Lecture 1- Medical Ethics

Question 1

Define: Clinical ethics

Answer 1

a practical discipline that provides a structured approach for identifying, analyzing, and resolving ethical issues in clinical med

Question 2

What four topics should EVERY clinical case be analyzed?

Answer 2

a. medical indications
b. patient preferences
c. quality of life
d. contextual features, defined as the social, economic, legal, and administrative context in which cases occur.

Question 3

Define Medical Indications

Answer 3

the diagnostic and therapeutic interventions that are appropriate to treat the problem

Question 4

Define: Clinical Judgment

Answer 4

The process by which discerning clinicians, faced with clinical uncertainty attempt to make consistently good decisions. The “art of medicine.

Question 5

Medical status includes what 5 things?

Answer 5

a. Nature of the dz
b. Prognosis
c. Treated or not
d. Tx alternatives
e. Goals of the intervention

Question 6

What Four ethical issues that depend heavily on the indications for or against medical interventions?

Answer 6

a. Medical futility
b. CPR and do not resuscitate
c. Good care of the dying
d. The definition of death

Question 7

Define: Patient preferences

Answer 7

In all med. tx the pt’s preferences that are based on the pt’s own values and personal assessment of benefits and burdens are ethically relevant.

Question 8

What are the 8 Patient Preferences?

Answer 8

a. What does the pt want?
b. What are the pt’s goals?
c. Has the pt been provided enough info?
d. Does the pt comprehend?
e. Is the pt consenting voluntarily?
f. Is the pt coerced?
g. If not, who has the authority to make decisions?
h. What is to be done if no surrogate can be found?

Question 9

Define: Quality of Life

Answer 9

The goal of medical intervention is to restore, maintain, or improve the quality of life.

Question 10

Define: Contextual Features

Answer 10

Deals with social, legal, economic, and institutional circumstances in which a particular case of pt care occurs. Contextual factors, such as costs and reorganization of health care, have created conflicts of interest for clinicians.

Question 11

The context of care is related to the clinical case in at least these 2 ways:

Answer 11

1. It establishes the limits and conditions in which decisions take place.
2. It is itself influenced by decisions made by and about the pt.

Question 12

Define: Justice

Answer 12

Justice concerns the fair and equitable distribution of burdens and benefits to the participants in social institutions

Question 13

Define: Loyalty and the Multiple Responsibilities of Physicians

Answer 13

Loyalty is a sustained commitment to the welfare of persons or to the success of an endeavor, requiring an investment of effort and sometimes even a subordination of self-interest.

Question 14

Define: Allegiance and Advocacy

Answer 14

Clinicians owe allegiance to their pts, that is they must respect their pt’s preferences and privacy and respond to their health and informational needs. This allegiance is an expression of loyalty.

Question 15

Define: Fiduciary Duty

Answer 15

A fiduciary owes undivided loyalty to those served and must work for their benefit. Fiduciaries must avoid financial conflicts of interest that could prejudice their clients’ interests.

Question 16

Define: Conflict of Interest

Answer 16

Often used to describe a situation in which a person might be motivated to perform actions that his or her professional role makes possible but that are at variance with the acknowledged duties of that role.

Question 17

Define: Role of Interested Parties

Answer 17

The primary interested parties in a clinical relationship are the pt and the clinician.

Question 18

How does the Family, Relatives, and Friends of the Pt fit into the picture?

Answer 18

It is common in family medicine to say “the family is the pt.” This phrase recognizes that in all illness, causal and curative factors can be found in the personal relationships that surround the pt. These other parties may constitute a number of differing roles concerning the pt: providing emotional or living support, providing info, serving as an interpreter of the pt’s values, or paying bills. The moral cooperation of these others should be sought and encouraged, their moral roles and claims must occasionally be sorted out.

Question 19

What role does the The Family of a Child Pt have?

Answer 19

In peds, families are of central importance. The primary responsibility of parents must be the welfare of their child.

Question 20

When can Clinician Confidentiality be breached?

Answer 20

Confidential info may be divulged to appropriate persons when a clinician is aware that lack of that info places some identifiable person at high risk of serious harm.

Question 21

When does Confidentiality and Public Welfare intersect?

Answer 21

Confidentiality must be broken in certain disease or exposure dilemmas where the causative agent or the exposure must be reported to the local Health Department. This is to attempt to protect the general public from such infections as Meningitis or preventing a person with a heart disorder from driving a motorized vehicle. This moral concept also surfaces when an individual tests positive for HIV, the clinician is obligated to ensure that partners of the infected pt are informed.

Question 22

When are Legal Implications and Confidentiality involved?

Answer 22

Most jurisdictions have statutes requiring clinicians to report cases of certain types, such as STDs, gunshot and knife wounds, and suspected child, partner, and elder abuse. These statutes attempt to protect the general public’s welfare.

Question 23

Why is Professionalism Important

Answer 23

1) PA’s need Expert knowledge

2) PA’s need to avoid self interest

Question 24

Define: PROFESSIONALISM

Answer 24

PROFESSIONALISM is the expression of positive values and ideals as care is delivered. Foremost, it involves prioritizing the interests of those being served above one’s own.

Question 25

Define: Hippocratic Oath

Answer 25

The Hippocratic Oath is an oath historically taken by physicians and other healthcare professionals swearing to practice medicine honestly. Do No Harm.

Question 26

Define: PA Student Oath

Answer 26

Specific to PA’s- we say it at the White Coat Ceremony.

Question 27

Define: Ethics

Answer 27

A way to decide what best to do, *common knowledge not always adequate.

Question 28

What is the Ethical Dilemma?

Answer 28

Ethical decisions rarely involve options that are clearly right or wrong - instead they are the complicated choices that appear to pit one right against another.

Question 29

What are the Beauchamp & Childress principles?

Answer 29

1) Respect for autonomy
2) Beneficence

3) Non maleficence
4) Justice

Question 30

Define: Respect for autonomy

Answer 30

respecting individuals to make reasoned informed choices. 


Question 31

Define: Beneficence

Answer 31

this considers the balancing of benefits of treatment against the risks and costs; the healthcare professional should act in a way that benefits the patient

Question 32

Define: Non maleficence

Answer 32

avoiding the causation of harm; the healthcare professional should not harm the patient. All treatment involves some harm, even if minimal, but the harm should not be disproportionate to the benefits of treatment.


Question 33

Define: Justice

Answer 33

distributing benefits, risks and costs fairly; the notion that patients in similar positions should be treated in a similar manner.

Question 34

What is the Jonsen et. al. Practical approach to ethical decisions?

Answer 34

1) Indications for medical intervention
2) Preferences of patient
3) Quality of life
4) Contextual features

Question 35

Define:Indications for medical intervention

Answer 35

establish a diagnosis, what are the options for treatment, what are the prognoses for each of the options.

Question 36

Define:Preferences of patient

Answer 36

is the patient competent- if so what does he / she want? If not competent then what is in the patient’s best interest?

Question 37

Define:Quality of life

Answer 37

will the proposed treatment improve the patient’s quality of life?

Question 38

Define:Contextual features

Answer 38

do religious, cultural, legal factors have an impact on the decision?

Question 39

What 5 types of people can help a PA make an ethical decision?

Answer 39

1) Supervising MD
2) Ethics Committee
3) Lawyer
4) Clergy
5) Colleagues