Professional Development Flashcards
What is T0?
experimental and applied research: defining mechanisms and targets
What is T1?
translation to humans: proof of concept clinical trials
What is T2?
translation to patients: clinical trials
What is T3?
translation to practice: long-term clinical training
What is T4?
translation to community: effect of treatment on population
What criteria should you use to determine your research question?
is it feasible, interesting, novel, ethical and relevant? (FINER)
What do patients need to know to be considered informed consent?
DRAC: Diagnosis and prognosis Recommended treatment Alternative treatment Consequences of no treatment
What are exceptions to informed consent?
WELT: Waiver Emergencies Lack of decision making capability Therapeutic privilege
What did the Salgo case decide?
Physician has duty to inform a patient of “any facts which are necessary to form the basis of an intelligent consent by the patient to proposed treatment”
How do you respond to competent, informed patients who refuse treatment?
SPIT: shared decision making protect patient's best interest inform patient completely try to persuade patients
Describe the Coward case.
requested to stop treatment for severe burns throughout his body, physicians refused
What did the Bouvia case decide?
a person could deny medical treatment as a competent patient (had cerebral palsy and wanted to starve to death, hospital refused)
What did the Bartling case decide?
competent patient can deny medical treatment; he was hospitalized and needed a respirator but wanted to be removed and hospital didn’t let him
What is consent?
patients with decision making capability have the ability to agree or refuse treatment
What is assent?
patients who lack decision making capability cannot consent or refuse treatment but health care professional has a moral obligation to get their acceptance of any treatment
What is the difference between advanced directives and living wills?
living wills are written advance directives that become active when a person is terminally ill
What is an advanced directive?
what you want done in the case that you do not have decision making capacity
What makes an advanced directive most accurate/valid?
SIR:
specific treatments
informed
repeated
What are systematic problems with advanced directives?
really difficult to predict what you would want done in a specific situation before you’re going through it
often they are uninformed or too general
What is the order for determining a surrogate decision maker?
court appointed guardian
surrogates selected by patients
family members
friend
What makes a surrogate a reliable decision maker?
consistent with patient’s values
no conflicts of interest
What actions should be taken if no relatives can act as surrogate s for the patient?
advanced directives
substituted judgement: what do you think is best based on patients values
best interest: what would a reasonable person do in this case
What did the Quinlan case decide?
courts decided family members can act as guardians (22 yr old woman in persistent vegetative state, physicians refused family request to remove her from ventilator)
What did the Cruzan case decide?
Provided the standard for individual states to determine evidence necessary for substituted judgment (33 yr old woman in PVS, family requested feeding tube be removed while physicians refused)
