Final exam Flashcards
Describe organizational ethics.
Involves resource allocation, business development, access to care, disagreement about treatment decisions.
It is applied ethics.
Being conscious of similarities/contrasts between different cultural groups + understanding in which ways culture can affect different persons approach to health, illness, healing.
A. Cultural Awareness
B. Cultural Sensitivity
C. Cultural Competence
D. Cultural Safety
A. Cultural awareness
Being aware + understanding the characteristics, values, perceptions of your own culture and the way this may impact your approach to patient from other cultures
A. Cultural Awareness
B. Cultural Sensitivity
C. Cultural Competence
D. Cultural Safety
B. Cultural sensitivity
Refers to the attitudes, knowledge, and skills of HCP. Blend knowledge, conviction, and capacities of action.
A. Cultural Awareness
B. Cultural Sensitivity
C. Cultural Competence
D. Cultural Safety
C. Cultural competences
Understanding the power imbalances that are inherent & the institutional discrimination. Understanding culture as context dependent + power lead/privileges + the way history impacts on the communities.
A. Cultural Awareness
B. Cultural Sensitivity
C. Cultural Competence
D. Cultural Safety
D. Cultural safety
In which step is cultural humility achieved?
A. Cultural Awareness
B. Cultural Sensitivity
C. Cultural Competence
D. Cultural Safety
D. Cultural safefy
Name the 8 ethical theories relating to normative ethics.
- Virtue ethics
- Deontology
- Utilitarianism
- Principlism
- Feminist ethics
- Care ethics
- Narrative Ethics
- Casuistry
What are the 4 fields of ethics
- Metaethics
- Normative ethics
- Descriptive ethics
- Applied ethics
Field of ethics that looks at deep philosophical questions. Defines moral terms; asks questions. Focuses on analysis of meaning + creating justification for actions and inference from moral concepts
Metaethics
Field of ethics that focuses on formulation and defence of basic principles, values, virtues and ideals governing moral behaviour. “What make someone good or bad?”. Justice as norm.
Normative ethics
Field of ethics that focuses on factual descriptions and observations. Empirical analysis of what people actually do. Does not try to answer what is good or how best to live. Describes the current reality.
Descriptive ethics
Field of ethics that focuses on the practical application of ethics to specific contexts. Poses questions such as “in real life and specific contexts, what is the right thing to do”
Applied ethics
Name some ways to develop ethical fitness
- know one’s strength.
- be aware of the professional code of ethics
- understand how the contexts of health care and nursing influence moral distress
- identify strategies that develop ethical fitness
- promote interventions that are in the best interest of patient and families
What kind of ethics issue is the following example:
How do we fairly allocate ICU beds if there is resource scarcity during a pandemic?
Organizational ethics
What kind of ethics issue is the following example:
Business development: is it ethical for hospitals to take money from having fast food restaurants on site?
Organizational ethics issues
What kind of ethics issue is the following example:
Access to care for the uninsured: a patient without RAMQ requires dialysis. What is the responsibility of the hospital?
Organizational ethics issues
What kind of ethics issue is the following example:
Disagreement about treatment decisions: Nurses in the ICU have different opinions on withdrawing treatment at the end-of-life. What is the hospital’s policy?
Organizational ethics issues
What branch of ethics is the following definition for:
The organization’s efforts to define its own core values and mission, identify areas in which important values come into conflict, seek the best possible resolution of these conflicts, and manage its own performance to ensure that it acts in accord with espoused values
Organizational ethics
What are the 7 values of the nursing profession as outlined by the OIIQ
- Integrity
- Respect of the person
- Professional autonomy
- Professional competence
- Excellence in care
- Professional collaboration
- Humanity
Which ethical theory focuses on the moral agent?
“What kind of person am I?”
“What kind of person should I be?”
Virtue ethics (subset of normative ethics)
Name some critiques of virtue ethics.
No clear guide as to how to act.
Focuses on agent’s own character
Not culturally relative.
Lacks guidance on how to become virtuous
Which ethical theory does this describe:
Non-consequentialist.
Conforming to a moral law or principle.
Actions should be motivated by duty to be right and good.
Deontology (normative ethics)
What are some critiques of deontologism
Outcomes/contexts not considered.
Conflicting duties?
Who makes the rules and who do they apply to?
Dismisses moral value of actions motivated by emotions or good will.
What ethical theory does this describe:
What is good? What is right?
Actions are right based on what produces the most good.
Actions are right/wrong based on consequences.
Egalitarian.
Doing nothing is an action.
Utilitarianism
What are some critiques of utilitarianism?
Only looks at future consequences.
Problem of agent’s integrity.
Possible conflicts with justice and rights.
Name some examples of utilitarianism in healthcare and nursing.
Scarcity - limited resources and allocations of resources.
Striving for collective good (public health)
Evidence-informed care
Global health & animal rights
The following describes which ethical field/theory?
Based on ethical principles such as: autonomy, beneficence, nonmaleficence, and justice
Principlism
How can Principlism be applied in Clinical ethics?
Consent
Resource allocation and distribution
Resuscitation orders for all unless specified
Which ethical field/theory does this feature in?
Importance of attention to context, especially social context, and to unique properties of individuals
Feminist and care ethics
Which ethical field/theory asks questions about power before questions of care and justice?
1. Feminist ethics
2. Care ethics
Feminist ethics
Which ethical field/theory does this apply to:
“The art or skill of applying abstract or general principles to particular cases”
Casuistry
ex: NANCY B vs Hotel Dieu “ventilator turned off murder? No. Right to stop treatment… is not suicide/murder”
Sue Rodriguez “whose body is this if I cannot consent to my own death”
What are the principles of ethics?
Autonomy
Beneficence
Nonmaleficence
Justice
Describe the principle of autonomy.
Moral and legal obligation to promote client autonomy.
Ex. Informed consent, respect
Describe beneficence/nonmaleficence and give an example.
Promoting good and avoiding harm.
End-of-life care.
Will our patient benefit from our action or will there be heightened risks.
Describe the principle of justice and provide examples.
Equity in resource allocation
Reduction of inequities
Limitations
ex. organ donations, bed management, low resources environments
What does IDEA stand for.
Identify the facts
Determine the relevant ethical principles
Explore the options
Act.
What are the elements of liability?
- Fault
- Damage (harm/prejudice has been done)
- Causation
The capacity of an individual to sustain or restore their integrity in response to moral complexity, confusion, or setbacks
Moral resilience
Negative feelings that arise when one decides on a morally correct action in a given situation but is constrained from taking that action. You can’t exercise your moral agency
Moral distress
Which kind of moral distress occurs in real time as the situation unfolds?
Initial distress
Which kind of moral distress arises after the situation has passed and involves lingering feelings about one’s failure to act on the initial distress?
Reactive distress or moral residue.
What can nurses do to address moral distress?
- Recognize the symptoms of moral distress. Practice awareness.
- Reflect on/be curious about the ethical aspects of clinical situations.
- Reconnect to your original purpose and intentions as a nurse.
- Commit to your personal well-being
- Support and restore your moral integrity
- Listen to your intuition/somatic responses
- Develop ethical competence
- Speak up about your ethical concerns and take principled actions
Define misconduct
Doing lawful things in an unlawful manner.
ex. failing to keep records as required; failing to renew one’s license; improperly delegating a controlled act; practicing while impaired
Define malpractice
Professional negligence.
Improper/unethical conduct or unreasonable lack of skill by a holder of a professional position. Denotes negligent or unskillful performances of duties when professional skills are obligatory
What is included in “Burden of proof” when seeking to have treatment authorized
- the person does not have the capacity to consent to proposed treatment.
- proposed treatment is in the patient’s best interest
What are the eligible criterion for MAiD
- RAMQ
- 18+
- Able to consent to care
- Serious incurable illness
- Advanced state of irreversible decline in capability
- Constant/unbearable physical/psychological suffering that cannot be relieved.
What are some arguments against MAiD?
Sanctity of life;
Nonmaleficence;
Social justice;
Palliative care is sufficient
What are some arguments FOR MAiD
Autonomy
Beneficence
Safeguards will protect the vulnerable
Palliative care will not work in all cases
Advance Medical Directives (AMD)
Means used to document and communicate a person’s preferences regarding life-sustaining treatment in the event that they become incapable of expressing those wishes themselves
Advance care planning
Ongoing process whereby patients, in consultation with health care professionals and loved ones, make decisions about their future healthcare
Doctrine of double effect
performing an act that brings about a good consequence may be morally right even though the good consequence can only be achieved at the risk of a harmful side effect.
Ex. giving a patient morphine to ease her pain and suffering which causes the side effect of respiratory depression causing her death.
Withholding treatment
What does it mean? Is it legal or not?
Failure to start treatment that has the potential to sustain a person’s life.
Cause of death: underlying disease
Legal: Yes
Withdrawing treatment
Stopping treatment that has the potential to sustain a person’s life.
Cause of death: underlying disease
Legal: Yes
Palliative care
Holistic care which focuses on relieving physical, social, psychological, spiritual suffering. Neither seeks to prolong life nor hasten it.
Continuous palliative sedation
Using medication to reduce consciousness to reduce suffering that can’t otherwise be alleviated
Medical aid in dying
Doctor gives medication to a person at their request to relieve their suffering by bringing about their death.
Legal since 2015
Conscientious objection (CO)
The refusal to perform a legal role or responsibility because of personal values/beliefs
What are the essential functions of public health
- health protection
- health surveillance
- population health assessment
- disease and injury prevention
- health promotion
- emergency preparedness and response
MADO reportable diagnoses
rabies, gonorrhea, chlamydia, hepatitis b & c, giardia, syphilis, HIV, measles, tuberculosis, lyme disease, amiantosis, carbon monoxide poisoning
Criterion for burden of proof
- person does not have capacity to consent to proposed treatment
- proposed treatment is in the patient’s best interest.
- expert reports required for both elements (psychiatrists)
Parameters for confinement in an institution?
- patient represents a serious and immediate danger to themselves or others
- burden of proof by the healthcare establishment
- 2 psychiatric reports in support of motion for confinement
- authorization by law or the court
What are the types of confinement possible?
- voluntary confinement
- Forced confinement (preventive, provisional, authorized)
Describe provisional confinement
Person must be a danger to himself/others
Court order is required on the request of physician or interested person.
Obtained if patient refuses to be evaluated on his dangerousness.
Usually concludes in which police assistance is authorized or ordered
Describe preventive confinement.
Person must be a danger to himself/other
Danger must be grave and immediate
Court order NOT required (ordered by physician)
Possible to get assistance from peace officer
Define authorized confinement
The only type of confinement that isn’t preliminary.
Motion requested by health institution
Authorized by court following 2 psychiatric examinations.
Duration is set by the court (max 30 days)
Must be reevaluated at 21 days. Can be extended for additional 90 days