FINAL EXAM PREP

Question 1

Which theory dominates the mental health care system?

Answer 1

Utilitarianism, not a good thing due to benefit for money making choices.

Question 2

What are the two things that utilitarianism is good for in health care?

Question 4

What is the best theory for supporting the professional commitments of RPN’s?

Answer 4

Virtue ethics
- trust between RPN’s & patients
- values in code of ethics show up in aristotle’s virtues

Question 5

What is the best professional theory for addressing the inequality in our healthcare system?

Answer 5

The ethics of care
- patients who genuinely feel cared for have better outcomes
- good at making mental health care system more responsive to real life concerns

Question 6

Beneficence

Answer 6

The moral principle that tells you that patients are entitled to benefit from care

Question 7

Benevolence

Answer 7

Not required/obligation (eg. charitable acts)

Question 8

What is beneficence highly linked too?

Answer 8

Autonomy

Question 9

What are the three cognitive resources for thinking about and being beneficent?

Answer 9

1. Be aware of the difference between active and passive approaches to care
2. Be aware of the difference between broad and narrow approaches to health, in particular illness vs disease
3. harm - non maleficence (do no harm)

Question 10

What is the difference between active and passive care?

Answer 10

Active care is more beneficent (eg. engaging with the client)
Passive care is waiting around until someone rings their call bell

Question 11

What is the difference between broad and narrow approaches to health? & difference between illness and disease

Answer 11

Broad is better (eg. treating the patient holistically)
Disease is the narrow conception of what is wrong with the person while illness is that AND the impact of the disease on tha patients life

Question 12

What is the doctrine of double effect? And harm in terms of being beneficent?

Answer 12

It is okay to inflict some harm on a patient as long as it is outweighed by the expected benefit.
You want to minimize the harm as much as possible and remove patient from harm as soon as possible

Question 13

What are 4 challenges to the benefit/harm balance?

Answer 13

1. Having a psychiatric diagnosis (finally finding out what you have been experiencing, but stigma surrounds diagnosis)
2. Harm reduction (can stop drug overdoses, but drugs are still harmful to the person)
3. Psychiatric treatment (psychosurgery/ECT/psychoactive drugs may decrease symptoms but may still be harmful to the person)
4. There is never enough money for mental health care in Canada

Question 14

What type of approach do you want to take to your future patients care as a RPN?

Answer 14

Active, Broad, and Holistic approach

Question 15

Name 3 movements that have occurred to promote greater autonomy?

Answer 15

1. Gay rights
2. Women
3. Patient groups incl mental health

Question 16

Paternalism

Answer 16

The physician is empowered to make decisions for the patient, even if the patient is perfectly capable of doing it themselves (old medical approach)

Question 17

What are the 3 reasons autonomy is important in health care?

Answer 17

1. Shift away from physician centered medicine (paternalism) to patient centered medicine (limited paternalism)
2. Legal reasons: you can’t do things to peoples bodies without permission otherwise, it is assault
3. Respect for persons: patients view are being respected

Question 18

How do we know if a patient is autonomous?

Answer 18

You go in assuming your patient is autonomous unless you have reason to think that they are not (presumption of autonomy)

Question 19

What are the 3 ways a patient can be considered autonomous?

Answer 19

1. They are at liberty (freedom)
2. They are capable of effective deliberation (able to think properly about what is happening to them, often missing in many mental health care patients)
3. They are capable of authenticity (we are able to think about how our goals, desires, and choices impact ourselves and others)

Question 20

What 3 situations are apparent to everyone that a patient is not autonomous?

Answer 20

1. Patient is unconscious
2. Patient is a child
3. Patient who is high on a substance

Question 21

What two reasons can a doctor act on an unconscious patient?

Answer 21

1. It is in their best interest
2. After they wake up they are able to make their own decisions again.

Question 22

What two things can we do if a patient is not autonomous but we need to find a way to make a decision about their care?

Answer 22

1. Look for documentation
2. Talk to a patient advocate/social worker/case worker/ethics committee/member of the clergy/patients family)

Question 23

What types of documentation are looked for?

Answer 23

1. DNR (only refers to CPR)
2. Advanced directives (broad set of instructions for patients health care)
3. BC’s comfort plan (not legally binding)
4. Legal proxy decision maker (who can make decisions on their behalf)

Question 24

Why is family consulted last when making a decision about patient care?

Answer 24

Families are ethically problematic

Question 25

What are 3 problems for patient autonomy?

Answer 25

1. Illness can lead to dependency (you are not yourself when you are ill)
2. Poor health literacy (lack of accessible language, need to understand consequences)
3. Cultural differences (view of autonomy is not the same across cultures)

Question 26

What are the 6 elements of informed consent (voluntary informed choice)

Answer 26

1. It relates to the proposed health care
2. It is given voluntarily
3. Not obtained by fraud or misrepresentation
4. The adult is capable of making a decision about whether to give or refuse consent to proposed health care
5. HCP gives the amount of information a reasonable person would require to make an informed decision
6. The adult has an opportunity to ask questions and receive answers

Question 27

What is considered the “reasonable person” standard?

Answer 27

• give the kind of information that a non-medical professional (ordinary person) could understand
• ask “can you tell me in your own words what you think is going to happen to you”

Question 28

What are the 4 components to give to the reasonable person for informed consent?

Answer 28

1. The condition for which the health care is proposed
2. The nature of the proposed health care
3. The risks & benefits that a reasonable person would be expect to be told
4. Alternative courses of health care

Question 29

What are the 3 main components of justice?

Answer 29

1. Legal
2. Philosophical (rights, freedoms)
3. Ethical (social justice, distributive justice $$)

Question 30

What are the five principles of justice according to the Canada Health Act?

Answer 30

1. Comprehensive (what’s covered)
2. Universality (who’s covered)
3. Accessibility (can you get your coverage?
4. Portability (does your care travel with you?)
5. Public administration (2 aspects)

Question 31

1. Comprehensive (what’s covered)

Answer 31

It is supposed to cover everything that is medically necessary
(excludes: birth control, dental, vision care, prescription drugs)

Question 32

2. Universality (who’s covered)

Answer 32

Everyone other than indigenous peoples who are on an alternate plan

Question 33

3. Accessibility (can you get your coverage?)

Answer 33

• Waitlists are the #1 barrier
• Geography (access not as good in less populated areas)
• Homeless population (need an address to get a care card)
• Lack of specialized care
• Low health literacy

Question 34

5. Public Administration

Answer 34

a. Health care is NOT a federal responsibility
b. private health care is not transparent about what/why they cover, but public health is accountable

Question 35

What are the 3 levels of health care resource allocation?

Answer 35

1. Societal level
2. Institutional level
3. Individual level

Question 36

1. Societal level

Answer 36

• Government raise taxes
• Politicians tell us these are the only two choices: raise taxes or cut services
• Because politicians are big fat dirty rotten lying ratbags
• BUT we could also lower pay of politicians and reduce their expenses, lower pensions, corporate subsidies & tax breaks

Question 37

2. Institutional level

Answer 37

• Budgeting by managers, not frontline workers leading to bad choices

Question 38

3. Individual level

Answer 38

• Healthcare workers
• Decisions made under less than optimal conditions due to inadequate funding

Question 39

What do RPN’s need to do at the individual level for health care resource allocation?

Answer 39

1. Be aware nurses sometimes undermine the value of their profession
2. Stand up for the lie of “there is not enough money for healthcare”
3. Be active in your union

Question 40

What are the 4 reasons truthfulness matters?

Answer 40

1. Legal reasons (to avoid fraud, protect yourself & employer from civil action, & protect own license)
2. Respect for persons (deontology & relational ethics)
3. Shift toward patient centered health care (more autonomy, can’t have autonomy without truthfulness)
4. Trust (what the therapeutic relationship is based on, & trust in health care system)

Question 41

What was therapeutic privilege?

Answer 41

• In the old physician centered model holding the truth was standard practice
• Grounded in beneficence to protect the patients and that patients may become worse due to stress of bad medical news