Medical Ethics- Elliott Flashcards
What are the medical profession’s values?
- DO NO HARM
- Respect the patient
- Benefit the patient
- Use scarce resources wisely
- Be honest
may conflict with patient autonomy and values
Shared decision making
Negotiated & Balanced!
Describes the decision-making process and ideal outcome of informed patient choice.
- physician provides unbiased and compete information + opinion of best way to proceed
- two way exchange of information/opinions concerning risks, benefits, values.
**patient centered care
Non-malificance
First, do no harm
The duty to do no harm to patients
Autonomy
the “right” of adult patients of sound mind to participate in decisions regarding their medical care
-the duty to protect and foster a patient’s free, un-coerced choices
Beneficiance
The duty to promote good and act in the best interest of the patient and the health of society
Locus of power in decision
- docs have power (even students)
- docs have information
Justice
The equitable distribution of the life-enhancing opportunities afforded by health care
Doc-Patient Relationship
Special obligations for the physician to serve the patient’s interest because of
- specialized knowledge that physicians possess
- the confidential nature of the relationship
- the imbalance of power between the patient and provider.
Situations that you can decline to treat……
- scope of practice
- clinical skills
- exposure to infection (legal but not ethical)
- Torure/Execution
- NEED TO Refer (can’t go untreated)
- Reproductive health
Conscience clauses
Legally permits professionals to not provide certain medical services, based on MD’s personal beliefs
Examples: Birth control, abortion, stem cell tx.
(legally don’t need to refer, but ethically you should)
DO NOT ABANDON YOUR PATIENTS (duh)
Paternalism
A term describing professional behavior in which a health care professional makes decisions for a patient without allowing the patient to participate fully in medical decision-making
Proxy or surrogate
When a person is non-decisional, another person must make health care decisions for them.
The surrogate makes decisions using either substituted judgements of best interest standards
Guardian or Conservator
When a person is deemed incompetent to make decisions for them self, the court may assign another person to be her gardian
Substituted judgement
-makes decision based on what that person “would have done”
- based on patient preferences
- Written documents
- Discussion
- Life story, life-style
Best Interests
- used when patient wishes are unknown or never known
- based on what is best for patient
- Sources of guidance = pain and suffering, functionality, prognosis
EMTALA
= Emergency Medical Treatment and Active Labor Act
requires hospitals to examine and stabilize a patient who presents to an emergency room for attention to an emergency medical condition- without consideration of insurance coverage or ability to pay
Do we need informed consent to treat a child in the ER?
Not for emergency situations
Three states you can get in trouble for not helping as a doc?
MINNESOTA
Vermont
Lousianna
What states is PAS legal?
Oregon Washington Montana Vermont New Mexico California
What is death with dignity?
Self-administered medication
Requested more often than used
Autonomy, beneficence
**need to be hospice eligible, clear of mind
Why is PAS NOT euthanasia?
Because it is self-administered!
Why is PAS NOT suicide?
Death is eminent
Intent
The intent for the treatment
determines the ethical outcome when the double effect is in place
Double Effect
Combination of medical interventions creating positive outcomes while also having the potential to do harm
*ethical interpretation of the outcome is based on the intent of the action
Morphine example: pain relief vs. decreased respiration
Prescribing morphine to relieve pain even though it decreases respiration is an example of what?
the double effect
Futility
non-beneficial care
-professionals not obliged to proved care they judge to be non-beneficial
Limits patient autonomy
Patients cannot demand care
Disproportionate or extra-ordinary care
- is the intervention proportionate to the benefit?
- large risk/procedure/ cost for small benefit?
When can you forego medical interventions?
When an intervention is likely to offer little benefit to the patient
Where do we go to when family doesn’t agree?
- Courts/Committees (ethics)
- Courts
- Landmark Cases
Who can ask for an ethics review?
ANYONE!
Conflicting Interests
Two concerns focus the professional’s attention at the same time
Attending to one compromises the other
Both cannot be fulfilled
Competing Interests
Tension that occurs when two concerns demand the professional attention at the same time
Both concerns can be addressed with-out compromising the other
Both have claim and must happen
Professional Guidance on conflicting/competing interests?
AVOID conflicts, and when cannot….
DISCLOSE them!
Privacy
Right guaranteed by constitution allows protection from intrusion by government
Family decision, family planning, abortion
termination of life-sustaining treatment
Confidentiality
Government involved
The right of the patients to privacy and control over their own medical records and information
Docs must respect patient confidentiality and to prevent public or inappropriate release of patient information
Tarasoff
Case law
“duty to protect” or “duty to warn”
obligation of professional who hears credible threat of harm to specific individual to warn the intended victim and assure the police can protect them
