Final Exam Flashcards
What are some reasons that truth-telling and confidentiality are important aspects of clinical relations between patients and health care providers?
Truth is a right, a utility, and a kindness. Respect for a person demands truth-telling. Truth-telling is the basis of interpersonal trust, covenants, contracts, and promises. The truth is also a utility, because it is required in order for a person to make informed judgements about their actions.
What are the two different types of deception?
Lying and withholding information.
Which is worse, lying or withholding information?
Lying.
What does weak paternalism appear to say about when we can deceive patients?
It is never okay to lie to competent or incompetent patients. It is okay to withhold information from incompetent patients in some situations.
What does strong paternalism appear to say about when we can deceive patients?
It’s okay to lie and withhold information from both competent and incompetent patients if you are doing it for the patient’s own good.
What does the Smith v Jones case say about when health care providers can breach confidentiality?
HCPs can breach confidentiality when it is done for public safety. The threat to public safety must be serious and imminent.
What is professional responsibility?
Professional responsibilities are found in professional ethics codes and related policy documents.
What is professional autonomy?
Professional autonomy is the duty to promote and maintain patients’ wellbeing and rights, and to uphold the standards of the profession.
How are professional responsibility and professional autonomy related?
Professional autonomy requires an understanding of professional responsibilities.
What are the range of situations where a hcp may wish to say “no” to a patient’s or a health care colleague’s request on the grounds that in conflicts with her professional responsibilities?
When a hcp disagrees with another hcp’s professional judgement, or if they disagree with gatekeeping.
What are proper grounds for refusing treatment?
Cost, harm to others, harm to self.
What are some different concepts of futility?
Physiological futility, futility in relation to a patient’s goals, or futility in relation to the standard of professional integrity.
What are some reasons that futility should never be used on its own to deny a request for treatment?
If there is a greater than 0% chance, it’s not really futile. Even if it’s 0%, there might be other psychological benefits.
Explain how futility is often confused with other reasons for saying “no” to a request for treatment?
Assumptions are made by the HCP in order to justify saying no for reasons related to cost. Futility is a short-cut to doing the ethical heavy-lifting.
In what ways does professional autonomy regulate relations between health care providers?
It is the right/duty to say no to other hcps when asked to do things that are contrary to one’s professional responsibilities. It also entitles hcps to have voices heard when they have knowledge based on areas of speciality/practice that are relevant to a patient’s care.
Do HCPs have duties sometimes to expose themselves to risk on grounds of professional responsibility?
Yes. There is a duty to provide care in emergencies, natural disasters, and pandemics.
What is the rationale that HCPs have duties to expose themselves to risks on the grounds of professional responsibility?
HCPs ability to provide care is greater than that of the general public. By freely choosing a profession devoted to care for the ill, they assume risks. The profession has a social contract that calls on members to be available in times of emergency.
Is conscientious objection a form of professional autonomy?
No. Conscientious objection is about personal values and professional autonomy is about professional values.
What process must a hcp observe if she conscientiously objects to a health care practice?
If the conflict is foreseeable, the HCP must let their employers know of any conflicts likely to occur. They must not abandon their patients, they must continue to provide care until an alternative arrangement is in place.
Why is it important for health care providers to meet as equal participants in clinical decision making?
Because they all have specialized knowledge that might be relevant to the decision making. Also it’s important for establishing trust and respect.
What are the etymological origins of the word euthanasia?
“Eu” means good and “thanatos” means death.
What is active euthanasia?
Active euthanasia is where you administer treatment in order to cause death.
What is passive euthanasia?
Passive euthanasia is where you withdraw/withhold treatment, and withholding treatment causes death.
What is physician-assisted dying (PAD)?
Euthanasia
What is lethal palliation?
Lethal palliation is when you provide palliative care that could potentially result in a person’s death.
What are the legal criteria for PAD in Canada based on the Supreme Court’s 2015 decision in Carter v The Attorney General?
PAD is permitted for competent adults, with “grievous and irremediable illness” that causes “enduring intolerable suffering” and who actively consent to termination of life.
What classes of patients does PAD appear to not cover?
Incompetent adults. Minors.
What are the main arguments for active euthanasia/PAD?
Right to minimize suffering, right to preserve dignity. Not allowing PAD limits the right to life, denies people right to make their own decisions. There is no difference between withdrawing treatment and PAD.
What are the main arguments against active euthanasia/PAD?
“Do no harm.” Risk of bad consequences/slippery slope.
What are some consequentialist arguments against PAD?
Risk of bad consequences/slippery slope.
What is a response to consequentialist arguments against PAD?
There is no evidence of a slippery slope.
What is a deontological argument against PAD?
PAD is intrinsically wrong. Violation of Universal Law and Principle of Respect for Persons.
What are some responses to a deontological argument against PAD?
Morally the same as WLST. Deontological approach should put autonomy above all else. Rights should trump considerations of general good/welfare.
What is an advance directive?
A directive that anticipates circumstances where a patient may be unable to make decisions about treatment and provides direction to hcps or substituted decision-makers about treatment choices, including when to withdraw or withhold life sustaining treatment.
