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IPAP > MedEthics > Flashcards

MedEthics Flashcards

1
Q

Define Ethics

A

Philosophical discipline concerned w/ human obligations, duties and responsibilities

The system/code of conduct belonging to a particular philosophy, group or profession

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2
Q

Who is the primary ancient expositor of Virtue Ethics?

A

Aristotle

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3
Q

What is the primary concern of virtue ethics?

A

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

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4
Q

What standard of judgement does Aristotle use for determining virtue?

A

What should I do?
Who should I be?
Aristotle golden mean

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5
Q

What ethical theory is primarily associated with Immanuel Kant?

A

Deontology- only acts done from duty have moral worth

Founded on reason

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6
Q

Kant is mostly concerned with ?

A

Greek word “deon”= Duty

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7
Q

Define Categorical Imperative

A

An exception less moral rule that is binding on everyone at all times

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8
Q

What are the two formulations of the Categorical Imperative?

A 
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)
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9
Q

Who were the two primary 19th Century expositors of Utilitarianism?

A

Jeremy Bentham

John Stuart Mill

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10
Q

Utilitarianism is primarily concerned w/ ?

A

Consequences

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11
Q

What is the basic mantra of utilitarianism?

A

Greatest good for the greatest number

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12
Q

What is the purpose of ethics for utilitarians?

A

To make the world a better place

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13
Q

Define BioEthics

A

All ethical issues pertaining to the biological/medical sciences- research, clinical, medical organization and public health ethics

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14
Q

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?

A

Code of Nuremberg

Four parts: voluntary, well informed, consent of person w/ full legal capacity

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15
Q

What are the four principles of Beauchamp and Childress’s “Principles of Biomedical Ethics’?

A

Respect for Autonomy
Nonmaleficence
Beneficence
Justice

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16
Q

Under what conditions can a person’s autonomy be restricted?

A

Restricted to prevent harm to self/others
Quarantine,
Compelled Medical practice,
Limits on the autonomy of minors

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17
Q

Define Nonmaleficence?

A

Above all do no harm

We act out to act in ways that do not cause needless harm, risk, or injury to others

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18
Q

Define Beneficence

What are the limitations?

A

What is in the PTs best interest
We should act in ways that promote the welfare of others

Resources- human, mechanical, technical

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19
Q

What does justice refer to in the context of principlism?

A

Distributive Justin’s- seeks to give each person why they is “due”
Asks the question “what is fair”

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20
Q

What are the commonly held principles?

A

To each person and equal share
To each person according to need
To each person according to effort

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21
Q

Are ethics and law equivalent?

A

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

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22
Q

The word “clinical” is derived from the Greek word for ?

A

Bedside “klinikos”

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23
Q

What is an ethics question but not a technical question?

A

What should we do?

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24
Q

What approach to ethics and ethical dilemmas in PT care uses “care based reasoning” and/or “bottom up reasoning?”

A

Casuistry approach- bottom up reasoning and use accumulated experience

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25
Q

Can preventative ethics be better than a crisis management approach?

A

Yes

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26
Q

The virtues approach asks which question?

What does it provide?

A

What kind of person should I be to do the right/good thing for my PT

Virtue provides motivation

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27
Q

How many clinical virtues does Fletcher suggest?

A 
CROTCH PCS
Technical competence
Objectivity and detachment
Caring*
Clinical benevolence
Subordination of self interest
Reflective intelligence
Humility
Practical wisdom
Courage*
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28
Q

An ethics of caring emphasizes ?

A

Relationships between professional, PT, and family and recognizes human needs and interests

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29
Q

What is the heart of clinical ethics?

A

Relationships between clinician and PTs

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30
Q

What word means holding in trust?

A

Fiduciary

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31
Q

What is it about PTs that amplifies the need for the relationship of trust?

A

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

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32
Q

To treat PTs solely as diseased bodies in need of repair amounts to ?

A

Psychological abandonment- Fletcher

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33
Q

What is the approach to ethics and ethical dilemmas in PT care that emphasizes the dedication and special responsibilities of the clinician?

A

Role involves special knowledge/training and agreed upon boundaries of practice

Professional approach

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34
Q

Per Fletcher, what are the 3 different aspects of informed consent?

A

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

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35
Q

What are the best four characteristics of informed consent?

A

Agreement w/ physicians recommendation
Right to refuse interventions
Choice among alternative
Shared decision making

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36
Q

Informed consent results in ?

A

Shared decision making

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37
Q

Who is the expert in the PT/Physician relationship?

A

Both- meeting as mutual SMEs of their respected field

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38
Q

Once the PT has been informed, what are the two valid options they have?

A

Decision

Authorization

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39
Q

What are the two requirements for proper informed consent?

A

Freedom from coercion or manipulation

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40
Q

States vary on standars of ? and include what three standards?

A

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

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41
Q

Does a signed consent form provide all necessary consent for a physician?

A

No- signed consent form w/out a consent discussion does not suffice

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42
Q

What are the three guidelines Fletcher gives for informed consent?

A

Threshold element
Information element
Consent elements- last, decision and authorization

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43
Q

What are the four possible exceptions to the requirement for obtaining informed consent

A

Lack of decision making capacity
Emergency
Therapeutic privilege
Waiver- PT or national state

44
Q

What federal regulation pertains to PT confidentiality?

A

HIPAA

45
Q

What are exceptions to PTs confidentiality?

A 
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
46
Q

What main prinicple is involved when confidentiality is over ridden to protect third parties?

A

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

47
Q

If someone is lied to they tend to feel ? or ?

A

Deceived

Manipulated

48
Q

What is the foundational reason we give full disclosure to PTs

A

Respect for PTs autonomy

49
Q

A lack of truth telling can lead to a PT being ? and ? when they need support

A

Avoided by caregivers and family

50
Q

Strictly speaking only a court can declare someone ?

A

Incompetent- describes a persons inability to care of themselves

51
Q

Define Decision-Making capacity

A

Clinical setting awareness/concern of if a PT can make a decision about their treatment

52
Q

The respect we have for our PTs autonomy is often in tension with what other ethical guideline?

A

Acting in best interest of PT

53
Q

What is the immediate follow up question to “Does the PT have capacity?”

A

For what decision?

54
Q

What is a decision making capacity based on?

A

Understanding info
Appreciating the consequences of the choice
Applies reasoning in election of choice

55
Q

How can clinicians determine if a PT has decision making capacity?

A

Individual abilities of the PT
Requirement of task at hand
Consequence that are likely to result from the decision

56
Q

If a PT articulates a choice, our confidence in their decision making capacity can be increased if they are able to articulate ?

A

Reasoning, consequences and understanding of disclosed info

57
Q

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?

A

To the PT= beneficence

Freedom to choose= autonomy of the PT

58
Q

What are the 3 follow up steps to a PT declining treatments?

A

Tactfully ask why
Validate the PT
Give the PT a choice

59
Q

Observation by medical personnel of unusual cultural or religious beliefs/practices may lead these personnel to ? assume the PT lacks ?

A

Inaccurately

Capability/ability to understand

60
Q

What is an example of an adult who can refuse lifesaving treatment based upon religious beliefs?

A

Jehovah’s Witnesses

61
Q

Standards used for decision making by others when the PT lacks the capacity include what 3?

A

Advance directives
Substitute judgments
Best interests

62
Q

Of the various standards used for making decisions for incapacitated PTs, what type provides the most clear and convincing evidence of their wishes?

A

Advance directives

63
Q

Define a Surrogate Decision Maker

A

One who has been appointed using an advance directive and has been assigned by PT to make decisions on their behalf

64
Q

Define the Standard of Substituted Judgement

A

Used in the absence of advanced directives

Assumes someone who knew the PT and their values and is available for decision making

65
Q

What is the lowest standard of decision making that is sometimes turned to when PTs lack decision making capacity

A

Best interests

66
Q

What principle of biomedical ethics primarily guides us as we make decisions using best interests as the standard?

A

Beneficence

67
Q

What type of decision maker has the strongest claim to make decisions for incapacitated PTs?

A

Proxy decision makers, stronger claim than immediate family members

68
Q

Futility comes from the Latin word for ?

A

Leaky

69
Q

Ideas for futility fall on a spectrum between ? concepts and ? concepts

A

Narrow- treatment is ineffective in producing a desired physiological effect.

Broad- lack of benefit even if treatment is philosophical effective in a given case

70
Q

What are the three safeguards when interventions are considered futile

A

Obtain second opinion
Discuss intervention w/ PT
Establish explicit guidelines on futility

71
Q

Define Terminal Sedation

Define Palliative Sedation

A

Inducing sedation in terminal PT with combo of drugs in order to relieve intolerable pain and suffering

Pal- induces coma and

72
Q

Statistically, how many PTs that receive CPR are discharged?

Some of those discharged will have life long issues of ?

A

15%

Neurological impairment

73
Q

Define Active Voluntary Euthanasia

A

PT requests their life is terminated by physician who then injects lethal chemicals into the PT

74
Q

What is the direct agent of death with assisted suicide?

A

Administration of the drugs

75
Q

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?

A

Karen Quinan Case of 1976

76
Q

One of the reasons against assisted suicide and active euthanasia is linked to what professional role of the physician?

A 
Sanctity of life
Suffering can almost always be relieved 
Requests for suicide are autonomous 
Fears of abuse
Physician's role
77
Q

What are the five criteria for a person to be in PVS?

A

Extensive brain damage
Unconscious, no purposeful activity
Wakefulness, cycles of sleeping and awake
Open, eye, blinking, grimace, smile yawn
Breathing and circulation function normally

78
Q

PTs in PVS have no ? function but their ? is functional

A

Cortical

Brainstem

79
Q

Criteria for Anoxic and Traumatic brain death

A

Anoxic- 3mon

Traumatic- 12mon

80
Q

Define Minimally Conscious State

A

PTs with brain injuries but progress to show some awareness of self and environment

81
Q

In order to avoid confusion, provider’s need to exercise what two traits when speaking to family members of PVS PTs?

A

Sensitivity

Patience

82
Q

What act gives a definition of death?

A

UDDA
Uniform determination of death act
Circ/Resp
Whole brain irreversible

83
Q

What right does the Karen Quinlan act support?

This case motivated the development of ? committee within hospitals?

A

Right to decline/withhold treatment

Ethics

84
Q

What was the argument during the Nancy Cruzan case?

A

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

85
Q

What are the two things the Nancy Cruzan case resulted in?

A

Increase in state legislation regarding advanced directives

Emplacement of the PT self determination act in 1991

86
Q

Define Morality

A

Latin for Morale, pertaining to manners (mores)

Conduct/behavior of group that reveals values/assumptions about good and evil

87
Q

What is the difference between ethics and morality?

A

Ethics- formal study of right and wrong
Morality- value placed upon ethical choices

What we OUGHT to do
What we CHOOSE to do

88
Q

Who was the first winner of the Nobel piece prize?

A

Henry Durant- proposed relief agency for humanitarian aid

89
Q

? applies to bioethics?

A

Deontology

90
Q

Advanced directives include what two things?

A

POA- appoints a proxy

Living will

91
Q

When all consequences must be measured and weighted?

A

Unitarianism

92
Q

What is the doctrine of double effect?

A

Good beneficial and moral
Ethically good or neutral

Cure is not worse than disease
Proportionate to risk ratio
Bad benefit must not be mean

93
Q

What are the four sources of ethics?

A

Religion
Philosophy
Law
Experience

94
Q

What are the 3 concerns of ethics?

A

Actor- who we ought to be?
Actions- what is our duty?
Results- what ought to happen?

95
Q

Utilitarianism is a form of ?

A

Consequentialism

96
Q

Consequentialism has a relationship between what three other parts of ethics?

A

Utilitarianism
Hedonism
Egoism

97
Q

Where do math and ethics finally merge?

What are the four defined terms of this utility?

A

Utilitarian calculus

Pleasure, Happiness, Ideals, Preferences

98
Q

How many treaties and protocols are in the Geneva Convention?

How many countries ratified it?

A

4 treaties, 3 protocols

196

99
Q

What is the only purpose of the Geneva Convention?

A

Protect the victims of war

100
Q

What are the 4 categories of detainees under the Geneva Convention?

A

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

101
Q

As a result of the Overseas Contingency Operations, the US has designated what type of 5th detainee?

A

Enemy combatant- not entitled to protections of Geneva convention by virtue of actions (terrorists, unlawful combatants)

102
Q

? and ? are given the same care as US personnel

A

EPWs

Retained medical

103
Q

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

A

1847

1950

1960

1970

104
Q

What was the Tuskegee experiment?

A

Syphilis in black men

105
Q

? is essentially applied ethics

A

Principalism- bridges the gaps between ethical theories

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