Lecture 8: The Ethical Practice of Medicine Flashcards
Who is the main committee for Medical Ethics?
The Joint Commission
When did healthcare ethics start?
1970’s in academia
What was the main event that caused the medical community to think about ethics?
WWII, with eugenics experiments by Dr. Joseph Mengele in Germany.
What are the two types of eugenics?
Positive eugenics: promotion of higher reproduction of people with desirable traits.
Negative eugenics: reduced reproduction of people with less desirable traits.
What are the US experiments that furthered ethics development?
Tuskegee Syphilis experiment
Glaxosmithkline (GSK) in 2004 testing AIDS meds on wards of the state
GSK in 2003 for Hep E vaccine.
What GSK experiment abroad helped further ethics development?
2012 Argentina vaccine trials on 1 year olds.
What documents began ethics development?
- Nuremberg Code post WWII (1948)
- Declaration of Helsinki (1964/2013)
- Belmont Report (1979)
When did healthcare start getting more complex?
1970-1980
What are trending changes that began to occur in healthcare?
- Patients seen by specialists who aggressively treat specific body systems and diseases.
- House calls no longer a regular part of physician’s practice.
- Physicians encouraged financially to see as many patients in a day as possible.
- Patients began educating themselves about their medical conditions and disease processes.
- Patients expectations regarding recovery dramatically increased with the advances in technology.
What are the Bioethical principles?
Autonomy
Beneficence
Nonmaleficence
Truth-telling
Justice
Confidentiality
Preservation of Life
What is autonomy?
The right of a patient to make an informed, uncoerced decision about their own health management.
What is informed consent?
Extension of autonomy
Process by which the PA provides adequate information that is comprehendible to a patient with capacity so that the patient can make a VOLUNTARY choice to accept/refuse treatment.
What can I do if I question a surrogate’s choice?
Request an ethics committee review
What are the elements of fully informed consent?
Reasonable alternatives
The nature of the decision/procedure
Assessment of patient understanding
Relevant risks, benefits and uncertainties to each alternative
The acceptance of the intervention by the patient.
What standards make up adequate information?
Reasonable physician standard
Reasonable patient standard
Subjective standard
What are the types of consent?
Implied consent
Expressed oral consent
Fully informed written and oral consent
What is the difference between competence and capacity?
Competence is a legal state, decided by a court. Competent until proven incompetent.
Capacity is an individual’s ability to make an informed decision.
Any licensed physician can make the determination.
If incapacitated or lacks capacity, needs competency hearing/guardian.
What is beneficence?
Acting in a patient’s best interest.
Protect and defend the rights of persons
Prevent harm from occurring to persons
Remove conditions that will cause harm to persons
Help persons with disabilities
Rescue persons in danger
What is nonmaleficence?
To do no harm
To impose no unnecessary or unacceptable burden upon the patient
Do not kill or physically harm
Do not cause pain
Do not incapacitate
Do not offend by insult or ridicule
Do not deprive others of goods of life
What is the key difference between nonmaleficence and beneficence?
Nonmaleficence:
One ought not to inflict evil or harm
Beneficence:
One ought to prevent evil or harm
One ought to remove evil or harm
One ought to do or promote good
What is justice?
Patients in similar circumstances should receive similar care.
What four main areas do we consider in justice?
Fair distribution of scarce resources.
Competing needs.
Rights and obligations.
Potential conflicts with established legislation.
What is truth-telling?
Providing truthful information to patients so they are informed.
What is confidentiality?
Keep personal health information private unless consent to release is obtained.
What are the two exceptions to breaching patient confidentiality?
- Concern for the safety of other specific persons.
- Legal requirement to report certain circumstances/conditions (Public health)
What is preservation of life?
A will to treat a patient’s illness with the aim of prolonging life. This principle may be overruled if the patient has made a living will stating their desire to not be resuscitated.
How do PAs help with preservation of life?
PAs should provide end of life planning.
PAs should assume terminally-ill patients want dignity and relief of pain primarily.
PAs should explain palliative and hospice care and facilitate patient access to those.
What is durable power of attorney?
A document that designates an individual to be your decision maker if you are incapable. Once recovered, you assume responsibility again.
What is a living will?
What treatments you want and do not want
What is medical futility?
Refers to interventions that are unlikely to produce any significant benefit.
What are some futile medical interventions?
Increasing patient’s pain and discomfort in the final days and weeks.
Give patients and family false hope.
Delay palliative and comfort care.
Expend finite medical resources.
What is euthanasia?
Physician or 3rd party intentionally causes death of terminally ill patient.
Active! Illegal in all states!
What is Patient-Assisted-Suicide?
Physician provides the means (aka syringe of morphine OD), patient administers it themselves.
Passive! Legal in like 10 states.
Who is the doctor of death?
Jack Kevorkian, american pathologist that championed the right to die via PAS.
What is palliative sedation?
Sedation is not euthanasia!
Continuous sedation that is intended to relieve suffering, like extra painkillers.
What is terminal sedation?
Practice of sedating a terminally ill patient to point of unconsciousness and letting them die to starvation/disease/dehydration.
What is a DNR?
Do not resuscitate. MUST RESPECT!!
What are morals?
Morals are PERSONAL opinions on right/wrong.
Unlikely to change, and are broad/general.
What are ethics?
LEGAL standards that dictate MINIMUM STANDARDS of acceptable behavior.
Ethics change over time.
Do we use morals or ethics in decision making?
Both, but ETHICS are legal, so if your morals conflict with the code of ethics, you should refer out a patient.
What is EMTALA?
Emergency Medical Treatment and Active Labor Act, AKA ethical obligation to treat patients and to responsibly transfer if outside scope.
What two ethical duties do we have to patients?
Ethical duty to offer every patient the full range of info on relevant treatment.
Ethical duty to see that each patient receives appropriate care.
