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Principles of HC - 350 > Midterm Review > Flashcards

Midterm Review Flashcards

1
Q

Micro ethics

A

individual’s right of right and wrong

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2
Q

Macro ethics

A

global view of right and wrong

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3
Q

Philosophical ethics

A

inquiry about ways of life and rules of conduct

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4
Q

Religious ethics

A

general pattern or way of life

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5
Q

Set of rules or “moral conduct”

A

professional codes for ethical behavior

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6
Q

Morality

A

describes a class of rules held by society to govern the conduct of its individual members

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7
Q

Morals

A

ideas about what is right or wrong

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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

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9
Q

Code of ethics provide for

A

standards, principles, and rules of expected conduct

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10
Q

Standards

A

Guides to human conduct

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11
Q

Principles

A

describes responsibilities

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12
Q

rules of expected conduct

A

no allowance for individual judgement

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13
Q

moral judgements

A

judgement concerned with what an individual or group believes to be right or proper behavior in a given situation

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14
Q

moral judgements involve:

A

assessment of another person’s moral character

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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

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16
Q

Moral dilemmas

A

arise when values, rights, duties, and loyalties conflict

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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

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18
Q

Ethical theories

A

attempt to introduce order into the way people think about life and action

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19
Q

Meta-ethics

A

the study of the origin and meaning of ethical concepts

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20
Q

Metaethics seeks to understaand

A

ethical terms and theories and their application

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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

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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

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23
Q

Applied ethics

A

The philosophical search (within western philosophy) for right and wrong within controversial scenarios

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24
Q

Consequential ethics

A

rightness or wrongness of an action is based on the consequences or effects oof the action

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25
Q

Deontology ethics

A

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”

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26
Q

The non-consequential ethical theory

A

denies that the consequences of an action are the only criteria for determining the morality of an action

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27
Q

ethical relativism

A

Actions can be considered right or wrong depending on the accepted norms of the society in which they are practiced

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28
Q

Example of ethical relativism

A

slavery may be considered an acceptable practice in one society & unacceptable in another

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29
Q

Autonomy

A

right to make one’s own decisions

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30
Q

Beneficence

A

-principle of doing good
-demonstrating kindness
-showing compassion
-helping others

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31
Q

Paaternaalism

A

making decisions for others

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32
Q

A case of Paternalism

A

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

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33
Q

Nonmaleficence

A

-avoid causing harm
-not concerned with improving others’
-well-being but with avoidling the infliction of harm

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34
Q

Virtue ethics

A

focuses on the inherent character of a person rather than on the specific actions he or she performs

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35
Q

Intrinsic value

A

something that has value in and of itself

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36
Q

Instrumental value

A

something that helps to give value to something else

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37
Q

Compassion

A

sympathy for another’s suffering

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38
Q

Conscientiousness

A

one who has moral integrity and a strict regard for doing what is considered the right thing to do

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39
Q

Discernment

A

ability to make a good decision without personal biases

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40
Q

Fairness

A

ability to make judgements free from discrimination

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41
Q

Fidelity

A

being true to out commitments and obligations to others

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42
Q

Partial reasoning

A

involves bias for or against a person based one’s relationship with that person

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43
Q

Deontology ethics

A

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”

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44
Q

Right to self-determination

A

every person has a right to determine what to do with his/her own body

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45
Q

2 million people die in the US every year

A

80% in hospital or LTC; 70% of those decide to forego life-sustaining treatment

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46
Q

Euthanasia

A

mercy killing of hopelessly ill, injured, or incapacitated (legal in Belgium for adults since 2002)

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47
Q

Active euthanasia

A

intentional commission of an act that results in death (lethal dose of meds)

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48
Q

Passive euthanasia

A

lifesaving treatment is withdrawn or withheld, allowing person to die natural death (removing respirator); treatment recognized as futile

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49
Q

Involuntary euthanasia

A

decision to terminate life of an incurable person made by someone else

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50
Q

Value questions face courts involuntary euthanasia

A

-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?

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51
Q

physician-assisted with death

A

dr. kevorkian

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52
Q

oregon, washington, and vermont…

A

legalized assisted death

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53
Q

oregon’s death with dignity act (1994)

A

“death with dignity act” allowed terminally ill patients to end their life

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54
Q

Consideration of the courts for the death with dignity

A

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

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55
Q

court can appoint a guardian if…

A

-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

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56
Q

In re Storar

A

every human being of adult years and sound mind has the right to determine what shall be done with his or her own body

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57
Q

In re Quinlan

A

-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

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58
Q

In re Dinnerstein

A

“no code” orders are valid to prevent the use of artificial resuscitative measures on incompetent terminally ill patients

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59
Q

In re Spring

A

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

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60
Q

Court involvement when

A

-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

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61
Q

Defining death

A

American Medical Association in 1974: when there is “irreversible cessation of all brain functions including the brain stem.”

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62
Q

Who is equipped to pursue issues of assisted suicide

A

legislative & executive branches of government are equipped to pursue these issues

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63
Q

Physician-assisted suicide

A

is an action in which a physician voluntarily aids a pt in bringing about his or her death

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64
Q

US Supreme Court, in two unanimous & separate decisions, ruled:

A
  1. laws prohibiting assisted suicide are constitutional
  2. laws allowing doctors to assist in suicide of their terminally ill pt’s is constitutional
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65
Q

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.

A

Steve Siebold, Huffington Post, March 14, 2014

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66
Q

Quill v. Vacco

A

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

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67
Q

Pt Self-Determination Act of 1990

A

-Pt’s have right to formulate advance directives
-HC providers receiving federal funds under Medicare need to comply with regulations

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68
Q

Advance Directives

A

-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

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69
Q

Durable Power of Attorney for Health Care

A

An agent makes health & personal care decisions for the pt in event the pt becomes unable to make his or her own decisions

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70
Q

Surrogate Decisioon Making

A

An agent who acts on behalf of a pt who lacks capacity to participate in a particular decision

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71
Q

Substituted Judgement

A

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
Q

Guardianship

A

Legal mechanism by which court declares a person incompetent and appoints a guardian

73
Q

Health Care Proxy

A

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
Q

Futility of Tx

A

-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
Q

Withholding of tx

A

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
Q

Withdrawal of tx

A

is a decision to discontinue tx or medical interventions for the pt. When death is imminent and cannot be prevented by available tx

77
Q

When to withhold or withdraw tx

A

-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
Q

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

A

-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
Q

Development of Law

A

tradition, culture, customs, beliefs

80
Q

Why laws change

A

political climate, social change, religious beliefs, values change

81
Q

Categories of law

A

private law and public law

82
Q

Public law

A

relationships between individuals and government

83
Q

Private Law

A

relationships between individuals

84
Q

Sources of law

A

common law, statutory law, administrative law

85
Q

Common-law principles

A

precedent, res judicata, stare decisis

86
Q

Bill of Rights

A

-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
Q

Administrative law

A

Public law is issued by administrative agencies to direct enacted laws

88
Q

Government organization legislative branch

A

enacts laws, amends or repeals existing legislation, creates new legislation

89
Q

Government organization judicial braanch

A

resolves legal disputes, supreme court, nation’s highest court, 8 associate justices & 1 chief justice

90
Q

Tort law

A

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
Q

Negligence

A

Commission or omission of an act that a reasonably prudent person would or would not do under given circumstances

92
Q

Commission of an Act

A

-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
Q

Malpractice

A

negligence of a professional person

94
Q

Examples of malpractice

A

-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
Q

Forms of negligence

A

malfeasance, misfeasance, nonfeasance

96
Q

Malfeaseance

A

execution of an unlawful or improper act

97
Q

Examples of malfeasance

A

-performing a partial birth abortion when prohibited by law
-performing aa procedure without having the appropriate credentials

98
Q

Misfeasance

A

improper performance of an act

99
Q

Examples of misfeasance

A

-wrong sided surgery
-leaving an instrument in pt’s body

100
Q

Nonfeasance

A

Failure to act when there is a duty to act

101
Q

Examples of nonfeasance

A

-failure to prescribe antibiotics when indicated
-failure to respond to emergency call

102
Q

Standard of Care

A

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
Q

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?

A

nursing center failed in its :duty to care” by not validating the nurse’s license

104
Q

Four elements of negligence

A

-duty to care, breach of duty, injury/actual damages, causation

105
Q

breach of duty

A

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
Q

Injury/actual damages

A

-actual damages must be established
-without injury daaages cannot be awarded

107
Q

Causation

A

must be a reasonable, close, and casual connection between the defendant’s negligent conduct and resulting damages suffered

108
Q

Intentional Torts

A

assault and battery, false imprisonment, defamation of character, invasion of privacy, infliction of mental distress

109
Q

Assault

A

deliberate threat, coupled with apparent ability to do physical harm to another. Actual contact not necessary

110
Q

Battery

A

intentional touching of another’s person in socially impermissible manner without person’s consent

111
Q

Defamation of character

A

involves communication to someone other than the person defamed that tends to hold that person’s reputation up to scorn and ridicule
-slander

112
Q

Infliction of mental distress

A

conduct that is so outrageous that it goes beyond bounds tolerated by decent society

113
Q

Crime

A

any social harm defined and made punishable by law

114
Q

Purpose of criminal law

A

-maintain public order and safety
-protect the individual
-use punishment as a deterrent to crime
-rehabilitate the criminal for return to society

115
Q

Misdemeanor

A

an offense punishable by less than one year in jail and or a fine

116
Q

Felony

A

is a much more serious crime and is generally punishable by imprisonment in a state or federal penitentiary for more than one year

117
Q

Fraud: billing scam

A

a pharmacist dispensed the generic equivalent of a drug and billed for the higher cost brand name

118
Q

Fraud: self-referrals

A

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
Q

Contract

A

a special kind of agreement, either written or oral, that involves legally binding obligations between two or more parties

120
Q

Kinds of Contracts

A

employment, exclusive, commercial ethics and non competitions

121
Q

Trial procedure: discovery

A

process of investigating the facts of a case before trial

122
Q

Trial procedure: preparation of witnesses

A

the manner in which a witness handles questioning at a deposition or trial is often as important as the facts of the caase

123
Q

the jury determines

A

question of fact

124
Q

the court determines questions

A

of law

125
Q

Subpoena

A

a legal order requiring the appearance of a person and or the presentation of document to a court or administrative body

126
Q

Subpoena ad testificandum

A

orders the appearance of a person at a trial or other investigative proceeding too give testimony

127
Q

Subpoena duces tecum

A

a written command to bring records, documents, or other evidence described in the subpoena to aa trial or other investigative proceeding

128
Q

Trial Procedure: Burden of Proof

A

the plaintiff is required to show that the defendant violated a legal duty

129
Q

Trial procedure: kinds of evidence

A

direct evidence, demonstrative evidence, documentary evidence, examination of witnesses, expert witnesses

130
Q

Defense of One’s Actions

A

assumption of aa risk, cmparative negligence, contributory negligence, good samaritan laws

131
Q

trial procedure

A
  1. closing statements
  2. judge’s charge to the jury
  3. jury deliberation
  4. damages
  5. appeals
132
Q

Executive Branch: US Office of Government Ethics

A

_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
Q

House. ofRep: Committee on Ethics

A

-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
Q

HR: Common Ethical Issues

A

gifts between employees, conflicting financial interests, remedies for financial conflicts of interest, misuse of position

135
Q

Senate: select committee on ethics

A

Authorized to receive and investigate

136
Q

US Judicial code of conduct

A

provides guidance for judges on issues

137
Q

A Principle of Law

A

principle of law which holds no one can lawfully do that which tends to be injurious to public

138
Q

Sources of public policy

A

legislation
-admin rules, regulations or decisions,
-judicial decisions
-professional code of ethics may contain an expression of public policy

139
Q

XIV Amendment: US Constitution

A

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
Q

Title VI: Civil Rights Act of 1964

A

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
Q

Sherman Antitrust Act

A

was the first federal act that outlawed monopolistic buisness practices

142
Q

Privacy Act of 1974

A

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
Q

HIPAA of 1996

A

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
Q

Emergency medical treatment and active labor act of 1986

A

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
Q

Health Care Quality Improvement Act

A

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
Q

Agency for HC Research and Quality

A

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
Q

Ethics in Patient Referral Act of 1989

A

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
Q

Pt Self-Determination Act of 1990

A

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
Q

Sarbances-Oxley Act of 2002

A

The SOX Act mandated strict reforms to improve financial disclosures from corporation and prevent accounting fraud

150
Q

Corporate Authority

A

-described under the laws in which a corporation is chartered
-described in a corporation’s articles of incorporation

151
Q

Kinds of authority

A

-express corporate authority
-implied corporate authority
-ultra vires acts

152
Q

Ultra Vires Act

A

acting beyond its scope fo authority

153
Q

Implied corporate authority

A

corporate powers not specifically granted in articles of incorporation

154
Q

express corporate authority

A

delegated by statute

155
Q

organizational ethics codes

A

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
Q

Unprofessional conduct

A

trust and integrity lacking, false advertisements, concealing mistakes

157
Q

Benchmark darling case

A

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
Q

Respondent Superior

A

a legal doctrine holding employers liable for wrongful acts of their employees

159
Q

Independent contractor

A

responsible for his or her own negligent acts

160
Q

Corporate duties and responsibility

A

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
Q

Prohibiting termination

A

disability, age, race, creed, color, religion, sex, national origin, pregnancy, filing of safety complaints with OSHA

162
Q

Refuse to participate with care

A

-refusal to participate in elective abortion upheld
-refusal to paarticipate in therapeutic abortion insubordinaate
-pharmacist’s refusal to fill prescriptions

163
Q

Equal Pay Act

A

Prohibits discrimination in payment of wages for women and men performing substantially equal work in same establishment

164
Q

Caregiver’s right

A

the nurse in the operating suite refuses to parcipate in an elective abortion

165
Q

Question pt care

A

public policy clearly mandates an obligation to serve the best interests of pts

166
Q

Freedom from sexual harassment

A

employees have a right to be free from sexual harassment

167
Q

Right to be free from intimidaation

A

those in power often abuse power through threats, abuse, intimidation, and retaliatory discharge

168
Q

Express consent

A

a verbal or written agreement authorizing treatment

169
Q

Implied consent

A

a presumption that consent has been authorized based on teh nature of the pt’s condiiton

170
Q

AMA Code of Medical Ethics

A

Pt has the right to receive info from physicians and to discuss the benefits, risks, and costs of appropriate treatment alternatives

171
Q

ANA Code of ethics

A

pts have the moral and legal right to determine what will be done with their own person

172
Q

Proof of consent

A

oral consent, written consent, implied: emergency consent

173
Q

Statutory consent

A

-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
Q

Failure to inform

A

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
Q

Who may authorize consent

A

competent pts, spouse, guardian, parents of minor

176
Q

Incompetent pts

A

the mentally incompetent connot legally consent to treatment

177
Q

Right to refuse tx

A

pts have a right to refuse tx and be secure from any touhcing

Principles of HC - 350 (2 decks)

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