Medical Ethics Flashcards
Steps in Ethical decision-making
Phase 1- Info gathering
Phase 2
decision making
Most common ethical violations?
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
What is Boundary issue?
Potential to cause a problem, but it is not inevitable
Boundary violation
boundary crossing, exploitative
Examples of Dual relationships?
Gift giving
Business relationship
Social (Don’t treat friends and family members, can’t date or marry a patient)
Financial
sexual attraction?
Unethical
Transferential reaction remains after therapy
ways to handle attration
Regularly introspect
Develop Cognitive script
Cognitive process of perpetrators?
They realize that their actions are harmful, they do it again anyway.
Rationalization
Minimization
Denial
Confidentiality Issues
Privileged communication Minors Parental notification Clear/ Imminent danger to others Child abuse Dual relationships Informed consent for services
What about CONFIDENTIALITY?
- 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
What are exceptions to CONFIDENTIALITY?
- 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
What about Confidentiality if posing threat to SELF/Others?
- Credibility
- Notify -> Law enforcement, Social services, Warn victim (Tarasoff)
- Differs by State
Medical decision-making
Informed consent/ Refusal?
-Patient must be informed of Nature of intervention and purpose, benefits, risks, alternative to proposed interventions…including…No ACTIONS
FREE of Coarcion
What is medical decision-making capacity?
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
What is ACE?
Effective tool to use: Determining medical decision-making capacity
Purpose of ACE?
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?
What are patient’s abilities to be ASSESSED in Eval of Medical decision-Making capacity?
- 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?
Questions about ability to understand Tx and proposed options for care
- 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?
More questions about ACE
- 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?
What is Life Sustaining Treatment?
- Medical procedure that:
Prolong process of Dying/ Sustain condition of Unconsciousness
What about patient who is receiving Life-sustaining Treatment?
She will die soon, whether or not treatment is administered
Are physicians legally required to provide all life-sustaining measures possible?
NO.
Patients have right to REFUSE medical Tx
life-sustaining Tx: Mech ventilation, artificial hydration/ nutrition
Is withdrawal/ withholding of Tx equivalent to Euthanasia?
NO.
Allows disease to progress natural course
Not a decision to seek death and end life
What about Euthanasia?
Actively seeks end patient’s life
Are you killing the patient when removing ventilator and TREAT pain?
NO.
- intent is to secure comfort, not death
- Meds-> for symptoms
- Meds-> with not intention to cause death
Are ventilator withdrawal and pain Tx= Euthanasia?
NO
Can the Tx of symptoms constitute Euthanasia?
NO
Opioids use is not Euthanasia
Is it illegal to prescribe large doses of opioids to relieve pain, breathlessness or other symptoms?
NO.
- Even very large doses
- Intent and doses are tirtrated to Pt’s needs
What is Euthanasia?
Killing on Request.
Dr intentionally killing a person (Adm of Drugs-> at that person’s voluntary and competent request.
Active Euthanasia?
Illegal in USA
Physician-assisted suicide?
Dr intentionally helping person to commit suicide (providing drugs for self-adm) at that person’s voluntary/ competent request
What is Palliative care?
Tx and relief of mental/physical pain. In Pts with terminal illness
Palliative care/ Hospice
They provide comfort
Palliative care?
Begin at diagnosis/ same time as treatment
Hospice?
- Begins after treatment of disease is stopped
- Clear that patient not survive illness
