Medical Ethics: Ethical Boundaries and Legal Limits -- Elliot

Question 1

Define Shared Decision Making.

Answer 1

Shared decision making describes the decision-making process and ideal outcome of informed patient choice. It refers to the robust communication process between patient and physician. The physician provides unbiased and complete information regarding all treatment options and information, plus his or her sense of the best way to proceed. For the patient, this process includes discussion of personal factors that might make one treatment alternative more preferable than others. This open, two-way exchange of information and opinions about options, risks, benefits, and values can lead to better understanding and better decisions about clinical management for patient-centered care.

Question 2

What are the 3 models that reflect locus of power in decision?

Answer 2

Paternalistic (beneficence/non-maleficence)
Informative (autonomy)
Shared Decision Making (negotiated/balanced)

Question 3

Legal and/or Ethical to decline to treat: Scope of Practice

Answer 3

Legal and Ethical

Question 4

Legal and/or Ethical to decline to treat: Clinical Skills

Answer 4

Legal and Ethical

Question 5

Legal and/or Ethical to decline to treat: Exposure to Infection

Answer 5

Legal, not Ethical

Question 6

Legal and/or Ethical to decline to treat: Torture/Execution

Answer 6

Not Ethical, but Legal?

Question 7

Legal and/or Ethical to decline to treat: Referral

Answer 7

Not Legal nor Ethical

Question 8

Legal and/or Ethical to decline to treat: Reproductive Health

Answer 8

Legal and Ethical

Question 9

What are conscience clauses?

Answer 9

For reproductive health, legally permits professionals to not provide certain medical services, but on doctor’s personal beliefs
Ex: birth control, abortion, stem cell research
Ex: refusing to provide information about or referrals for these services
Ex: extending end-of-life care

Question 10

Define Truth Telling.

Answer 10

Truth-telling is regarded as a virtue in the practice of medicine, and is regarded as integral to the exercise of patient autonomy. However, truth telling is also a nuanced and complex term in the practice of medicine. Informed consent is based on the physician-patient exchange of information that is valid and complete. However, many factors impact the ability and desire to reveal (complete) truth.

Question 11

Define Informed Consent.

Answer 11

A pre-eminent concept in medical ethics, grounded primarily in respect for patient autonomy. Informed consent requires that a patient or patient surrogate be provided with information regarding a proposed medical intervention, so that she may consent to, or decline, the intervention. There is some variance amongst authors in medical ethics regarding what constitutes “adequate” informed consent; a more rigorous view would include patient competence, patient voluntariness (no coercion), disclosure of
information by the health care professional (including the nature of the intervention, benefits/risks, alternatives, and uncertainties regarding intervention), assessment of patient understanding, and exploration of
patient’s preference.

Question 12

What is the difference between a Proxy/Surrogate and a Guardian/Conservator?

Answer 12

Guardian/Conservator is court appointed.

Question 13

Define Substituted Judgment.

Answer 13

Substituted Judgment is one of the standards used for making decisions on behalf of patients who lack capacity to make their own decisions. A surrogate decision-maker (see below) who uses the Substituted Judgment standard, makes decisions
based on what the patient would have wanted, were she be
able to speak for herself. The Substituted Judgment decision could be based on oral or written advance directives, knowledge of the patient’s values, preferences, goals, and beliefs, and so forth. When using Substituted judgment, the surrogate does not make decisions based on what the surrogate would want if she were in the patient’s situation, nor does the surrogate make decisions based on what the surrogate wanted the patient to decide. Rather, the patient’s wishes, as previously communicated to the surrogate, are to be substituted
for the surrogate’s wishes when making the decisions.

Question 14

Define Best Interests.

Answer 14

The Best Interests standard is one of the standards that may be used in making decisions for a patient when she cannot make decisions for herself. In using the Best Interests standard, the decision-maker chooses what is deemed to be best for the patient, and thus, in the patient’s ‘best interests.’ The Best Interests standard may be compared with the Substituted Judgment standard (see definition below), which is generally used (when possible) in American Bioethics

Question 15

Define EMTALA.

Answer 15

This acronym references the federal Emergency Medical
Treatment and Active Labor Act, which 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.

Question 16

Define Death with Dignity or Physician-Assisted Suicide.

Answer 16

When a physician actively and intentionally makes the means to commit suicide available to a patient who then follows through with the suicide. For example, writing prescriptions for a lethal drug or combination of drugs, giving explicit instructions
on how to take them so as to cause the death of the patient
would be considered physician-assisted suicide if the patient follows through and commits suicide. If certain conditions are met, some instances
of physician-assisted suicide are legal in Oregon, Washington, and Montana, but not in other states.

Question 17

Define Intent.

Answer 17

Many medical interventions create positive outcomes while also having the potential to do harm. The combination of these two circumstances is known as the “double effect” and the ethical interpretation of the outcome is based on the intent of the action.

Question 18

Define Futility.

Answer 18

In medicine, the judgment that some kinds of medical treatments will be non-beneficial in given circumstances. Certain medical interventions may be considered medically futile and therefore some invoke futility in arguing that the interventions should not be offered or given to patients.

Question 19

Define Goals of Care.

Answer 19

The goals of medical treatment reference the outcomes of care that are preferred by the patient and shared by the physician. It is important to discuss and agree on the goals.

Question 20

Define Disproportionate or Extra-Ordinary Care

Answer 20

Disproportionate care is any medical treatment that either offers no reasonable hope of benefit or is too burdensome
for the patient or others, considering the personal, financial, familial, social, and spiritual circumstances (the burdens or risks outweigh the expected benefits of the treatment).

Question 21

Define Conflicting/Competing Interests.

Answer 21

This term references tension that occurs when there are two concerns that demand the professional’s attention at the
same time. In many instances both concerns can be addressed without compromising either. For example, time devoted to patient care cannot be spent on continuing medical education, teaching, clinical research, personal hobbies, or family activities. These competing interests can usually all be accommodated with careful time management.

Question 22

Define Privacy.

Answer 22

This right guaranteed that there are particular aspects of life that are protected from intrusion
by government. With regard to medical practice, reproductive care decisions (including abortion) are acknowledged as private decisions, and thus protected from government intervention.

Question 23

Define Confidentiality.

Answer 23

In medical ethics, the right of patients to privacy and
control over their own medical records and information. In most cases health care professionals are obliged to respect patient confidentiality and to prevent public or inappropriate release of patient information. Exceptions to this include steps necessary to protect patients themselves (for example, in cases of child abuse), or third parties (for
example, infectious diseases, impaired drivers, or violence).

Question 24

Define Tarasoff Law.

Answer 24

Tarasoff references a 1970’s case from the Supreme Court
of California that established the ‘duty to protect’ or ‘duty to warn’
obligation of a (mental health) professional. It obliges a professional who hears a credible threat of harm to a specific individual to warn the intended victim and assure that the police and/or others who can protect the threatened individual are also informed.