Philosophy 2 Flashcards

1
Q

supports autonomy (ADC) (autonomy is the abcs)

A

Determining the patient’s ability to understand the issues, consider the consequences of different options, and communicate these thoughts to professionals is necessary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

personhood (babies to comatose are persons)

A

newborns, cognitive impairment, comatose, children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Competence (in legal terms) (your dad)

A

Competence is a legal presumption that a person who has reached the age of majority has the requisite cognition and judgment to negotiate legal tasks, such as entering into a contract, making a will, or standing for trial.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

decisional capacity (in medicine)

A

clinical context it is customary to refer to the patient’s decisional capacity, a clinical determination of the ability to make decisions about treatment or health care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Elements of Decisional Capacity (DPT BRD) decision to dip bird - this is basically informed consent

A

Decisional capacity refers to the patient’s ability to perform a set of cognitive tasks, including • • • • • understanding and pro­cessing information about diagnosis, prognosis, and treatment options; weighing the relative benefits, burdens, and risks of the therapeutic options; applying a set of values to the analysis; arriving at a decision that is consistent over time;

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Capacity can be seen as an index of a person’s…

A

ability to exercise autonomy by making decisions that reflect personal preferences, values, and judgments at a given time.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Having capacity enables but does not obligate patients to…

A

to act in­de­pen­dently. Despite our good intentions, we cannot force people who are unwilling to exercise their capacity for self-­ determination to do so.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

delegated autonomy - assisted autonomy

A

These patients often entrust to others the authority to make decisions on their behalf

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Capacity is not global, but…

A

decision-­ specific, referring to the ability to make par­tic­u­lar decisions. ie - can decide what to have for lunch, but not specifics about surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Just as capacity is not global in its application to all decisions, it is not always…

A

constant. Elderly patients and sundowning.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

The fact is, we only question the capacity of people who

A

not agree with us.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

mini mental status exam (MMSE) - pros and cons

A

good for “orientation of the subject to person, place, and time, attention span, immediate recall, short-­ term and long-­ term memory, ability to perform simple calculations, and language skills” (Lo 2000, pp. 84– 85), it is less helpful in assessing an individual’s ability to grasp situations, weigh alternatives, and appreciate consequences— the skills required for capable decision making

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Three standards are customarily invoked in attempting to make decisions as the patient would have made them (p (prior) is)

A

prior explicit articulation, substituted judgement - inferring, best interest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

most problematic decision making standard (hardest for the substitute)

A

substituted judgement most problematic because, as commonly formulated, it requires the intellectually convoluted task of imagining what the now-­incapacitated patient would choose if she were ­ magically capable and in possession of all the relevant clinical facts.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

how to use decision making standard (decisions must be authentic bc life is cohesive) AND what is it called

A

Apply Authenticity, which expresses the value of having one’s life be a coherent narrative, and surrogate decisions guided by this value seek to maintain the coherence of the patient’s life through the decisions that are made on her behalf, rather than to honor her hypothetical choices

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

advanced directives (disease is advancing) use by whom?

A

used for the formerly capacitated, ie dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

2 types of advanced directives (instructions for the appointment)

A

instruction ­directives, also known as living wills, and appointment directives, also known as health care proxies or powers of attorney for health care.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

hybrid advance directive, Five Wishes (5 hybrids decide my treatment, comfort, treat me, and loved ones)

A

provides the opportunity to communicate decisions about (1) the person I want to make care decisions for me when I can’t; (2) the kind of medical treatment I want or don’t want; (3) how comfortable I want to be; (4) how I want people to treat me; and (5) what I want my loved ones to know.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Without the patient’s explicit instructions in an advance directive, health care decisions made by surrogates have traditionally been based on the remaining two decision- (BS - is this judgement in the best interest?)

A

making standards— either ­substituted judgment (when the patient’s wishes can be inferred) or the best interest standard

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

EDMM - steps (FEPACCD) EDMM is fee packed

A

1) gather the facts
2) determine the ethical issues
3) state the principles which have a Bearing on the Case
4) List the Alternatives
5) Compare the Alternatives with the Principles
6) Consider the Consequences
7) Make a Decision
8) glossary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

EDMM - ethical issues compete

A

“Ethical issues are stated in terms of legitimate competing interests or goods. These competing interests are
what actually create an ethical dilemma. The issues should be presented in an X versus Y format in order to
reflect the competing interest in a particular dilemma”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

EDMM - state the principles

A

In bullet point fashion, list the ethical principles involved in the case. Such principles include things like:
professional codes of conduct, constitutional principles, legal principles, commonly accepted cultural
principles, natural law principles, or religious principles. The principles should be listed in order of their
ethical weight in the given case, e.g. P1, P2, P3, P4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

EDMM - Consider the Consequences

A

“Both positive and negative consequences should be considered. They should be informally weighted since
some positive consequences are more beneficial than others, and some negative consequences are more
detrimental than others” (Rae, p. 106). You might list the alternatives with their consequences in the order of
informal weight, e.g. A2→ C2 weightier than A3→C3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

EDMM - make a decision

A

“Deliberation cannot continue indefinitely. At some point, you must make a decision. Realize, too, that
ethical dilemmas often have no easy and painless solutions. Frequently, the decision that is made is one that
involves the least number of problems of negative consequences, not one that is devoid of them” (

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

principles of autonomy (RI DC) autonomy is redic (think about signing paper at doc office)

A

1) Informed Consent
2) Disclosure of Medical Information
3) Confidentiality
4) Right to Refuse Treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Four Main principles in medical ethics (the big ones - AJNB)

A

1) Autonomy (self-law/self-determination)
2) Justice (fairness/make-right; “doing and
pursuing the good”)
3) Nonmaleficence (do no harm/not
harming)
4) Beneficence (benefitng)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

2 components of informed consent (doctor do job and patient understood)

A

1) doctor’s disclosure of medical information to the patient
2) competent patient

28
Q

informed consent - doctor’s disclosure (DPAR BR) what you didn’t get for your mom - (disclosure is a dapper bro)

A

diagnosis, prognosis, available and
alternative treatments, and the risks,
benefits, and consequences of having or
refusing treatment.

29
Q

informed consent - competent patient (was I competent)

A

A patient who understands the nature of his or her condition and the consequences of accepting or refusing an intervention for it.
If a patient thinks or believes that the
burdens of treatment will outweigh the benefits of treatment, then the patients autonomy must be respected.

If the level of risks to the patient for refusing treatment is high, then a greater level of competence is required by the patient

30
Q

Competence vs. Risk vs.

Invasiveness of the Procedure

A
Some would argue that	only	a minimal	
degree	of	competence	would	be	necessary	
for	the	patient’s	doctor	to	be	obligated	to	
respect	and	not	override	the	patient’s	
decision
31
Q

2 ways surrogates act (surrogate in your shoes or theirs)

A

1) They make decisions about treatment as the patient would have made them if they were
competent.
2) They can decide on a course of action that they believe to be in the patient’s best interest.

32
Q

informative model (information is basic)

A

The physician is obligated to provide all the
available medical facts. On the basis of
personal values, the patient then determines
which treatments they will accept or refuse.

33
Q

interpretive model

A

In addition to the medical facts, the physician
also provides the patient with information
about the nature of their condition and the
risks and benefits of different interventions.

34
Q

deliberative model (deliberately tell me what to do)

A

The physician is engaged in not only
presenting medical information to the
patient, but also in recommending treatment
in line with the patient’s health-related
values and preferences. (Non-coercive)

35
Q

disclosure of medical information - This obligation is grounded in both..

A

deontological and consequentialist reasons

36
Q

arguments to support confidentiality (Kant and Mill)

A

1) It is deontological (there is a duty) and
involves respect for the patient’s autonomy
and privacy. It is an extension of the
patient’s right to privacy.
2) It is consequentalist (bad outcome), e.g., if
physicians violate confidentiality by
divulging information about their patients to
third parties, then patients might lose trust

37
Q

research/experimentation

A

Practices aimed at the advancement of scientific knowledge

38
Q

therapy

A

Practices aimed at maintaining or restoring wellness of subject

39
Q

therapeutic research

A

: Research which “offers the prospect of direct medical benefit” to the research participant

40
Q

Utilitarian justification for research

A
Social benefits of	advanced knowledge	
applied to therapeutic practice;	
controlled research methods enhance	
efficacy	of therapies,	reducing	overall	
suffering	over time, thus justifying pains	
endured	by research participants.
41
Q

justification for research (pay the research forward)

A

Duty
Duty to participate in research professed via appeals to fairness:
“paying back”
or
“paying forward”; just distribution of burdens/
benefits of medical advancement

42
Q

Protection model v. access model: Protection model

A

Safeguard participant from undue risks, faulty experimental

design, uninformed/under-informed consent.

43
Q

access model

A

Ensure participant has access to experimental trials that might
provide therapeutic benefit; ensure representative access to such trials, particularly to traditionally underrepresented groups.

44
Q

Informed consent requirement - voluntary

A
1.	Nuremberg	Code	(1946)	and
Declaration of	Helsinki	(1964):	Two	of	
the	more than thirty statements	of	
human-participant	research	ethics	
promulgated	since World	War	II.	
2.	Informed	consent	is the central	issue
45
Q

Voluntary informed consent as a central issue

A
Duties	of	trust,	loyalty,	veracity	in	
practioner-patient	interactions.	
	 	1.		Sometimes	viewed	as	a	safeguard	
	against	act-utilitarian	impulse	to	use
	bodies/pains/sufferings	of	the	few	to	
	benefit	the	many.
46
Q

Voluntary informed consent as a central issue - cont

A
2.	Thus, respect	for	persons	entails	
informed-consent	requirement:	
i)	Each	has	a	right	to	decide	for				
herself,	whether	to	consent;	
ii)	Consent	is	autonomous	if	and	only	
if	it	is	fully	informed.	
				3.	Proxy	consent	for	incompetent	
	 	participants:	Helsinki	code,	 			 	 	Articles	24-26.
47
Q

two principles and 3 more

A
  1. Voluntary Informed Consent
  2. Ratio of Benefits
    Later
  3. Distinction between therapeutic
    research (benefit patient) and
    nontherapeutic (generate scientific
    knowledge; not to benefit patient)
  4. Institutional Mechanisms to ensure
    ethical principles (Inst. Review Boards).
  5. Provision for Proxy consent by family
    member
48
Q

fernald state school (no ferns grow)

A

low does of raditation

49
Q

willowbrooke (willow will never get it)

A

hepatitis

50
Q

san quentin

A

testosterone

51
Q

statesville (don’t have it in our state)

A

malaria

52
Q

holmsburg (hopefully not in our home)

A

dioxin - carcenogen

53
Q

guatalmala

A

radiation

54
Q

marshall islands

A

radiation

55
Q

ethical dilemmas - randomized trial

A
  1. Patient may or may not receive
    potentially-preferable treatment; thus,
    conflicting obligations of Researcher qua
    Physician (ensure patient benefit)
    Vs.
  2. Researcher qua Scientist (ensure viability
    of experimental control group).
56
Q

ethical dilemma - con’t

A
Others	argue	against	the	assumption	of	
ethical	equipoise (balance of interest)	between	MD	as	
researcher	and	MD	as	care-giver;	
different	roles	have	different	ethical	
obligations;	model	of	“researcher-as-	
caregiver”	yields	an	overly	paternalistic	
relationship	between	researcher	and	
participant.
57
Q

equipoise (equipoise is not biased)

A

A researcher is in equipoise when he or she
does not know whether one treatment is
more effective than another.

58
Q

A research community is in equipoise when

A

there is genuine disagreement within the
community about the comparative merits
of the experimental and control arms of the
trial.

59
Q

design of clinical trials - the phases

A

1) Phase I: Test the toxicity.
2) Phase II: Test the dosing.
3) Phase III: Test for effectiveness and side-effects.
4) Phase IV: Once FDA approved, collect more information and continue to test for side-effects.

60
Q

Phase I and II are….(AND main moral obligation)

A

nontherapeutic

  1. Main moral obligation:
    i) Protect subjects from harm.
61
Q

Phase III and IV may be (AND main moral obligation) (is nara risky?)

A

therapeutic
2. Main moral obligation:
i) Ensure that there is an appropriate risk-
benefit analysis.
• Ideally there is a randomized controlled
clinical trial (double-blind).

62
Q

3 ethical requirements to protect human participants (informed risk and distribution)

A
  1. Voluntary Informed Consent
  2. Appropriate Risk-Benefit Ratio
  3. Fair Distribution of Risks between different
    groups
63
Q

singer is a…

A

utilitarianist

64
Q

cohen

A

animals cannot have rights because they are not moral

65
Q

for children, there should never be…

A

more than a minimal risk

66
Q

Pellegrino and Thomasma

A

argue that the patient autonomy model does not give
sufficient attention to the impact of disease
on the patient’s capacity for autonomy.