Medical Ethics Flashcards
What are the three guiding ethical principles?
Autonomy, Beneficence, Justice
What is Autonomy?
The patient’s wishes and values, the patient’s wishes should guide the treatment and patient incompetence should be taken into consideration
What is Beneficence?
What can be done to help the patient and how can harm be avoided? the hippocratic oath is to do no harm. What are the risks and benefits associated with the treatment options? Avoid making assumptions by discussing options thoroughly.
What is Justice?
Is the patient being treated fairly and needs being met? Will others be burdened by the treatment chosen?
What is the Autonomy Principle?
Patients have the right to decide what they want when it comes to healthcare, and patients have the right to be treated in respectful ways by healchare practitioners
What is Informed Consent?
Part of the autonomy principle. Patients take responsibility for their own care and to protect themselves from unwanted treatments. It protects healthcare practitioners from unwanted litigation.
What should be talked about with informed consent?
Risk and benefits as well as other options
How is informed consent given?
Written, verbal, nonverbal
When should the practitioner get consent?
For the main treatment, for side effects of each treatment, when changing the treatment modality
What should you note when getting consent for a minor?
The person giving consent has the legal right to do so, the legal relationship between the person giving consent and the patient, the person for whom consent is being given.
What if the patient is a mature minor?
Make sure htey understand the nature and consequences of the treatment as well as the risks and benefits
What is reduced autonomy?
Minors or elders voluntarily give up autonomy, or perhaps during critical illness when they are mentally unable to do so
Under what circumstances will a patient have reduced autonomy?
Children under the age of 19, a legal guardian must give consent, voluntarily give up autonomy, critical illness
What is the infants act?
A mature minor may make decisions regarding their health as they can be autonomous. This decision is up to the practitioner
Based on rational thought and by the principle of autonomy, patients have the right to:
Choose the type of healthcare they receive, a second opinion, get information about the treatment, refuse treatment, and make foolish choices about their own health
When should consent be obtained?
Before treatment
From whom should consent be obtained?
Patient or legal guardian
Who is responsible for obtaining consent?
Practitioner
What should be disclosed to the patient during informed consent?
Side effects (mild and severe), physical and energetic side effects
What are some exceptions to consent?
Critical illness
What is the principle of beneficence?
Help those in need by doing no harm.
What is the principle of non-maleficence.
Doing no harm, meeting a set standard of practice.
How does beneficence differ from “best interests” standard?
The best interests standard assumes that there is a correct course of action that can be determined objectively. It disregards the patient’s values/beliefs/autonomy. (the doctor makes decisions by assuming the patient’s values and beliefs)
Adhering to the principle of beneficence, practitioners need to consider the following with regards to illness and treatment:
The patient’s pain, physical and emotional suffering, patient’s quality of life, patient’s expectations, possibility of disability or death, patient’s moral or religious values/beliefs
When is it better to just do nothing?
If they are too weak, if they haven’t been checked by a doctor, acute condition, if you think there will be no change, mental illness
Is it possible to do too much good?
Yes. Maybe you are too mothering of the patient has no chief complaint.
What is the hippocratic oath?
Do no harm
How can we do harm as acupuncturists?
Ignorance of dangerous acupoints, incompetence, aggressive treatment
What is justice?
The patient is being treated fairly and having their needs satisfied. Other people are not burdened by the treatment chosen. Patients should not be denied treatment based on stereotypes, they have the right to access goods and services. Acceptable use of patient factors such as a ge and gender and occupation to assist in TCM diagnosis.
What are the three areas of medical professionalism?
Knowledge, attitude, virtues
What does knowledge mean in professional conduct?
being licensed, continuing education, passing board exams, regulations and duties, self study, standard of practice from the CTCMA
What does attitude mean in professional conduct?
Interaction with patients, safety, respect for patients and colleagues, creating a safe environment, being mindful and polite
What does virtues mean in professional conduct?
How honest you are with patients, compassion, practitioner’s morals, trustworthiness and responsibility, compassion
What does professional competence fall under?
Knowledge
Where does honesty with patients fall under?
Virtue
Where does patient confidentiality fall under?
Virtue
Where does setting boundaries with patients fall under?
Attitude
Where does improving quality of care fall under?
Knowledge
Where does improving access to care fall under?
Attitude
Where does distribution of resources fall under?
Virtue
Where does scientific knowledge fall under?
Knowledge
Where does maintaining trust by managing conflicts of interest fall under? (2)
Attitude and virtue
Where does professional responsibilities fall under? (3)
Attitude, virtue, knowledge
What kind of boundaries does a practitioner need to set with the patients?
- Practitioner should limit sharing of personal information
- Friendships and relationships
- Times available to patient
- Not disclosing info about other patients
- Ask only relevant questions to condition (privacy trust)
- Practitioner should not take advantage of patient
- Practitioner feels unsafe - might not want to treat someone
What does setting boundaries between a practitioner and patient do?
An important part of the relationship and is the key to avoid conflicts of interest
What kind of dynamics are important in a therapeutic relationship?
Power: there should be a balance of power
Trust: having the patient’s best interests at heart
Respect: respecting each patient
Personal choices: the patient is vulnerable, degrees of undress, sensitive areas or topics
What are some ways to establish boundaries?
- Setting clear expectations about treatments, communications and proper behavior
- Addressing the patient by name
- Active listening in a non-judgemental way
- Obtaining informed consent
- Using a patient centered approach to care
- Refraining from verbal or non-verbal language that may be interpreted as sarcasm, intimidation, teasing, or impatience
- Adhering to privacy regulations
- Reflecting on your own patient interactions
How are boundaries broken?
Crossings, Violations, Gifts, Sexual impropriety
What are crossings?
Minor infractions, such as accepting tokens of appreciation or attending a social event hosted by a patient. There are grey areas where a boundary may have been crossed unintentionally
What are violations?
More serious by intent or the action, where the practitioner deliberately crosses a line. Violations undermine the therapeutic relationship.
What are gifts?
Gifts from patients may be inappropriate if too frequent/excessive; from practitioners to patients may require advice from professional/regulatory bodies if unusual
What is sexual impropriety?
Therapeutic relationships that lead to romantic encounters, sexual relations or abuse are prohibited.
What are some signs a boundary has been crossed?
- Being hesitant to discuss a particular event, feeling or activity with a colleague.
- Making excuses when questions are asked regarding your relationship with your patient.
- Worrying your actions may be misunderstood.
- Changing your behavior or the treatment.
- Maintain patient on treatment longer than necessary.
- Spend more time on the patient than necessary.
- Respond to personal overtures
- Sharing personal problems
- Dress differently for the patient
What are errors?
Any outcome or process one would have preferred not occured. In some instances there may have been no harm to the patient it may be upon reflection a practitioner thinks something better could have been done. Errors are divided into two categories separating minor incidents from those that cause harm.
What are adverse events?
Incidents caused by the therapy such as light-headedness from acupuncture or loose stools from herbal medicine (bruises, fainting)
What is negligence?
An event that causes harm, is preventable and would not have been made by a careful clinician in the same circumstances.
- A duty of care
- A breach of the standard of care
- An injury to the patient (pneumothorax, forgotten needle)
- The injury/harm is due to the breach
Why is transparency important?
Public expectations, legal requirements, philosophical and psychological reasons, plus patient trust and respect.
Why is disclosure important?
- It establishes a rapport with the patient by expressing sympathy and being direct about what happened
- Avoid defensiveness
- Do not blame others or yourself
- Don’t speculate, only talk about what you know
- Empathize with the patient’s feelings
- Apologize for the event and be accountable for your part in its occurrence, management and prevention
- Avoid language such as, I dropped the ball, i made a mess, it’s all my fault
What is professional misconduct?
Conduct that falls below a minimum standard for safe and ethical practice. Engaging in professional misconduct may lead to disciplinary proceedings which may have serious consequences.
What are the different areas of professional misconduct?
Incompetence
Sexual Misconduct
Illegal actions
Incapacity
What is illegal conduct?
- Allowing a non registered person to practice in your clinic
- Submitting claims to MSP for treatments provided to family members
What is Incapacity?
A health condition that prevents a practitioner from practicing safely, mostly related addictions or mental illness that may impair professional judgement
What is professional reporting?
Health professionals are expected to disclose information about the risks that healthcare workers may pose to the public, although health professionals are not required to report their health status or their patients. In some jurisdictions health professionals are required to inform their regulatory body if they carry serious transmissible diseases such as HIV
What is competence?
An assessment of functional capacity
What are the five tests of competency?
- Expressing a choice
- Expressing a reasonable choice
- Expression a choice on rational reasons
- Showing an ability to understand the information necessary to make a decision
- Showing an ability to appreciate one’s situation and its consequence
What are the two aspects of competency?
The ability of the patient to understand the information relevant to making a decision, and the ability to appreciate the consequences of the decision
What must one understand in order to be competent?
One’s condition, the nature of the proposed treatment, alternatives to the treatment, the consequences of either accepting or rejecting the treatment, the risks and benefits of the various problems (WHAT THE PRACTITIONER NEEDS THE MATURE MINOR TO KNOW)
To demonstrate the appreciation needed for decision making, one must:
Acknowledge the condition, be able to assess the affect o the various treatments, be able to reach a decision and stick to it, make a choice not based on a delusional belief
What are some things to look for to see if a patient is competent or not?
Confused/irrational thinking, inability to retain information, fluctuating alertness, extreme suffering, influence of alcohol or drugs
What must you not stereotypically think of as incompetent characteristics?
Advanced or very young age, poor education, physical disability, different cultural/religious backgrounds, unusual/eccentric beliefs, psychiatric illness, refusal of treatment
What are some instances where reporting is mandatory according to the Health Protection Act?
Sexual misconduct
Danger to the public
Hospitalized registrants
Duty to warn
?What does danger to the public mean
A health care provider may constitute as a danger to the public
What does hospitalized registrants mean?
A health professional is hospitalized for psychiatric care or addiction, the doctor must report it to the CTCMA
What does duty to warn mean?
Where a practitioner believes another health care provider is going to cause death or bodily harm to another person
What is duty of candour
Requires the practitioners to be open and honest with patients when something goes wrong or there is a problem with their assessment, treatment, or has the potential to cause harm
What is the practice standards for communicable disease?
The practitioner must follow the established principles to protect patients from communicable diseases
