Final Exam Flashcards
What are the essential characteristics of a profession? (5)
Formal Education - specific to your field of practice.
Licensure - to achieve the status of the given profession
Code of professional ethics
Fiduciary duty - possess exceptional loyalty to the person whom duty Is owed; do not put personal interests before duty
Internal Policing - to ensure high-quality and adherence to standards
Roles and Responsibilities of a PA: in regard to the patient.
The Patient is the foundation of the practice of medicine.
Trustworthiness - cornerstone of provider-patient relationships
We have a legal/ethical responsibility to our patients
Fiduciary duty - possesses exceptional loyalty to the person whom duty is owed; do not put personal interests before your duty
Confidentiality - HIPPA
Maintain appropriate emotion, physical and financial boundaries between patients and their families.
Honesty - be honest to patients about their condition and recommended treatment; disclose any errors made to collaborating physician and the patient
Roles and Responsibilities of a PA: in regard to the individual
Personal: Don’t misrepresent your skills, training, credentials or identity uphold the dignity of the PA profession and accept its ethical values.
Professional: Commit to providing competent medical care; continuing education
Conflict of interest: place service to patients before personal gain
Roles and Responsibilities of a PA: in regard to other professionals (3)
- Supervisory Relationship - Central to PA practice! Defined by state law, specific rules of the institution and delegation from supervising physician. The legal responsibility for the PA remains with the supervising physician.
- Business relationship - defines that terms and conditions under which a PA works and is compensated (contract)
- Professional Relationship - built on mutual respect and trust of knowledge and understanding, responsibility and accountability
Roles and Responsibilities of a PA: in regard to the healthcare system
Access to care/resource allocation
Managed care - focus on cost containment and resource allocation
PAs are EDUCATORS!
Roles and Responsibilities of a PA: in regard to society
values of compassion, service, altruism, and trustworthiness
What is fiduciary duty and what does it require?
Fiduciaries possess exceptional loyalty to the person to whom duty is owed;
will not put personal interests before the duty, and will not profit from their position as a
fiduciary without consent (Loyalty and Care)
-Requires adherence to the highest standard of care
-Requires PA to serve interests of patients above self-interests
-PA have a fiduciary duty to our patients, but also to physician supervisors/collaborators
-Must adhere to code of ethics and rules of professional conduct as federal/state laws
The PA-Physician Team - key points regarding the supervisory relationship between the PA and Physician
Supervisory Relationship
■ Specific rules of the institution
■ A delegation from the supervising physician should include ongoing communication regarding patient care
■ Never assume that because you are asked to perform a task, that you have the authority to carry it out
■ You carry the mantle of the physician
■ You bear the liability of the physician and his actions
What are some of the relevant issues facing you in the future and what ideas do you have about how to face these challenges
○ Accomplishing goals with small time frames while avoiding medical errors
○ Dealing with insurance companies when they will not approve needed tests/procedures
○ How the field of medicine must adapt to the current reality and yet remain ethical
This should be personal to you!
Understand the history of healthcare ethics and what documents were prepared in response to some of the atrocities that were committed in the past
Historical events that raised the need for healthcare ethics:
● WWII →Eugenics (improving genetic quality of human pop) →eventually lead to unethical measures
● Tuskegee Syphilis Experiment – terminated only after leaked to press
● Glaxo SmithKline – children used to test safety/tolerance of AIDS meds
Documents prepared in response to atrocities: Nuremberg Code and Declaration of Helsinki
Autonomy
right of a patient to make an informed, uncoerced decision about their own health management
Nonmaleficence
to do no harm; impose no unnecessary/unacceptable burden on patient
Beneficence
acting in the patient’s best interest
● Requires procedure be provided with intent of doing good for the patient
● One ought to prevent and remove evil; promote good
Justice
Patients in similar circumstances should receive similar care
● Also applies to norms for fair distribution of resources, risks and costs
● Healthcare provided must consider 4 main areas when evaluating justice:
○ Fair distribution of scarce resources
○ Competing needs
○ Rights and obligations
○ Potential conflicts with established legislation
Truth Telling
provides truthful information to patients shows respect, allowing pts to be informed participants in important decisions
● Only appropriate to withhold information if: could cause real/predictable harm and if patient himself states an informed preference not to be told
Confidentiality
must keep personal health info private unless consent is provided by the patient
Preservation of Life
will to treat patient’s illness with aim of prolonging life
● Principle may be overruled if the patient has a living will states desire not to be resuscitated (DNR)
Informed consent is an extension of…
Autonomy
What is the main goal of informed consent and what does it include?
The patient has the opportunity to be an informed participant in the healthcare decisions including:
● Nature of the decision/procedure
● Reasonable alternatives to proposed intervention
● Relevant risks, benefits and uncertainties related
● Assessment of patient understanding
What are the essential elements of full consent?
written and oral consent
● Patient must read and signs document and express their wish to have the procedure
What are the two types of consent?
● Implied Consent = action by initiating movement
● Expressed = verbal consent
What is capacity?
Capacity = individual’s ability to make an informed decision
■ Any licensed physician may make determination of capacity
What is competence?
Competence = legal state, not a medical one (Court decision)
■ Refers to degree of mental soundness necessary to make decisions about specific issue or to carry out specific act
■ All adults are presumed competent unless adjudicated otherwise by court
What is medical futility and what are some examples?
providing unnecessary care, putting the patient through unnecessary discomfort or wasting medical resources
Futile interventions may:
● Increase patient’s pain and discomfort in final days/weeks of life
● Give patients and family false hope
● Delay palliative and comfort care
● Expend finite medical resources
What is euthanasia?
physician intentionally causes death of terminally ill patient
(illegal in ALL states).
*Active=killing
*Passive=allowing to die (DNR)
What is physician-assisted suicide?
physician provides means for death, but the patient will ultimately administer lethal medication and decide when to do it
(legal in 10 states)
What is the role of palliative sedation?
relieving distress of terminally ill, suffering patient in their end stages of life by continuous IV or SQ infusion of sedative drug
● Goal is to control symptoms through sedation, not shorten their life
● Sedation DOES NOT equate euthanasia
What are morals? be ready to know the difference between morality and ethics
PERSONAL judgement as to right and wrong
● Tend to be broad, general considerations; held personally and deeply
● Different persons, groups and societies have different moral standards
What is ethics? be ready to know the difference between morality and ethics
OBJECTIVE and specific
● Describe minimum standards of acceptable behavior
● Ethics can change more easily based on societal factors/pressures
