Midterm Review Flashcards
1
Q
Micro ethics
A
individual’s right of right and wrong
2
Q
Macro ethics
A
global view of right and wrong
3
Q
Philosophical ethics
A
inquiry about ways of life and rules of conduct
4
Q
Religious ethics
A
general pattern or way of life
5
Q
Set of rules or “moral conduct”
A
professional codes for ethical behavior
6
Q
Morality
A
describes a class of rules held by society to govern the conduct of its individual members
7
Q
Morals
A
ideas about what is right or wrong
8
Q
code of conduct
A
generally prescribes standards of conduct, states principles of expressing responsibilities, and defines the rules expressing duties of professionals to whom they apply
9
Q
Code of ethics provide for
A
standards, principles, and rules of expected conduct
10
Q
Standards
A
Guides to human conduct
11
Q
Principles
A
describes responsibilities
12
Q
rules of expected conduct
A
no allowance for individual judgement
13
Q
moral judgements
A
judgement concerned with what an individual or group believes to be right or proper behavior in a given situation
14
Q
moral judgements involve:
A
assessment of another person’s moral character
15
Q
Morality legislated
A
-law has explicit rules, penalties
-laws are created to set boundaries for societal behavior
-laws are enforced to ensure that expected behavior happens
16
Q
Moral dilemmas
A
arise when values, rights, duties, and loyalties conflict
17
Q
Caregiver must not only examine what he or she considers the right thing to do, but…
A
-what are the alternatives
-what are the patient’s knwn wishes
18
Q
Ethical theories
A
attempt to introduce order into the way people think about life and action
19
Q
Meta-ethics
A
the study of the origin and meaning of ethical concepts
20
Q
Metaethics seeks to understaand
A
ethical terms and theories and their application
21
Q
Normative ethics
A
is prescriptive in that it attempts to determine what moral standards should be followed so that human behavior and conduct may be morally right
-euthanasia and abortion
22
Q
Descriptive ethics
A
also known as comparative ethics, is the study of what people believe to be right and wrong and why they believe it
23
Q
Applied ethics
A
The philosophical search (within western philosophy) for right and wrong within controversial scenarios
24
Q
Consequential ethics
A
rightness or wrongness of an action is based on the consequences or effects oof the action
25
Deontology ethics
if often referred to as duty-based ethics. It involves ethical analysis according to a moral code of rules, religious or secular. Deon is derived from the greek word meaning "duty"
26
The non-consequential ethical theory
denies that the consequences of an action are the only criteria for determining the morality of an action
27
ethical relativism
Actions can be considered right or wrong depending on the accepted norms of the society in which they are practiced
28
Example of ethical relativism
slavery may be considered an acceptable practice in one society & unacceptable in another
29
Autonomy
right to make one's own decisions
30
Beneficence
-principle of doing good
-demonstrating kindness
-showing compassion
-helping others
31
Paaternaalism
making decisions for others
32
A case of Paternalism
the family physician does not fully inform Mr. Smith as to the seriousness of his illness and how the consequences of the various alternative treatments might affect his life style
33
Nonmaleficence
-avoid causing harm
-not concerned with improving others'
-well-being but with avoidling the infliction of harm
34
Virtue ethics
focuses on the inherent character of a person rather than on the specific actions he or she performs
35
Intrinsic value
something that has value in and of itself
36
Instrumental value
something that helps to give value to something else
37
Compassion
sympathy for another's suffering
38
Conscientiousness
one who has moral integrity and a strict regard for doing what is considered the right thing to do
39
Discernment
ability to make a good decision without personal biases
40
Fairness
ability to make judgements free from discrimination
41
Fidelity
being true to out commitments and obligations to others
42
Partial reasoning
involves bias for or against a person based one's relationship with that person
43
Deontology ethics
is often referred to as duty-based ethics. It involves ethical analysis according to a moral code of rules, religious or secular.
-Deon is derived from the greek word meaning "duty"
44
Right to self-determination
every person has a right to determine what to do with his/her own body
45
2 million people die in the US every year
80% in hospital or LTC; 70% of those decide to forego life-sustaining treatment
46
Euthanasia
mercy killing of hopelessly ill, injured, or incapacitated (legal in Belgium for adults since 2002)
47
Active euthanasia
intentional commission of an act that results in death (lethal dose of meds)
48
Passive euthanasia
lifesaving treatment is withdrawn or withheld, allowing person to die natural death (removing respirator); treatment recognized as futile
49
Involuntary euthanasia
decision to terminate life of an incurable person made by someone else
50
Value questions face courts involuntary euthanasia
-who should decide withhold or withdraw treatment?
-factors on which decision should be based?
-criminal sanctions be imposed on a person assisting in ending life?
-when does death occur?
51
physician-assisted with death
dr. kevorkian
52
oregon, washington, and vermont...
legalized assisted death
53
oregon's death with dignity act (1994)
"death with dignity act" allowed terminally ill patients to end their life
54
Consideration of the courts for the death with dignity
1 - level of function and ability to improve
2 - statements made regarding their wishes when they were competent
3 - the extent known of the pt's values and beliefs toward medicine, sickness and death
4 - degree of physical pain caused by tx or termination of tx
5 - loss of dependence/humility caused by tx
6 - life expectancy, possibility of recovery
7 - impact of family
55
court can appoint a guardian if...
-family members disagree to incompetent persons wishes
-pts wishes cannot be known because he/she has always been incompetent
-doctors disagree on prognosis
-evidence exists of wrongful motives or malpractice
-no family member can serve as guardian
56
In re Storar
every human being of adult years and sound mind has the right to determine what shall be done with his or her own body
57
In re Quinlan
-constitutiional right to privacy protects pt's right to self-determination
-a state's interest does not justify interference with one's right to refuse treatment
58
In re Dinnerstein
"no code" orders are valid to prevent the use of artificial resuscitative measures on incompetent terminally ill patients
59
In re Spring
Pt's mental impairment & his/her medical prognosis with or without treatment must be considered prior to seeking judicial approval to withdraw or withhold treatment from an incompetent pt
60
Court involvement when
-family members disagree as to incompetent's wishes
-physicians disagree on the prognosis
-a pts wishes are unknown because he or she always haas been incompetent
-evidence exists of wrongful motives or maalpractice
61
Defining death
American Medical Association in 1974: when there is "irreversible cessation of all brain functions including the brain stem."
62
Who is equipped to pursue issues of assisted suicide
legislative & executive branches of government are equipped to pursue these issues
63
Physician-assisted suicide
is an action in which a physician voluntarily aids a pt in bringing about his or her death
64
US Supreme Court, in two unanimous & separate decisions, ruled:
1. laws prohibiting assisted suicide are constitutional
2. laws allowing doctors to assist in suicide of their terminally ill pt's is constitutional
65
NM judge ruled that terminally ill, mentally competent pt's have the right to get a doc to end their lives. The ruling by judge Nan Nash of the NM Second Judicial District would make NM the 5th state to allow doc's to prescribe fatal prescriptions to terminal pts.
Steve Siebold, Huffington Post, March 14, 2014
66
Quill v. Vacco
The supreme court found that neither the assisted suicide ban nor the law permitting pts to refuse medical tx treats anyone differently from anyone else or draws any distinctions between persons
67
Pt Self-Determination Act of 1990
-Pt's have right to formulate advance directives
-HC providers receiving federal funds under Medicare need to comply with regulations
68
Advance Directives
-pts have a right to make decisions about their HC
-with their physicians may agree to a proposed tx choose among offered tx, or say no to a tx
69
Durable Power of Attorney for Health Care
An agent makes health & personal care decisions for the pt in event the pt becomes unable to make his or her own decisions
70
Surrogate Decisioon Making
An agent who acts on behalf of a pt who lacks capacity to participate in a particular decision
71
Substituted Judgement
Form of surrogate decision-making where the surrogate attempts to establish what decision the pt would have made if that pt were competent to do so
72
Guardianship
Legal mechanism by which court declares a person incompetent and appoints a guardian
73
Health Care Proxy
A document that allows a person to appoint health care agent to make treatment decisions in event he/she becomes incompetent and is unable to make decisions for him/herself
74
Futility of Tx
-physician recognizes that effect of tx will be of no benefit to the pt
-morally, the physician has a duty to inform the pt when there is little likelihood of success
-the determination as to futility of medical care is scientific decision
75
Withholding of tx
is a decision not to initiate tx or medical intervention for the pt. This is a decision often made when death is imminent and no hope of recovery
76
Withdrawal of tx
is a decision to discontinue tx or medical interventions for the pt. When death is imminent and cannot be prevented by available tx
77
When to withhold or withdraw tx
-pt is in a terminal condition
-reasonable expectation of imminent death
-pt is a non-cognitive state with no reasonable possibility of regaining cognitive function
-restoration of cardiac function will last but for a brief period
78
27 y/o Terry suffered a cardiac arrest in 90' & never regained consciousness, lived in nursing homes, & fed & hydrated by tubes. In 98', Micheal petitioned the court for guardianship to authorize termination of life-prolonging procedures. Terry's parents, opposed the petition
-Micheal contended his wife never wanted to be kept alive artificially
-Terry's parents told justices that their son-in-law is trying to rush her death so he can inherit her estate
-be free to marry another woman
79
Development of Law
tradition, culture, customs, beliefs
80
Why laws change
political climate, social change, religious beliefs, values change
81
Categories of law
private law and public law
82
Public law
relationships between individuals and government
83
Private Law
relationships between individuals
84
Sources of law
common law, statutory law, administrative law
85
Common-law principles
precedent, res judicata, stare decisis
86
Bill of Rights
-Amendments to the US constitution were added to protect rights of citizens: freedom of rights, right to keep and bear arms, freedom of speech
87
Administrative law
Public law is issued by administrative agencies to direct enacted laws
88
Government organization legislative branch
enacts laws, amends or repeals existing legislation, creates new legislation
89
Government organization judicial braanch
resolves legal disputes, supreme court, nation's highest court, 8 associate justices & 1 chief justice
90
Tort law
a tort is a wrong, other than a breach of contract, committed against a person or property for which a court provides a remedy, generally in the form of monetaray damages
91
Negligence
Commission or omission of an act that a reasonably prudent person would or would not do under given circumstances
92
Commission of an Act
-administering wrong medication, wrong dose of meds, medication to wrong pt
-performing procedure on wrong pt
-removing wrong body part
-failing to assess a pt's nutritional needs
93
Malpractice
negligence of a professional person
94
Examples of malpractice
-surgeon whoo conducts surgery on the wrong body part, nurse who administers wrong meds injuring pts, pharmacist who mislabels a med and the pt is harmed
95
Forms of negligence
malfeasance, misfeasance, nonfeasance
96
Malfeaseance
execution of an unlawful or improper act
97
Examples of malfeasance
-performing a partial birth abortion when prohibited by law
-performing aa procedure without having the appropriate credentials
98
Misfeasance
improper performance of an act
99
Examples of misfeasance
-wrong sided surgery
-leaving an instrument in pt's body
100
Nonfeasance
Failure to act when there is a duty to act
101
Examples of nonfeasance
-failure to prescribe antibiotics when indicated
-failure to respond to emergency call
102
Standard of Care
Actual performance of an individual in a given situation will be measured against what a reasonably prudent person would or would not have done
103
A nurse was hired sight unseen over telephone an applicant who falsely stated in his application that he was a licensed LPN. In reality, he was not an LPN and he committed 56 criminal offenses of theft and assaulted a resident. Verdict?
nursing center failed in its :duty to care" by not validating the nurse's license
104
Four elements of negligence
-duty to care, breach of duty, injury/actual damages, causation
105
breach of duty
failure to perform an adequate history and physical in the ED, such as, failure to properly diagnose a pt at risk for Ebola and discharging the pt back into the community
106
Injury/actual damages
-actual damages must be established
-without injury daaages cannot be awarded
107
Causation
must be a reasonable, close, and casual connection between the defendant's negligent conduct and resulting damages suffered
108
Intentional Torts
assault and battery, false imprisonment, defamation of character, invasion of privacy, infliction of mental distress
109
Assault
deliberate threat, coupled with apparent ability to do physical harm to another. Actual contact not necessary
110
Battery
intentional touching of another's person in socially impermissible manner without person's consent
111
Defamation of character
involves communication to someone other than the person defamed that tends to hold that person's reputation up to scorn and ridicule
-slander
112
Infliction of mental distress
conduct that is so outrageous that it goes beyond bounds tolerated by decent society
113
Crime
any social harm defined and made punishable by law
114
Purpose of criminal law
-maintain public order and safety
-protect the individual
-use punishment as a deterrent to crime
-rehabilitate the criminal for return to society
115
Misdemeanor
an offense punishable by less than one year in jail and or a fine
116
Felony
is a much more serious crime and is generally punishable by imprisonment in a state or federal penitentiary for more than one year
117
Fraud: billing scam
a pharmacist dispensed the generic equivalent of a drug and billed for the higher cost brand name
118
Fraud: self-referrals
Dr. L ordered unnecessary highly expensive esoteric lab tests for his pts. Dr. L referred his pts to a private lab, in which he owned 30%
119
Contract
a special kind of agreement, either written or oral, that involves legally binding obligations between two or more parties
120
Kinds of Contracts
employment, exclusive, commercial ethics and non competitions
121
Trial procedure: discovery
process of investigating the facts of a case before trial
122
Trial procedure: preparation of witnesses
the manner in which a witness handles questioning at a deposition or trial is often as important as the facts of the caase
123
the jury determines
question of fact
124
the court determines questions
of law
125
Subpoena
a legal order requiring the appearance of a person and or the presentation of document to a court or administrative body
126
Subpoena ad testificandum
orders the appearance of a person at a trial or other investigative proceeding too give testimony
127
Subpoena duces tecum
a written command to bring records, documents, or other evidence described in the subpoena to aa trial or other investigative proceeding
128
Trial Procedure: Burden of Proof
the plaintiff is required to show that the defendant violated a legal duty
129
Trial procedure: kinds of evidence
direct evidence, demonstrative evidence, documentary evidence, examination of witnesses, expert witnesses
130
Defense of One's Actions
assumption of aa risk, cmparative negligence, contributory negligence, good samaritan laws
131
trial procedure
1. closing statements
2. judge's charge to the jury
3. jury deliberation
4. damages
5. appeals
132
Executive Branch: US Office of Government Ethics
_OGE exercises leadership in executive branch to prevent conflicts of interest
-resolves those conflicts of interest
-fosters high ethical standards for employees
-strengthens public confidence in government business
133
House. ofRep: Committee on Ethics
-Designated to "supervising ethic office" for the House of Reps
-Only standing committee of the House of Reps with its membership divided evenly by party
134
HR: Common Ethical Issues
gifts between employees, conflicting financial interests, remedies for financial conflicts of interest, misuse of position
135
Senate: select committee on ethics
Authorized to receive and investigate
136
US Judicial code of conduct
provides guidance for judges on issues
137
A Principle of Law
principle of law which holds no one can lawfully do that which tends to be injurious to public
138
Sources of public policy
legislation
-admin rules, regulations or decisions,
-judicial decisions
-professional code of ethics may contain an expression of public policy
139
XIV Amendment: US Constitution
citizenship rights and equal prootection of the laws and was proposed in response to issues related to former slaves following the American Civil War
140
Title VI: Civil Rights Act of 1964
prohibits discrimination on the basis of race, color, or national origin in any program or activity that receives Federal funds or other federal financial assistance
141
Sherman Antitrust Act
was the first federal act that outlawed monopolistic buisness practices
142
Privacy Act of 1974
establishes a code of fair information that governs the collection, maintenance, use, and dissemination of information about individuals that is maintained in systems of records by federal agencies
143
HIPAA of 1996
the privacy rule protects all "individually identifiable health information" held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral
144
Emergency medical treatment and active labor act of 1986
is a federal law that requires anyone coming to an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay, but since its enactment in 1986 has remained an unfunded mandate
145
Health Care Quality Improvement Act
a federal law that was enacted to create aa national tracking system of physicians with a history of medical malpractice payments or adverse actions. This system is known as the National Practitioner Data Bank
146
Agency for HC Research and Quality
a US government agency that functions as apart of the Department of Health and Human Services to support research to help improve the quality of HC
147
Ethics in Patient Referral Act of 1989
a federal law, the Stark law, enacted in 1989, that prohibits referrals by a physician to a clinical lab in which the physician has a financial interest
148
Pt Self-Determination Act of 1990
is a federal law, and compliance is mandatory. It's the purpose of this act to ensure that a pt's right to self-determination in HC decisions be communicated and protected
149
Sarbances-Oxley Act of 2002
The SOX Act mandated strict reforms to improve financial disclosures from corporation and prevent accounting fraud
150
Corporate Authority
-described under the laws in which a corporation is chartered
-described in a corporation's articles of incorporation
151
Kinds of authority
-express corporate authority
-implied corporate authority
-ultra vires acts
152
Ultra Vires Act
acting beyond its scope fo authority
153
Implied corporate authority
corporate powers not specifically granted in articles of incorporation
154
express corporate authority
delegated by statute
155
organizational ethics codes
provide guidelines for behavior that help carry out an organization's mission, vision, and values
-help to build trust
-increase awareness of ethical issues, guide decision-making
-encourage staff to seek advice and report misconduct when appropriate
156
Unprofessional conduct
trust and integrity lacking, false advertisements, concealing mistakes
157
Benchmark darling case
the court in this case enunciated a "corporate negligence doctrine" under which hospitals have a duty, for example, to provide adequately trained medical and nursing staff
158
Respondent Superior
a legal doctrine holding employers liable for wrongful acts of their employees
159
Independent contractor
responsible for his or her own negligent acts
160
Corporate duties and responsibility
appointment of CEOO; screen job applicants; credentialing, appts and privileging; discipline of physicians; provide adequate staff; provide adequate supplies & equipment; allocate scarce resources; comply with tules & regulations; comply with accreditation standards; provide tiimely tx
161
Prohibiting termination
disability, age, race, creed, color, religion, sex, national origin, pregnancy, filing of safety complaints with OSHA
162
Refuse to participate with care
-refusal to participate in elective abortion upheld
-refusal to paarticipate in therapeutic abortion insubordinaate
-pharmacist's refusal to fill prescriptions
163
Equal Pay Act
Prohibits discrimination in payment of wages for women and men performing substantially equal work in same establishment
164
Caregiver's right
the nurse in the operating suite refuses to parcipate in an elective abortion
165
Question pt care
public policy clearly mandates an obligation to serve the best interests of pts
166
Freedom from sexual harassment
employees have a right to be free from sexual harassment
167
Right to be free from intimidaation
those in power often abuse power through threats, abuse, intimidation, and retaliatory discharge
168
Express consent
a verbal or written agreement authorizing treatment
169
Implied consent
a presumption that consent has been authorized based on teh nature of the pt's condiiton
170
AMA Code of Medical Ethics
Pt has the right to receive info from physicians and to discuss the benefits, risks, and costs of appropriate treatment alternatives
171
ANA Code of ethics
pts have the moral and legal right to determine what will be done with their own person
172
Proof of consent
oral consent, written consent, implied: emergency consent
173
Statutory consent
-an emergency in most states eliminates the need for consent
-when a pt is clinically unable to give consent to a lifesaving emergency treatment, the law implies consent
174
Failure to inform
a pt underwent a mastectomy only to learn that a less destructive alternative procedure was available in a region near her home. The procedure, a lumpectomy, has the same survival rate as a mastectomy. the pt claims the surgeon never informed her as to the alternative
175
Who may authorize consent
competent pts, spouse, guardian, parents of minor
176
Incompetent pts
the mentally incompetent connot legally consent to treatment
177
Right to refuse tx
pts have a right to refuse tx and be secure from any touhcing
