Introduction to Biomedical Ethics Practice Question Flashcards
A newspaper reporter asks a hospital receptionist about a famous person who was recently involved a serious accident and hospitalized. What information can be given to the reporter?
A) The basic fact that the person is a patient in the hospital.
B) The name and phone number of the attending physician.
C) A very brief statement about the person’s medical condition and prognosis.
D) Contact information for the person’s spouse.
E) None
Correct answer is E. Confidentiality is an important legal and ethical concept in healthcare. No information (even confirmation of being a patient) should be released to a third-party who is not directly involved in the patient’s care.
A 75-year-old woman with multiple medical problems is hospitalized for respiratory distress.
including repeated intubation for pulmonary aspiration. The patient appears to have good mental capacity and has consistently refused a feeding tube. She has also been told that eating a normal diet could lead to asphyxiation and death. Despite her condition, the patient is medically stable and steadfast in her desire to go home even though there is no one available to care for her there. There are no other discharge options since a nursing home or hospice care will not accept her in her current condition. Which of the following is the best course of action for the physician planning her discharge?
A) Proceed with the feeding tube placement in order to fulfil the ethical obligation of beneficence since this is clearly the most beneficial treatment.
B) Delay her discharge from the hospital and try to persuade her into additional treatments because of the risks of going home alone without additional care.
C) Coordinate home healthcare nurses to check on her regularly and contact family members to make them aware of her condition.
D) Provide education and support while she is in the hospital but honor her autonomy to make unwise and unsafe decisions.
E) Contact the hospital’s Institutional Review Board (IRB) to help determine your legal responsibility and the best course of
action.
Correct answer is D. This question deals with the ethical principle of autonomy and an individual’s right to refuse treatment. Particularly since there is no evidence to be concerned about her mental capacity, she has a right to decline a feeding tube and be discharged home even if this decision places her at increased risk for future complications or even death. It would not be appropriate to go against her consistent wishes (answer A) or attempt to delay a discharge in order to persuade her to change her mind (answer B). Given that this scenario does not represent an emergency situation, it would not be appropriate to break confidentiality to contact family members (answer C). The IRB is only involved in approving and monitoring research activities (answer E) and it would not be appropriate to involve them in this situation.
A researcher at a local University is interested in conducting a study on Type II diabetes. The study is looking to simplify diabetes treatment by decreasing the number of insulin injections through dietary changes and will involve close tracking of food intake as well as monitoring blood glucose levels over the course of 6 weeks. To recruit participants, the researcher sets up a booth at a health and wellness fair in the community. He finds that some of the people at the event speak Spanish and he is able to discuss the study with them since he is also bilingual (Spanish-English). What is one of the required elements of the informed consent process that is relevant to this situation?
A) The researcher should avoid getting consent from non-English speaking participants in order to focus the study on a more specific population.
B) The researcher should help persuade and influence participation by offering to provide all meals during the study as well as significant monetary compensation.
C) Potential participants can complete the informed consent process by signaling their willingness with a non-verbal response such as a head nod.
D) Informed consent should be voluntary but all of the risks do not need to be fully disclosed if the researcher believes the benefits outweigh the risks.
E) Any written documentation describing the study’s risk and benefits should be written in clear language and translated (with back translation) to ensure participants understanding.
Correct answer is E. This question relies on understanding the elements of informed consent in research. A research study may include participants from various ethnic and cultural backgrounds and does not have to be limited to one specific language (answer A) as long as the participants understand and are given an opportunity to ask questions about the study. Informed consent should be voluntary and avoid coercion (answer B). While children may be able to nonverbally signal their willingness to participate in a study, also called assent, adults should authorize their participation in writing (answer C). Informed consent should also fully explain potential risks and benefits (answer D).
4) A 78-year old woman has been diagnosed with rheumatoid arthritis and her primary care physician decides to prescribe a nonsteroidal anti-inflammatory medication to relieve her pain and reduce the inflammation. However, he is also concerned that this medication may result in gastrointestinal bleeding which is a common side effect in older adults. Which two ethical principles are involved in this situation?
A) Justice (making the medication fairly available to her) and Autonomy (allowing her to choose a specific medication).
B) Autonomy (giving her a choice of treatments) and Beneficence (choosing a treatment with no side-effects).
C) Non-maleficence (doing what is best for the woman) and Justice (protection of a vulnerable adult)
D) Beneficence (prescribing a medication that alleviates pain) and Non-maleficence (considering potential side-effects).
Correct answer is D. In this situation, the physician is providing a treatment to alleviate pain and reduce inflammation (i.e., Beneficence – acting for the benefit of the patient). The physician is also recognizing that the treatment may have the potential to cause unwanted, negative side-effects which will need be carefully monitored (Non-maleficence – do no harm).
List 4 primary ethical principles relevant to clinical practice and example.
- Beneficence: Acting for the benefit of others
- Nonmaleficence: Do no harm; cause no undue risk or needless harm
- Autonomy: Individual’s rights to choose or refuse
- Justice: Fairness and equity - distribution of scarce resources
The health care provider must consider four main areas when evaluating justice:
- Fair distribution of scarce resources
- Competing needs
- Rights and obligations
- Potential conflicts with established legislation
Boundary Crossing vs. Boundary Violation
Boundary Crossing: harmless, non- exploitative, possibly even supportive.
Boundary Violation: harmful, or potentially harmful to the patient.
Elements of Informed Consent in Research:
Disclosure
Participant fully informed about potential risks and benefits (to the individual foremost and secondarily society); Description of procedures to ensure confidentiality; Available compensation and treatment in the event of a research-related injury; Who to contact with additional questions
Elements of Informed Consent in Research:
Understanding
Participant must understand what was explained and be given the opportunity to ask questions; Documents should be written in clear language; Translation (with back translation) to verify accuracy
Elements of Informed Consent in Research:
Voluntariness
Participant’s consent should be voluntary and free of any coercion.
Elements of Informed Consent in Research:
Competence
Participant must be legally competent to provide consent; designated surrogate may provide consent if it is in the participant’s best interest.
Elements of Informed Consent in Research:
Consent
Potential subject must authorize his/her participation, preferably in writing; children who cannot read/write should still signal willingness (e.g., nod); consent by minors is referred to as assent.
The principle of nonmaleficence states that doctors must not ____ their patients.
- Disrespect
- Make decisions for
- Harm
- Have sexual relations with
- Doresearchon
- Harm
