medical ethics Flashcards
60 y/o male with hx metastatic lung cancer to hosp in severe resp distress. intubated and on respirator. few hours later his daughter arrives with living will states withhold sustaining interventions if he is terminally ill and incapable of making decisions. she demands disconnect vent and extubation. best action?
disconnect the respirator
14 y/o boy admit with stage 4 Hodgkin’s disease. oncologist advises chemotherapy and good chance for a cure. parents refuse chemo in spite of detailed explanation. child agrees with his parents decision. best course of action?
get court permission to give chemotherapy
you are aware that a colleague is addicted to alcohol. have seen him making rounds at hospital many occassions in an impaired state. what should you do?
report him to the chief of staff or the Impaired Physician Board of the state or consult ethics committee of your hospital
mentally competent patients have a right to
consent or refuse a treatment
when a patient is incompetent, decisions should be guided by:
- Living Will
- durable power of attorney for healthcare
- caring family may express patients values and interests
- court appointed guardian
- informed consent not required for emergency care
the same reasons that justify not starting the treatment also
justify stopping the treatment
Minors not living independently of parents, not married, not in armed forces cannot legally
make their own decisions
adults cannot make decisions for a minor child that are judged to be
significantly detrimental to the childs interest
Surrogate (Proxy)
- can consent to or withdraw any type of care including nutritional
- has priority over any other decision makers
- can make only health care decisions
- can overrule the living will document
- review medical records of the patient
decision making capacity of dementia patients
*the ability to understand the proposed treatment & alternative intervention. ask patient to repeat what the doc explained and the ability to grasp the consequences of accepting or declining the suggested treatment
decision making capacity of the depressed patient
decision to limit care should be deferred until depression has been adequately treated
DNR orders
- can be written when pt or surrogate requests them
- DNR orders do not preclude provisions of other life-prolonging measures or palliative care
- doc can write it if CPR will be futile
- if DNR orders are not written, it is unethical to perform half hearted effort or “slow codes”
- narcotics and sedatives may be used to relieve pain or dyspnea in terminally ill patients
definition of “Brain Death”
*irreversible cessation of lall functions of the brain including brain stem (EEG not required)=>supportive measures can be withdrawn
*in patient with “persistent vegetative state” (unconscious but not brain dead), life support equipment can be withdrawn if living will is available or family & surrogate are agreeable
confidentiality
- you are obligated to maintain medical info in strict confidence
- HIPPA established federal standards for privacy protection & disclosure of health information to outside entities-patient consent is needed for each release of information
- conficentiality can be overridden in these situations:
- disclosure of domestic violence
- protect 3rd parties: reporting of infectious dz, impaired driver to public health officials,injuries caused by weapons or crimes
Medical error (failure of planned action to be completed as intended)
- apologize to patient & explain what happened
- failure to report an error is unethical
- near miss: error that does not lead to patient harm
