q
which type of consent ensures verbal consent is documented in notes
A
oral consent
5
Q
WHAT ARE THE CRITERIA TO BE MET FOR A CONSENT TO BE VALID
A
1- patient is fully informed
2- patient is competent
3- consent is voluntary
6
Q
what factors determine patient capacity (competence) to provide an informed consent
A
-patient UNDERSTANDS and RETAINS relevant info
-patient weight PROS and CONS to make decision
-patient can communicate their decision to doc (talking, writing, signing)
7
Q
what is the defenition of informed consent
A
- Documents describing a medical treatment or research project,
including proposed procedures, risks, and alternatives, that are to be
signed by an individual, or the individual’s proxy, to indicate his/her
understanding of the document and a willingness to undergo the
treatment or to participate in the research
8
Q
Contrary to popular belief, informed consent is not required only
for research or experimental procedures
* Informed consent is required for any action that affects a person’s
———-
A
physiological, psychological, or moral integrity
9
Q
Consent Form, Why?
A
- Avoiding malpractice
- Respecting patient’s rights
- Emphasizing patient’s autonomy
- Underlining importance of shareholding of patients in decisions
concerning their lives and health - Eliminating paternalistic culture
10
Q
—— incorporate patient preferences, issues of QoL, and guesswork
A
Risks
11
Q
HCPs usually have to tailor their disclosures on factors like ——-
A
urgency,
family members, patient’s capacity
12
Q
Legally; ethical consent emphasis on
A
- Minimum requirements
- Documentation
- Legal protection for the HCP
13
Q
A —– informed consent could be perceived by patients as a
‘technicality’
A
written
- The use of ‘decision aids’ could help close that gap
14
Q
Spending few minutes to ask about the patient’s life; their
worries; priorities; concerns; and wishes
HCPs MUST not only be technically competent, but also morally
skilled
They must have a covenant relationship with their patients such
that treatments SERVE the patient’s wishes
A
Concordance in Consent
Concordance= decision‐sharing
* New model for sharing complex information
* A need to do more than what is legally required:
15
Q
When is consent is an ethical requirement?
A
when there are major differences between treatment outcomes:
Likely complications are much greater for one treatment than another
Choice of treatment involves trade‐off between near and distant benefits
Apparent difference between outcomes is small, but actual options are quite distinct
Patient is more opposed to certain risks
Patient attaches special importance to certain outcomes
16
Q
what are the Legal Requirements of a Consent Form
A
- Information
- Comprehension
- Freedom
17
Q
Treatments that involves ‘physical trespassing’ requires consent
In healthcare, invading a person’s body without consent can be ground for litigation
Rectal and vaginal examination, procedures while the patient is unconscious require
explicit consent
Patients should be treated for what they consented for EXCEPT IN ——-
A
EMERGENCY
18
Q
- In research, certain information might be
withheld from the patient, BUT the patient
must be informed that there will be
information that will be revealed only ——— (when?)
A
after
the research is done
19
Q
what is the Most complicated and difficult requirement in ethical consent
A
20
Q
If the patient can not understand, a ——- has to be nominated to
act for the patient
A
3rd party
21
Q
The patient’s health must be taken in consideration, and the final
decision becomes —— decision
A
collaborative
22
Q
The primary role of the physician‐researcher is ——- first
A
physician
* Participants in research (i.e. subjects) must not be worse off in
research than if using accepted therapy
23
Q
whats another term for proxy consent
A
vicarious
24
Q
statement
A
- Decision FOR the incompetent person must be made for the good of
the individual not the society at large
25
Choices that would benefit other people must not be considered
except when the proxy believes that these choices would have been
considered by the incompetent person
for example ----
infant with birth defect
can not be sacrificed by the family because of burden on the family, organ donation after death
26
what * Other persons can also be consulted with regard to proxy decision making
physicians,
religious individuals,
counselors
27
The assumptions is that people with close or blood bond (parent,
spouse, relatives) ought to look for the best of the patient. This assumption could be challenged when ------
when a decision that seems
un‐ethical or controversial is taken
-Intervening people are usually physicians and other health providers
* Examples: withdrawing or withholding life support
28
Exceptions to Requirements for Consent: caution
means?
* Patient waves the consent
29
Exceptions to Requirements for Consent
* Patient waves the consent: caution
* Patient delegates the consent
* Mental incapacity (requires proxy)
* Emergencies (except if at a previous time, the patient refused the
emergency treatment)
30
HCPs do not require a consent in case of an emergency except if -----
if at a previous time, the patient refused the
emergency treatment
31
what is therapeutic treatment
Patient must be made aware that consenting to a treatment may implicitly
involve agreeing to as sequence of other procedures, and what these might be
(also to other effects or situations: waking up on ventilator; sore throat after
intubation; etc)
32
statement
* The obligation to confer benefits and actively prevent and remove harms from
patients is important in pharmacy ethics. However, EQUALLY important is the obligation to assess or “weigh and balance the possible goods against the possible harms of an action”
33
what are the two principles under the general principle of beneficence
1. The principle of positive beneficence: provide benefits & prevent harms
AND
promote welfare
2. principle of utility: weighing and balancing benefits and harms in moral life
34
it should be noted and
emphasized that the principle of beneficence is always associated with a
number of implications especially when used in issues of -----.
biomedicine
35
The principle of ------ is a prima facie obligation that should
“always be acted upon unless it conflicts on a particular occasion with
an EQUAL or STRONGER principle
beneficence
36
statement
For many people, the reasonable goal is not maximum well-being in any one area (including health), but maximum well-being across all kinds of possible
goods.
37
The current Code of Ethics for pharmacists commits the pharmacist simply to
the “-----” of the patient; it does not limit the focus to health and safety.
* But this means out of area of expertise for pharmacists.
good
38
one might try to maximize benefit/harm ratio rather than maximize the net
goods.
This relates benefits and harms geometrically rather than arithmetically.
39
* If one imagines two courses, the second of which has twice the expected benefit and twice the expected harm, according to the ----- method there is no difference between the two, but according to the method of ------- harms from benefits, the option with twice the benefits and twice the harms would produce a net gain that is twice as large as the alternative.
ratios
-subtracting
40
what is the moral priority over beneficence. According to this view, the duty to not harm is more stringent than the duty to help.
nonmaleficence, the
duty to avoid causing harm
41
* In contrast to the approaches that calculate net good done or ratios, giving priority to avoiding harm
gives a preference to the more ------ course.
cautious
42
Those who calculate consequences do so with reference to specific cases considered in
isolation. They look only at effects of alternative actions in the specific case.
* Others, called “---------,” hold that one should look at the potential consequences of
alternative rules and choose the rule that would produce consequences as good as or better than any alternative.
When a rule is adopted, MORALITY requires that it be followed without
reassessment in specific cases.
rule utilitarians
43
* Only at stage of adopting rules do --------- count
consequences
44
* Rule utilitarians oppose -------either for
1. PRAGMATIC reasons:
because they
think there is too much room for error in the heat of a crisis, because such calculations are too
time consuming—or for
2. THEORETICAL reasons because morality means playing by the rules once
they have been adopted.
case-by-case calculations
45
* One of the possible groups other than patients that could command the
attention of the pharmacist is the----------
profession of pharmacy
46
statement
There was never a formal recognition that the interests of the health
professional could ever legitimately compete with those of the patient
47
------- is a psychological and a moral term
Autonomy
Autonomy means creating one’s own legislation, s being an autonomous person is a matter of DEGREE
48
Small children, the mentally
retarded and the mentally ill all may be able to make limited choices
based on their own beliefs and values but are ------ -autonomous
enough to be called self-determining in any meaningful way
HARDLY autonomous
49
to which ppl does SUSBTANTIAL-autonomy apply ?
* Persons housed in special institutions, sometimes called “total”
institutions, such as
prisons,
boarding schools, or the
military,
may
be subject to substantial external control over their choices
-Those persons who
have a sufficient degree of autonomy we treat as being self- determining; we
call them “substantially autonomous persons.”
-* For purposes of public policy, we assume that persons below the age of
majority, usually 18, unless proven otherwise, are lacking sufficient autonomy
for public significant decisions.
50
Persons may be ------ autonomous in the sense they have the
necessary neurological and mental capacity as well as adequate
knowledge but nonetheless be constrained by external forces from
making specific choices.
substantially
51
the working presumption is that minors lack competence to make many ------ autonomous decisions.
substantially
52
* In the case of ----, even if lack of autonomy is warranted, it is still necessary
to determine who is authorized to speak for the individual, and even if one is
believed to be substantially autonomous, it does not necessarily follow that he
or she should be free to make all decisions about his or her actions.
adults
53
The principle of -------- is a basis for constraining actions that affect others. That
is, we may want to control people because of the effect of their actions
* Some believe it is acceptable to constrain people to produce a greater good for
society.
* Constraining in order to produce good for others is, however, more controversial
than constraining to protect others from harm.
justice
54
* Some believe it is acceptable to constrain those who are substantially
autonomous in order to produce good for those individuals themselves.
This is what is called ------.
paternalism
-The moral principle of autonomy holds that an action or practice is morally wrong if attempts to control the actions of substantially autonomous persons on the basis of a concern for their own welfare.
55
Presently no clear legal authority exists for -------, on their own, to declare incompetency and assume the role of surrogate decisionmaker.
health professionals
56
* The transfer of decision-making to the appropriate surrogate is -----,
even without a formal court review.
acceptable
57
------professional ethics contains no moral principle of autonomy
Classical Hippocratic
-Classical Hippocratic ethics in the health care professions has been committed to
the principle that the health care worker should do whatever is necessary to
benefit the patient.
* This has been understood to include violating the autonomy of the patient.
58
Pharmacists, in the name of Hippocratic paternalism, have refused to tell
patients the names of drugs they are taking, filled prescriptions for
placebos, refused to dispense drugs believed dangerous, and engaged in all manner of violations of the autonomous choices of patients.
* They have done so not out of a concern to protect the welfare of others or
to promote justice, but rather out of concern that the patient would hurt
himself or herself.
59
Even if an action is deemed to be a killing, the use of that term does not automatically imply that the action is morally wrong.
* For example, accidental killings, such as from a lethal idiosyncratic
reaction to a prescription, are not always morally wrong.
ye
60
We can distinguish killing with the consent of the one killed from those that are
-------- against the victim’s wishes, (INvoluntary or NON-voluntary?)
INVOLUNTARY
61
We can distinguish killing with the consent of the one killed from those that are
-------- without the approval or disapproval of the one who is killed, (INvoluntary or NON-voluntary?)
NON-VOLUNTARY
62
-the health provider or
other acquaintance of the patient will kill on the patient’s request
-is this homicide on request OR assisted suicide ?
homicide on request
63
- the health provider supplies information or materials (such as medication) but patients themselves take the last decisive step in ending their own lives
-is this homicide on request OR assisted suicide ?
assisted suicide
64
in modern readings of the hippocratic oath, physicians and pharmacists are prohibited from ----- in killing
PARTICIPATION
65
The codes of pharmacists generally do not mention a prohibition on killing, but one can assume that it would be opposed by the ------- pharmacist organizations
traditional
66
some people who base moral judgments on consequences do not believe it is
right to directly calculate the consequences in each individual case. Instead they
consider possible alternative moral rules or policies.
* They assess the net consequences of the alternative rules or policies and choose
the rule or policy that they believe will do more good than any alternative.
These people are called rule-utilitarians.
67
* --------- considers killing an intrinsic wrong, but this tradition does not
extend its condemnation to all actions that will shorten life.
* It accepts certain forgoing of life support
Catholicism
68
------ has even gone beyond the view that killing, at least killing of the
innocent, is wrong to the view that all human life is sacred.
* According to this perspective, it is ALWAYS wrong for humans to make decisions, such as
deciding to withdraw life support, which will predictably shorten a patient’s life.
Judaism
69
In several states in the US, patients who meet certain criteria, including mental
competence, can now legally get prescriptions filled for purpose of killing themselves.
* E.g. some terminally ill patients are in pain and dying rapidly, could be spared the
misery of the dying if someone actively intervened with an injection of a drug to
hasten death.
70
Terminal sedation. defined as administering drugs to keep patients in deep
sedation or coma until death. Recently it has been suggested that terminal
sedation, combined with the
withdrawal of nutrition and hydration, a
ventilator, or a
life-prolonging antibiotic,
would accomplish everything
desired by those advocating active killing for mercy or assisted suicide
while still not crossing the line to active killing
This controversial proposal raises serious questions about whether
withdrawal of nutrition and hydration or these other life-prolonging
interventions really should be considered active killing
71
unintended killing, they are called "indirect killings".
Eg
when a health
professional produces a fatal anaphylactic reaction by giving penicillin to a
patient who is not suspected to be allergic, the death was not intended
72
Catholic theologians have held that something as evil as a death may
be morally tolerable if it is unintended, even if it is FORESEEN.
If the patient dies from respiratory depression resulting from a heavy narcotic dose given to control pain, the death can be called an indirect killing, foreseen, but was not intended.
73
* If a therapy has begun, -------- it could seem to be morally
similar to not having provided it in the first place, but to many health care providers, it may feel, psychologically, much closer to actively doing something to cause the patient’s death.
withdrawing
74
Counseling requires assessing and informing parents whether a
condition is inherited and, if so, how?
* It now involves prenatal sampling of ---------samples that permit determinations of whether a fetus is
afflicted with a disease.
amniotic fluid or chorionic villi blood sampling
75
Genetic Counselling-When??
-DURING pregnancy or BEFORE when there is a concern about the health of
baby
-Family history of mental illness or cancer
-other genetic concerns
76
in efforts of community-based genetic screening programs, the professional staff really has ---- with the people being screened.
NO ongoing contact
-Sometimes these programs have racial or ethnic implications that
complicate the counseling.
* E.g., proposals to screen for sickle-cell anemia, an autosomal recessive rare
blood disease affecting primarily persons of African origin, raises issues of
whether the purpose is to discourage fertility among this group
77
More controversial than IVF is what is referred to as --------
gene therapy or genetic engineering
like ADA deficiency
78
Perhaps the most controversial and intractable issue in health care ethics is
---------.
* Does avoiding killing apply to fetuses or only humans after they are born.
abortion
79
Catholic bioethicist has suggested that the development of the so-called
--------- signals the point at which a unique individual is established.
primitive streak
80
if someone proposed to abort a fetus because of a genetic abnormality, at stake would be
whether the key genetic characteristics are
nevertheless present.
81
an example of a case of a woman who has a history of a ruptured uterus and is pregnant again and whose
thin uterine wall is likely to rupture is
a pregnant woman with
systemic lupus erythematosus (SLE)
