Medical Ethics Flashcards
https://www.youtube.com/watch?v=Vn4_4GBDSJ4
Medical Ethics
What are the four bedrock principles of medical ethics?
Autonomy
Beneficence
Nonmaleficence
Justice
Medical Ethics
Assuming a patient has full decision-making capacity, what is the ethical difference between withholding life-saving care that the patient has refused and removing life-saving care that the patient has requested be discontinued?
There is no ethical difference between withholding and removing life-saving treatment.
(Patient autonomy is paramount.)
Medical Ethics
What are the three main components of the hierarchy of substitute decision makers in cases of medical care?
- Legally appointed SDMs
- Automatic family member SDMS
- SDM of last resort
Medical Ethics
Describe the hierarchy of substitute decision makers who are legally appointed in cases of medical care.
(Yellow category)
Medical Ethics
Describe the family hierarchy of substitute decision makers in cases of medical care.
(Green category)
Medical Ethics
In what order do parents, children, spouses, and siblings fit into the hierarchy of substitute decision makers (in terms of medical care)?
Spouse >
Parents or children >
Siblings
Medical Ethics
Describe the last resort in the hierarchy of substitute decision makers in cases of medical care.
(Blue category)
Medical Ethics
What is palliative sedation (as an alternative to euthanasia)?
Prescribing high doses of opiates or other medications to the point of producing unconsciousness in order to treat refractory physical pain
Medical Ethics
The doctrine of double effect distinguishes effects that are intended from those that are foreseen but unintended.
What is an example of this?
Opiates are used to relieve pain, but they also have the side effect of causing respiratory depression and hastening death
Medical Ethics
What are some basics regarding medical disputes over minors?
Medical Ethics
How would you describe the difference between medical negligence and battery?
Medical Ethics
Can a patient’s next of kin override their living will?
No. Only the patient can modify the living will.
Medical Ethics
What is the difference between consent and assent?
- Assent is the non-legal affirmation that children must give.
- Consent is the legal affirmation that parents, legal guardians, and emancipated minors give.
Medical Ethics
In what situations should a physician treat a minor without parental consent?
Emancipated minors; treatment for STDs, substance abuse, birth control, and emergency situations
Medical Ethics
Depressed patients who are suicidal and want to withdraw treatment should not have their wishes honored until this happens (2):
1) Assessment of competence
2) No honoring of decisions until depression resolves
Medical Ethics
What should a physician do if a patient makes sexual advances?
Should a physician have sexual or romantic relationships with past patients?
Immediately terminate the doctor-patient relationship.
No (the power differential is too large).
Medical Ethics
How long must a physician continue to provide treatment after termination of the doctor-patient relationship?
30 days (So the patient has time to find a new provider)
List some of the scenarios in which the need for an ethics consultation may arise if there is uncertainty and/or disagreement as to how to proceed.
- Advance directive
- Brain death
- Capacity/informed consent
- Confidentiality
- Discharge/placement
- DNR
- Futility
- Isolated incapacitated patient
- Maternal/fetal conflict
- Medical error
- Pain management
- Refusal of recommended treatment
- Research ethics
- Resource allocation
- Surrogate decision making
- Transplant issues
- Truth telling
- Withdrawal of ventilator or artificial nutrition or hydration or other life-sustaining therapy
When should an ethics consult be placed in a case involving a patient who does not have full decision-making capacity?
-
Consult an ethics committee or other institutional resource when:
- No surrogate is available or there is ongoing disagreement about who is the appropriate surrogate.
- Ongoing disagreement about a treatment decision cannot be resolved.
- The physician judges that the surrogate’s decision:
- Is clearly not what the patient would have decided when the patient’s preferences are known or can be inferred
- Could not reasonably be judged to be in the patient’s best interest
- Primarily serves the interests of the surrogate or other third party rather than the patient
Medical Ethics
Case 1
D
- Personal diagnoses are not to be divulged (Even to partners) against the patient’s will.
- Certain diseases must be reported to the CDC:
Hepatitis A, B, C;
HIV, AIDS;
Syphilis, gonorrhea;
MMR;
TB;
Salmonella, Shigella, E. coli;
Varicella;
Meningitis.
Medical Ethics
Case 2
C
The first step in controversial, difficult situations is to attempt to understand the alternate party’s point of view.
Medical Ethics
Case 3
E
- As a parent, this patient is an emancipated minor that can consent to her own treatments and make her own decisions.
Medical Ethics
Case 4
A
- The mother has full control and precedence over the child.
Medical Ethics
Case 5
A
- HIPPA - “I am not allowed to say whether or not…”
Medical Ethics
Case 6
D
- Gifts should always be refused.
Medical Ethics
Case 7
B
- The physician failed to obtain informed consent.
No words were exchanged, no benefits or risks were explained, and no alternative options given.
- There were no damages due to a breach of duty; so, there is no case of negligence here.
Medical Ethics
Case 8
A
- Res ipsa loquitor - Literally means ‘the thing speaks for itself.’
- Anything extremely obvious as your mistake and liability.
Medical Ethics
Case 9
B
- The Good Samaritan Law protects HCPs that provide ‘reasonable intervention’ in an unexpected emergency outside usual medical practice in a clinic or hospital.
Medical Ethics
Case 10
E
- All three parties are liable
Medical Ethics
Case 11
C
- Autonomy trumps beneficence if the patient is competent.
- The religious beliefs are not the determining factor here; it is the patient’s decision that counts.
Medical Ethics
Case 12
B
- Life-saving treatment overrides religious beliefs for children.
- Religious beliefs do not give parents the right to deny treatment to their child.
Medical Ethics
Case 13
C
- Passive euthanasia is the allowance of a patient to make their own decision about your providing or withholding treatment.
- Active euthanasia is physician-assisted suicide - This is not allowed.
Medical Ethics
Case 14
E
- The patient should always be in charge of the flow of information.
Medical Ethics
Case 15
A
- The patient’s decisions override the family’s wishes.
Medical Ethics
Case 16
A
- The spouse makes the call in the absence of a living will.
- If the spouse is unavailable and the adult children disagree, you go to the ethics committee.
- If the spouse is unavailable and the adult children agree, you follow the children’s wishes.
Medical Ethics
Case 17
B
- The Good Samaritan Law allows for reasonable, life-saving measures while waiting for EMS to arrive.
- The physician is easily being unreasonable because we can assume the physician did nothing to stabilize the patient’s spine.
Medical Ethics
Case 18
A
- Certain cases regarding minors (E.g. drugs, STDs, abortion) do not need to be reported to the patient’s parent(s).
Medical Ethics
Case 19
B
- Assent is the non-legal affirmation that children must give.
- Minors have to assent to clinical trials.
- Consent is the legal affirmation that parents, legal guardians, and emancipated minors give.
Medical Ethics
Case 20
A
- Strange case and this probably should not be asked by the student or physician, but if the family gives consent, then it is technically allowable.
Medical Ethics
Case 21
E
- Brain death must be confirmed before removing mechanical ventilation.
- No brainstem reflexes (Pupillary or corneal - Must rule out other toxic causes) + neurologic exam.
Medical Ethics
Case 22
A
- Physicians must arrange for someone else to cover their patients while they’re gone.
- It does not matter that the patient was non-compliant, the physician is still first in line for blame as he did not make alternate arrangements for the patient.
Medical Ethics
Case 23
B
- The patient is clearly not competent to make decisions as she is deluded to her situation.
- Only a surrogate decision maker’s consent is needed.
Medical Ethics
Case 24
B
- In almost every state, the genetic mother has the right to change her mind and keep the child, regardless of any signed contract.
Medical Ethics
Case 25
D
- Impaired healthcare providers must ALWAYS be reported.
- You need to get someone else in to help as soon as possible.
- Allowing the intoxicated physician to assist or attempting the case alone are both inappropriate decisions.
Medical Ethics
Case 26
D
- Living alone legally implies consent.
Medical Ethics
Case 27
E
- Any sensitive work with a patient of the opposite sex is a time when a chaperone should be called.
Medical Ethics
Case 28
E
- There is a moral obligation to tell the child as we do not know how capable the child is of understanding.
- However, there is no legal obligation.
Medical Ethics
Case 29
D
- There is no binding legal obligation that arises from organ donor cards.
- The next-of-kin can refuse the donation unless there is some other living will involved (Which organ donor cards are not).
Medical Ethics
Case 30
E
- The student has meningitis.
- Although he is contagious, the student cannot be held against his will.
- The CDC should be notified as this is a reportable disease, and the college needs to be notified that they have a contagious student on campus with a dangerous disease.
