MedEthics Flashcards
Define Ethics
Philosophical discipline concerned w/ human obligations, duties and responsibilities
The system/code of conduct belonging to a particular philosophy, group or profession
Who is the primary ancient expositor of Virtue Ethics?
Aristotle
What is the primary concern of virtue ethics?
Character based and not a principle based theory
Approach the de-emphasizes rules, consequences and particular acts and places focus on the kind of person who is acting
Focuses on moral concern and someone having virtues= moral conduct
What standard of judgement does Aristotle use for determining virtue?
What should I do?
Who should I be?
Aristotle golden mean
What ethical theory is primarily associated with Immanuel Kant?
Deontology- only acts done from duty have moral worth
Founded on reason
Kant is mostly concerned with ?
Greek word “deon”= Duty
Define Categorical Imperative
An exception less moral rule that is binding on everyone at all times
What are the two formulations of the Categorical Imperative?
Respect formulation (not using others for personal gain) Universal formulation (law of nature- if it's good for one, it's good for the many)
Who were the two primary 19th Century expositors of Utilitarianism?
Jeremy Bentham
John Stuart Mill
Utilitarianism is primarily concerned w/ ?
Consequences
What is the basic mantra of utilitarianism?
Greatest good for the greatest number
What is the purpose of ethics for utilitarians?
To make the world a better place
Define BioEthics
All ethical issues pertaining to the biological/medical sciences- research, clinical, medical organization and public health ethics
What is the name of the code of ethics that came out of the Nazi doctor trials that governs the use of human subjects in research?
Code of Nuremberg
Four parts: voluntary, well informed, consent of person w/ full legal capacity
What are the four principles of Beauchamp and Childress’s “Principles of Biomedical Ethics’?
Respect for Autonomy
Nonmaleficence
Beneficence
Justice
Under what conditions can a person’s autonomy be restricted?
Restricted to prevent harm to self/others
Quarantine,
Compelled Medical practice,
Limits on the autonomy of minors
Define Nonmaleficence?
Above all do no harm
We act out to act in ways that do not cause needless harm, risk, or injury to others
Define Beneficence
What are the limitations?
What is in the PTs best interest
We should act in ways that promote the welfare of others
Resources- human, mechanical, technical
What does justice refer to in the context of principlism?
Distributive Justin’s- seeks to give each person why they is “due”
Asks the question “what is fair”
What are the commonly held principles?
To each person and equal share
To each person according to need
To each person according to effort
Are ethics and law equivalent?
No
Similar in development of law and ethics but not based on feelings alone
A product of careful thought and defended with arguments and reason
The word “clinical” is derived from the Greek word for ?
Bedside “klinikos”
What is an ethics question but not a technical question?
What should we do?
What approach to ethics and ethical dilemmas in PT care uses “care based reasoning” and/or “bottom up reasoning?”
Casuistry approach- bottom up reasoning and use accumulated experience
Can preventative ethics be better than a crisis management approach?
Yes
The virtues approach asks which question?
What does it provide?
What kind of person should I be to do the right/good thing for my PT
Virtue provides motivation
How many clinical virtues does Fletcher suggest?
CROTCH PCS Technical competence Objectivity and detachment Caring* Clinical benevolence Subordination of self interest Reflective intelligence Humility Practical wisdom Courage*
An ethics of caring emphasizes ?
Relationships between professional, PT, and family and recognizes human needs and interests
What is the heart of clinical ethics?
Relationships between clinician and PTs
What word means holding in trust?
Fiduciary
What is it about PTs that amplifies the need for the relationship of trust?
PTs are vulnerable and dependent.
Entitles to be treated w/ respect and as partners in the process of making health care decisions
Clinicians are responsible for communicating w/ PTs to enlist participation in the health care process
To treat PTs solely as diseased bodies in need of repair amounts to ?
Psychological abandonment- Fletcher
What is the approach to ethics and ethical dilemmas in PT care that emphasizes the dedication and special responsibilities of the clinician?
Role involves special knowledge/training and agreed upon boundaries of practice
Professional approach
Per Fletcher, what are the 3 different aspects of informed consent?
Legal rules regarding clinicians interactions w/ PTs
Doctrine of autonomy that supports PT right to self determination
Process that clinicians and PTs interact to select an appropriate course of care
What are the best four characteristics of informed consent?
Agreement w/ physicians recommendation
Right to refuse interventions
Choice among alternative
Shared decision making
Informed consent results in ?
Shared decision making
Who is the expert in the PT/Physician relationship?
Both- meeting as mutual SMEs of their respected field
Once the PT has been informed, what are the two valid options they have?
Decision
Authorization
What are the two requirements for proper informed consent?
Freedom from coercion or manipulation
States vary on standars of ? and include what three standards?
Disclosure
Professional standard- what would reasonable physician of ordinary skill disclose
PT standard- what a reasonable PT would find relevant
Individual/Subjective standard- PT specific information tailored to the PTs need for info and understanding
Does a signed consent form provide all necessary consent for a physician?
No- signed consent form w/out a consent discussion does not suffice
What are the three guidelines Fletcher gives for informed consent?
Threshold element
Information element
Consent elements- last, decision and authorization
What are the four possible exceptions to the requirement for obtaining informed consent
Lack of decision making capacity
Emergency
Therapeutic privilege
Waiver- PT or national state
What federal regulation pertains to PT confidentiality?
HIPAA
What are exceptions to PTs confidentiality?
Infectious diseases Impaired drivers Injuries caused by weapons/crimes Partner notification by public health officials Warnings by physicians to persons at risk Violence by psychiatric PTs Child/elder abuse Domestic violence
What main prinicple is involved when confidentiality is over ridden to protect third parties?
Non-maleficence:
Harm to 3rd party is serious
High likelihood of harm
No alternative for warning/protecting those at risk
Breaching confidentiality will prevent harm
Harm to PT is minimized and acceptable
If someone is lied to they tend to feel ? or ?
Deceived
Manipulated
What is the foundational reason we give full disclosure to PTs
Respect for PTs autonomy
A lack of truth telling can lead to a PT being ? and ? when they need support
Avoided by caregivers and family
Strictly speaking only a court can declare someone ?
Incompetent- describes a persons inability to care of themselves
Define Decision-Making capacity
Clinical setting awareness/concern of if a PT can make a decision about their treatment
The respect we have for our PTs autonomy is often in tension with what other ethical guideline?
Acting in best interest of PT
What is the immediate follow up question to “Does the PT have capacity?”
For what decision?
What is a decision making capacity based on?
Understanding info
Appreciating the consequences of the choice
Applies reasoning in election of choice
How can clinicians determine if a PT has decision making capacity?
Individual abilities of the PT
Requirement of task at hand
Consequence that are likely to result from the decision
If a PT articulates a choice, our confidence in their decision making capacity can be increased if they are able to articulate ?
Reasoning, consequences and understanding of disclosed info
The dilemma of does a physician’s responsibility to help the PT ever override the PTs freedom to choose is an example of which ethical concept?
To the PT= beneficence
Freedom to choose= autonomy of the PT
What are the 3 follow up steps to a PT declining treatments?
Tactfully ask why
Validate the PT
Give the PT a choice
Observation by medical personnel of unusual cultural or religious beliefs/practices may lead these personnel to ? assume the PT lacks ?
Inaccurately
Capability/ability to understand
What is an example of an adult who can refuse lifesaving treatment based upon religious beliefs?
Jehovah’s Witnesses
Standards used for decision making by others when the PT lacks the capacity include what 3?
Advance directives
Substitute judgments
Best interests
Of the various standards used for making decisions for incapacitated PTs, what type provides the most clear and convincing evidence of their wishes?
Advance directives
Define a Surrogate Decision Maker
One who has been appointed using an advance directive and has been assigned by PT to make decisions on their behalf
Define the Standard of Substituted Judgement
Used in the absence of advanced directives
Assumes someone who knew the PT and their values and is available for decision making
What is the lowest standard of decision making that is sometimes turned to when PTs lack decision making capacity
Best interests
What principle of biomedical ethics primarily guides us as we make decisions using best interests as the standard?
Beneficence
What type of decision maker has the strongest claim to make decisions for incapacitated PTs?
Proxy decision makers, stronger claim than immediate family members
Futility comes from the Latin word for ?
Leaky
Ideas for futility fall on a spectrum between ? concepts and ? concepts
Narrow- treatment is ineffective in producing a desired physiological effect.
Broad- lack of benefit even if treatment is philosophical effective in a given case
What are the three safeguards when interventions are considered futile
Obtain second opinion
Discuss intervention w/ PT
Establish explicit guidelines on futility
Define Terminal Sedation
Define Palliative Sedation
Inducing sedation in terminal PT with combo of drugs in order to relieve intolerable pain and suffering
Pal- induces coma and
Statistically, how many PTs that receive CPR are discharged?
Some of those discharged will have life long issues of ?
15%
Neurological impairment
Define Active Voluntary Euthanasia
PT requests their life is terminated by physician who then injects lethal chemicals into the PT
What is the direct agent of death with assisted suicide?
Administration of the drugs
PTs have a right to be free of unwanted bodily invasions even if they are life saving ones. Which principle of biomedical ethics most directly supports this right?
Karen Quinan Case of 1976
One of the reasons against assisted suicide and active euthanasia is linked to what professional role of the physician?
Sanctity of life Suffering can almost always be relieved Requests for suicide are autonomous Fears of abuse Physician's role
What are the five criteria for a person to be in PVS?
Extensive brain damage
Unconscious, no purposeful activity
Wakefulness, cycles of sleeping and awake
Open, eye, blinking, grimace, smile yawn
Breathing and circulation function normally
PTs in PVS have no ? function but their ? is functional
Cortical
Brainstem
Criteria for Anoxic and Traumatic brain death
Anoxic- 3mon
Traumatic- 12mon
Define Minimally Conscious State
PTs with brain injuries but progress to show some awareness of self and environment
In order to avoid confusion, provider’s need to exercise what two traits when speaking to family members of PVS PTs?
Sensitivity
Patience
What act gives a definition of death?
UDDA
Uniform determination of death act
Circ/Resp
Whole brain irreversible
What right does the Karen Quinlan act support?
This case motivated the development of ? committee within hospitals?
Right to decline/withhold treatment
Ethics
What was the argument during the Nancy Cruzan case?
Missouri Supreme Court wanted a clear and convincing statement about the PTs desires and wishes about treatment
Acknowledgment that nutrition and hydration was a medical intervention and can be removed at PTs request
What are the two things the Nancy Cruzan case resulted in?
Increase in state legislation regarding advanced directives
Emplacement of the PT self determination act in 1991
Define Morality
Latin for Morale, pertaining to manners (mores)
Conduct/behavior of group that reveals values/assumptions about good and evil
What is the difference between ethics and morality?
Ethics- formal study of right and wrong
Morality- value placed upon ethical choices
What we OUGHT to do
What we CHOOSE to do
Who was the first winner of the Nobel piece prize?
Henry Durant- proposed relief agency for humanitarian aid
? applies to bioethics?
Deontology
Advanced directives include what two things?
POA- appoints a proxy
Living will
When all consequences must be measured and weighted?
Unitarianism
What is the doctrine of double effect?
Good beneficial and moral
Ethically good or neutral
Cure is not worse than disease
Proportionate to risk ratio
Bad benefit must not be mean
What are the four sources of ethics?
Religion
Philosophy
Law
Experience
What are the 3 concerns of ethics?
Actor- who we ought to be?
Actions- what is our duty?
Results- what ought to happen?
Utilitarianism is a form of ?
Consequentialism
Consequentialism has a relationship between what three other parts of ethics?
Utilitarianism
Hedonism
Egoism
Where do math and ethics finally merge?
What are the four defined terms of this utility?
Utilitarian calculus
Pleasure, Happiness, Ideals, Preferences
How many treaties and protocols are in the Geneva Convention?
How many countries ratified it?
4 treaties, 3 protocols
196
What is the only purpose of the Geneva Convention?
Protect the victims of war
What are the 4 categories of detainees under the Geneva Convention?
EPW- engaged in combat under government orders (armed forces, militia/volunteer corps, not classified as CI or RP)
Civilian internees- intern during conflict for security reasons
Retained persons- medical, chaps, staff of red cross
Other- don’t fall under other categories until legally determined
As a result of the Overseas Contingency Operations, the US has designated what type of 5th detainee?
Enemy combatant- not entitled to protections of Geneva convention by virtue of actions (terrorists, unlawful combatants)
? and ? are given the same care as US personnel
EPWs
Retained medical
What year was the first set of AMA cod of ethics developed?
Year of renal transplant
Year of heart transplant, brain death
PT Bill of Rights
1847
1950
1960
1970
What was the Tuskegee experiment?
Syphilis in black men
? is essentially applied ethics
Principalism- bridges the gaps between ethical theories
