KC Ethics Flashcards
*What are 3 elements of capacity?
- Nature of the proposed investigation or treatment
- Anticipated effect of the proposed treatment and alternatives
- Consequences of refusing treatment
*What are 5 clinical situations or patient characteristics apart from intoxication, when you can deem someone without capacity?
Unconscious patient
Under public/private curator
Minor below provincial threshold
Advanced dementia
Severe psychiatric disease
*What are 2 instances where a physician can circumvent asking for consent and treat anyway?
Life threatening situations
If life or limb are in danger and the patient is unable to consent and the substitute decision maker is not immediately available, a doctor has a duty to:
Do what is immediately necessary.
Respect any known previous wishes of the patient.
Obtain consent as soon as reasonably possible.
*What are the elements of informed consent?
Patient is:
Informed
Not-coerced
Capable
Informed
Free of coercion
Understand risk and benefit
Capacity (communicate)
Specific
*CAEP 2018 Resident Wellness statement. What are the three elements that comprise burnout?
Emotional exhaustion
Reduced sense of personal accomplishment
Depersonalization
DEESPerAte
*What are 8 psychological, professional, or physical consequences of burnout?
Suboptimal patient care
Greater self reported clinical errors
Difficulty focusing
Suicidal ideation
Depression
Substance abuse
Headaches
GI upset
Insomnia
Metabolic syndrome
Systemic inflammation and sympathetic system activation
Poor health behaviors
*What 2 psych conditions are reduced in family members of patients who are allowed to
witness the resuscitation in cardiac arrest
PTSD
Depression
Anxiety
*What are the 8 steps to break bad news in an empathetic manner
Introduce self and role.
Sit down.
Assume comfortable communication distance.
Use acceptable tone and rate of speech.
Make eye contact.
Maintain open posture.
Give advance warning of bad news.
Deliver news of death clearly (use dead or died).
Tolerate survivor’s reaction.
Explain medical attempts to “save” patient.
Use no medical jargon; use language that is clear and easily understood.
Offer viewing of deceased.
Offer to be available to survivor.
Conclude appropriately.
*4 components of ethical decision making:
Justice
Autonomy,
Beneficence,
Nonmaleficience,
Confidentiality,
Personal integrity
*3 situations of medical futility
- Clinicians can identify in only a limited set of circumstances - in which the intervention is effective in less than 1% of identical cases, based on the medical literature. ED thoracotomy for blunt trauma is a well-documented example
- Physiologic futility is when known anatomic or biochemical abnormalities will not permit succesful medical interventions. Example: EMS will not trasnport rigor mortis.
- When the proposed intervention will not achieve the patient’s goals for medical therapy in accordance with the patient’s values
*3 ‘tests’ that can be applied in ethics when there is no precedent
impartiality test (whether the practitioner would accept this action if he or she were in the patient’s place)
universalizability test (whether the practitioner would be comfortable having all practitioners perform this action in all relevantly similar circumstances)
interpersonal justifiability test (whether the practitioner can supply good reasons to others for the action)
*What is the order to determine an SDM?
SDM is the spouse first, then adult children, then parents
*In general, when do you need to ask an SDM for treatment?
When the patient lacks capacity and there isn’t a clear pre-made statement of their wishes (eg, there’s no level of care or clear advance directive)
*How would you frame a conversation with the SDM if they want to act contrary to the DNR?
I would remind them that the role of an SDM is not to make decisions that they want, but rather to make decisions that reflect what the wishes of the incapacitated patient would be if they were able to make a decision for themselves (ie, what the patient would want).
*Three symptoms that would happen once extubated and evidence-based treatments to relieve them (end of life)
- Drooling / secretions – treat with glycopyrrolate 0.1mg IV/SC q4h prn for secretions
- Agitation – treat with Ativan lorazepam 1mg IV/SL q2h prn for anxiety
- Respiratory distress – treat with morphine
morphine 0-10mg /hr for reduction of dyspnea (D/C if RR<8)
