Lecture 4: Ethics and Legal Issues

Question 1

What is the primary role of an ethics committee?

Answer 1

Advise

Question 2

Who is in an ethics commitee?

Answer 2

• Physicians
• APPs
• Nurses
• Social workers
• Attorneys
• Theologians
• Immediate community representatives

Question 3

Top 2 indications for ethics consultation?

Answer 3

1. Advance directive
2. Brain Death

Question 4

What two things are required for informed consent?

Answer 4

• Decision making capacity
• Competence

It is a patient right.

Question 5

What is the general rule of thumb in terms of information presented to a patient?

Answer 5

The minimum amt of information that an “average” person would need to make a decision.

Question 6

What is the MC situation that results in concern regarding patient decision-making capacity?

Answer 6

Refusal

We think theyre challenging us so they must be craycray

Question 7

What do we call it when a provider withholds information due to patient risk?

Answer 7

• Therapeutic exception
• Privilege

Must document thoroughly

Both refer to the same thing.
Basically, we think the risks associated with disclosing information outweighs the benefit of knowing that information

Question 8

If a patient has not designated a surrogate as part of their advanced directive, who then assigns the next surrogate?

Answer 8

Physician

Question 9

Surrogate ranking (6)

Answer 9

1. Spouse
2. Adult children
3. Parents
4. Adult siblings
5. Adult Grandchildren
6. Close Friend

Physician can still adjust if someone is weird af

Question 10

In the event of two surrogates determined but they disagree, who might be given precedence over the other?

Answer 10

The one who has assumed more of the care responsibilities

Question 11

Even if a DNR is signed and in a chart, what should always be remembered?

Answer 11

A patient can reverse their DNR at any time

AKA discuss code status everytime a patient is admitted.

Question 12

What is a common scenario that occurs in surgery in terms of DNR status?

Answer 12

• Patient is turned full code during surgery.
• Patient is returned to DNR upon transfer to the recovery room

Essentially, DNR is only rescinded perioperatively.

Question 13

If a patient dies in the OR while DNR, what is the term?

Answer 13

Expected death

Question 14

What is the DNI conundrum?

Answer 14

DNI/partial DNRs compromise integrity because resuscitation without intubation is quite futile. CPR in general is not highly effective.

Question 15

What do ICDs and PPMs count as in terms of treatment?

Answer 15

• They can be viewed as treatment
• They can be viewed as biologic transplants

Overall, the patient retains ability to deactivate/remove them.

Question 16

Define Physiologic futility

Answer 16

Absolutely or impossible to achieve a physiologic effect such as CPR in the setting of persistent acidosis.

Establishing proper physiology is futile

Question 17

Define Qualitative futility

Answer 17

Improvement in patient physiology, but no change in quality of life

Quality of life is still futile

Question 18

Quantitative futility

Answer 18

Intervention has not worked in similar patients with an accepted confidence interval

Aka low success rate treatment

The numbers are futile

Question 19

What is LST?

Answer 19

Life sustaining treatment

Question 20

I GET SMASHHED

Pancreatitis mnemonic

Answer 20

• Idiopathic
• Gallstones (MC)
• Ethanol (2nd MC)
• Trauma
• Steroids
• Steroids
• Mumps
• Autoimmune Disease
• Scorpion Sting
• Hypercalcemia
• Hypertriglyceridemia
• ERCP
• Drugs (Diuretics)