Medical Ethics

Question 1

Steps in Ethical decision-making

Answer 1

Phase 1- Info gathering

Question 2

Phase 2

Answer 2

decision making

Question 3

Most common ethical violations?

Answer 3

Confidentiality
exceeding professional competence
Negligence
Expertise when not posses
Imposing values
Creating dependency in patient
Sexual activity with patient
Conflicts of interest
Finances
Improper advertising

Question 4

What is Boundary issue?

Answer 4

Potential to cause a problem, but it is not inevitable

Question 5

Boundary violation

Answer 5

boundary crossing, exploitative

Question 6

Examples of Dual relationships?

Answer 6

Gift giving
Business relationship
Social (Don’t treat friends and family members, can’t date or marry a patient)
Financial

Question 7

sexual attraction?

Answer 7

Unethical

Transferential reaction remains after therapy

Question 8

ways to handle attration

Answer 8

Regularly introspect

Develop Cognitive script

Question 9

Cognitive process of perpetrators?

Answer 9

They realize that their actions are harmful, they do it again anyway.
Rationalization
Minimization
Denial

Question 10

Confidentiality Issues

Answer 10

Privileged communication
Minors
Parental notification
Clear/ Imminent danger to others
Child abuse
Dual relationships
Informed consent for services

Question 11

What about CONFIDENTIALITY?

Answer 11

• Patient decides disclosure (or NOT)
• Signs away right for insurance purposes
• Physicians responsible for letting patient know RISK and BENEFITS of releasing information
• Global releases DO NOT imply informed consent
• Informing Family member/ Friend VIOLATES ethical principle

Question 12

What are exceptions to CONFIDENTIALITY?

Answer 12

• Child/Elder abuse ->Mandatory reporting Law
• Risk of Suicide/ Homicide (duty to protect, Tarasoff rule
• Reporting Infectious Diseases
• Subpoena from court
• If SUED by patient

Question 13

What about Confidentiality if posing threat to SELF/Others?

Answer 13

• Credibility
• Notify -> Law enforcement, Social services, Warn victim (Tarasoff)
• Differs by State

Question 14

Medical decision-making

Informed consent/ Refusal?

Answer 14

-Patient must be informed of Nature of intervention and purpose, benefits, risks, alternative to proposed interventions…including…No ACTIONS
FREE of Coarcion

Question 15

What is medical decision-making capacity?

Answer 15

Patient should have the ability to:

• understand info about diagnostic tests, Tx, consequences of no Tx
• Appreciate their situation
• Use Reason to make desicions
• COMMUNICATE their choice

Question 16

What is ACE?

Answer 16

Effective tool to use: Determining medical decision-making capacity

Question 17

Purpose of ACE?

Answer 17

Able to UNDERSTAND:

• Medical problem
• Proposed Tx
• Alternative of Tx
• Option of Refusing Tx (withholding/ withdrawing)
• Appreciate consequences of accepting/ refusing Tx
• Decision affected by Depression?
• Decision affected by Delusions/ Psychosis?

Question 18

What are patient’s abilities to be ASSESSED in Eval of Medical decision-Making capacity?

Answer 18

• understanding of her condition
• Options for her situation
• Benefits and odds that Tx work for you?
• Risks of Tx? and odds of side effects/ bad outcome
• Understanding of what will happen in nothing is done?

Question 19

Questions about ability to understand Tx and proposed options for care

Answer 19

• What you really believe about your medical condition?
• Why do you think that Dr has recommended this Tx?
• Do you think it is the best Tx? Why/Why not?
• What do you think if you accept Tx/ If not?

Question 20

More questions about ACE

Answer 20

• Important factors in deciding about Tx
• Plus and minus of Tx?
• Do you trust your Dr?
• What do you think will happen to you now?
• Have you decided what is best medical option for you?
• Out of several choices. What do you want to do?

Question 21

What is Life Sustaining Treatment?

Answer 21

• Medical procedure that:

Prolong process of Dying/ Sustain condition of Unconsciousness

Question 22

What about patient who is receiving Life-sustaining Treatment?

Answer 22

She will die soon, whether or not treatment is administered

Question 23

Are physicians legally required to provide all life-sustaining measures possible?

Answer 23

NO.
Patients have right to REFUSE medical Tx
life-sustaining Tx: Mech ventilation, artificial hydration/ nutrition

Question 24

Is withdrawal/ withholding of Tx equivalent to Euthanasia?

Answer 24

NO.
Allows disease to progress natural course
Not a decision to seek death and end life

Question 25

What about Euthanasia?

Answer 25

Actively seeks end patient’s life

Question 26

Are you killing the patient when removing ventilator and TREAT pain?

Answer 26

NO.

• intent is to secure comfort, not death
• Meds-> for symptoms
• Meds-> with not intention to cause death

Question 27

Are ventilator withdrawal and pain Tx= Euthanasia?

Answer 27

NO

Question 28

Can the Tx of symptoms constitute Euthanasia?

Answer 28

NO

Opioids use is not Euthanasia

Question 29

Is it illegal to prescribe large doses of opioids to relieve pain, breathlessness or other symptoms?

Answer 29

NO.

• Even very large doses
• Intent and doses are tirtrated to Pt’s needs

Question 30

What is Euthanasia?

Answer 30

Killing on Request.

Dr intentionally killing a person (Adm of Drugs-> at that person’s voluntary and competent request.

Question 31

Active Euthanasia?

Answer 31

Illegal in USA

Question 32

Physician-assisted suicide?

Answer 32

Dr intentionally helping person to commit suicide (providing drugs for self-adm) at that person’s voluntary/ competent request

Question 33

What is Palliative care?

Answer 33

Tx and relief of mental/physical pain. In Pts with terminal illness

Question 34

Palliative care/ Hospice

Answer 34

They provide comfort

Question 35

Palliative care?

Answer 35

Begin at diagnosis/ same time as treatment

Question 36

Hospice?

Answer 36

• Begins after treatment of disease is stopped

- Clear that patient not survive illness