Medical Ethics Limits and Boudnaries

Question 1

What are the 5 main values for this profession?

Answer 1

1. first, do no harm (non-maleficence)
2. Respect the patient (autonomy)
3. Benefit the patient (beneficence)
4. Use scarce resources wisely (justice)
5. Be honest

Question 2

What are the thre emodels that reflect the locus of power in decision?

Answer 2

1. paternalistic
2. Informative (autonomy)
3. Deliberative (negotiated/balanced)

Question 3

When can you decline to treat someone? Which ones are not necessarily legal or ethical?

Answer 3

1. when it’s outside of your scope of practice
2. when it’s beyond your clinical skills
3. when there’s a concern for exposure to infection (legal, but ethical?)
4. Torture/Execution
5. Referral
6. Reproductive health

Question 4

Under most situations, refusing to refer a patient for treatment is illegal and unethical. What’s the exception?

Answer 4

reproductive health issues

Question 5

What is a conscience clause?

Answer 5

it legally permits professionals to NOT provide certain medical services, based on MD’s personal beliefs

in regards to birth control, abortion, stem cell trx

Question 6

What’s the difference between proxy/surrogate and guardian/conservator? Which trumps which?

Answer 6

proxy is personallyl designated by the patient

guardian is court appointed and will trupmp a proxy

Question 7

What is substituted judgement?

Answer 7

when a proxy makes a decision based on what they think the patient’s preference would be

Question 8

What sources of info can you use to make a substituted judgement?

Answer 8

written documents like living wills, advanced directives,
discussions with th eperson
life story/life style

Question 9

If you don’t have any information to use in substitute djudgement, what should a proxy base the decision on?

Answer 9

best interests - based on pain and suffering, funcitonality and prognosis

Question 10

FOr the case with the guy who killed a police officer, what law forces you to give care and to what extent?

Answer 10

EMTALA

you have to treat them in the ER (implied consent) and must stabilize them

Question 11

Does EMTALA apply to children?

Answer 11

yes - in most cases they say you need a parent’s permission to go ahead, but if it’s dire and you can’t find a family member for decision making, you can go ahead

Question 12

What does the Good Samaritan protect you for?

Answer 12

you are protected as long as you are only doing things you were trained to do

but you can be exposed if you cause harm or just walk away? I’m confused.

Question 13

Where is the Death with Dignity act legal?

Answer 13

oregon
washington
montana
vermont
new mexico
failed barely in colorado

Question 14

What are the ethical issues surrounding the death with dignity act?

Answer 14

autonomy for the patient

beneficence/non-maleficence on our side

Question 15

Is this euthanasia?

Answer 15

no - it gets to the self administration of the med

Question 16

What is the issue with intent or double effect?

Answer 16

if there is a patient who is pregnant and has breast cancer, the intent is the chemo to cure the cancer. the double effect is that the chemo harms the fetus

Question 17

Are you obliged to provide any care the patient requests?

Answer 17

no - we are not obligued to provide care that we judge to be non-beneficial - this limits patient’s autonomy (can refuse, but not demand care)

Question 18

Can we forego medical interventions as physicians?

Answer 18

yes

we can say no CPR, we can say no feeding tube, we can say no vent or dialysis - it doesn’t have to be considered futile

but you need to have a trusted patient/doctor relationship

Question 19

What are some ways to resolve ethics boundary issues

Answer 19

consultants/ethics committees
court decisions
landmark cases

Question 20

What are the exceptions to confidentiality laws?

Answer 20

1. public health reporting for ID
2. Tarasoff
3. Impaired professionals
4. Emancipated minors
5. Patient’s/others at risk

Question 21

What are the public health reporting requirements?

Answer 21

1. infectious conditions
2. firearm injuries
3. elevated blood lead
4. cancer registries
5. birth defects

Question 22

What are the mandated reporting situations regarding patients/others at risk?

Answer 22

1. tarasoff
2. child and culnerable adult abuse
3. domestic abuse (depending on state)
4. impaired patients like unsafe drivers and public safety
5. infectious conditions
6. genetic conditions

Question 23

What are the considerations in regards to reporting impaired professionals?

Answer 23

1. illness - mental illness, dementia, MS (etc). goes to the board of heatlh
2. drugs and alcohol
3. chronic infectious conditions

Question 24

What program works with impaired professionals to help them keep working?

Answer 24

the Health Professionals Services Program

Question 25

What are some situations that will emancipate or overrule the law to notify parents?

Answer 25

1. specific care isuses like birth control and STIs, also mental health concerns and drug or alcohol abuse
2. legally married
3. consenting as a parent (if over 15)
4. military emancipates them
5. court ordered emancipation