Professionalism and Medical Ethics Flashcards

1
Q

Which one of the following is NOT a required component for assessing an individual’s capacity to make a specific treatment decision?
a. Understand the information
b. Retain the information for long enough to
be able to make the decision
c. Use or weigh up the information to make
the decision
d. Communicate their decision
e. Make a rational decision

A

e. Make a rational decision

A lack of capacity can be permanent or tempo- rary and should be assessed in relation to a spe- cific decision to be made. A person with the capacity to consent to therapy should be able to understand the relevant information (treat- ments purpose, nature, likely effects and risks, chances of success and alternatives to the pro- posed treatment), retain the information, weigh up the information to make a decision and be able to communicate it in some way. In the UK, the Mental Capacity Act 2005 a might be used to give treatment for physical health problems to someone aged over 16 years who lacks capacity in their best interests (e.g., because of a mental illness, dementia, learning difficul- ties, unwell).

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2
Q

An 8-year-old boy requires a posterior fossa craniotomy for a space occupying lesion. His parents consent to the treatment plan. Which one of the following would you try to establish with respect to the child himself?
a. Informed consent
b. Informed assent
c. Parens patriae
d. Gillick competence
e. Coercion

A

b. Informed assent

Historically, children have been thought to lack capacity and are hence unable to provide consent on their own. Typically, decisions were made by their surrogate, usually a parent or guardian, and often without the input of the child. More recently, developmentally capable minors can be allowed to consent on their own, and those without the developmental capacity still partici- pate in the process of decision-making through assent. The American Academy of Pediatrics issued a policy statement in 1995 on assent that should be followed where possible. The process of assent involves (1) helping the child achieve a developmentally appropriate awareness of the nature of his/her condition, (2) telling the child what they can expect from tests and treatments, (3) assessing the child’s understanding of the situ- ation and the factors influencing how they are
For each of the following descriptions, select the most appropriate answers from the list above. Each answer may be used once, more than once or not at all.
1. To treat equals equally and unequals unequally according to morally relevant inequality.
2. The right not to be killed and to possess property.
3. Take from each according to ability and give to each according to need.
4. A rational person who makes a decision behind a veil of ignorance will look after the least well off.
5. Act to maximize welfare for the greatest num- ber at the least cost.
responding, and (4) soliciting an expression of the child’s willingness to accept the proposed care. In other jurisdictions (e.g., England, Australia, Canada), this presumption may be rebutted through proof that the minor is “mature” (e.g., “Gillick competent” in the UK) although it is still good practice to also seek parental consent/agree- ment. Although there is no lower age limit defined for which a child can be deemed Gillick competent, it is unlikely to apply for children under 13 years old. In cases of incompetent minors, informed con- sent is usually required from a person with parental responsibility. If the person with parental respon- sibility refuses to consent for a specific treatment and is deemed negligent, medical treatments can be given in the best interests of the child in emer- gencies or the treating team can make an applica- tion to the High Court which can exercise its power as parens patriae (legal protector of citizens unable to protect themselves) by making the child a ward of the Court, such that it takes on the responsibility for consenting for the child.

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3
Q

A 61-year-old male is admitted with a right frontal space occupying lesion, consistent with a glioblastoma multiforme. His imaging shows a significant amount of edema and midline shift and he is started on high-dose dexameth- asone. He is confused with a mild left hemipar- esis. His family arrive a few hours later, and you explain that he will need an operation and that the mass is probably cancerous. As you take them back to his bedside, they ask you not to tell their father about the likely diagnosis. Which one of the following princi- ples would be most compromised by operating on him at this point in time?
a. Autonomy
b. Non-maleficence c. Justice
d. Beneficence
e. Futility

A

a. Autonomy

This case highlights challenges to the consent process often seen in neurosurgical patients. Firstly, his capacity to make autonomous deci- sions is compromised because of the effects of his tumor. Therefore, the immediacy of the clin- ical situation will dictate whether we can afford to

wait and see if he regains capacity after a period of dexamethasone treatment or if a surrogate deci- sion maker (e.g., partner, family member) is con- sulted about what they think the patient would request to have done if they had the capacity. Sec- ond, the family has asked that information be withheld from the patient. In a patient with com- petence or capacity, the withholding of informa- tion does not allow the patient to make an informed decision hence any subsequent consent cannot be valid. For patients, full disclosure of relevant information (including risks and bene- fits) is a right but not a duty—they may not wish to have this information disclosed to them. In this situation they are effectively waiving their right to consent (as valid consent must be informed)— hence it must be well documented and reasons explored. In the case above, while it may be rea- sonable to withhold certain information while he remains confused, if he regains capacity before any planned operation then an attempt to get informed consent must be made.

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4
Q

A 31-year-old female who has been treated for recurrent cerebral metastases from breast cancer presents with multiple new cerebral lesions, including several radiation necrosis lesions from previous radiosurgery. She is mildly drowsy but understands her situation and is competent to make decisions regarding her care. During the consultation palliative care is discussed, but her husband demands that she be treated with any available life prolonging treatment. She says she doesn’t want to go through it any more, to which he responds by threatening to leave her if she is just going to give up. Which one of the follow- ing principles is potentially at risk in this situation?
a. Capacity
b. Voluntariness
c. Disclosure of relevant information
d. Authorization
e. Justice

A

b. Voluntariness

An action such as consenting to a treatment is con- sidered voluntary if it is undertaken freely, without undue influence or coercion from others. How- ever, medical decisions are almost always influ- enced by the opinion of doctors, family, friends, and past experience or knowledge. Identifying the difference between persuasion which is allow- able and under certain circumstance perhaps even obligatory (e.g., if a particular option is clearly in the best interests of a particular patient), and the coercion demonstrated in the husband’s threat to leave her if she doesn’t want to keep going is key to maximizing patient autonomy.

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5
Q

Which one of the following is/are NOT part of the four principles of biomedical ethics?
a. Autonomy
b. Utilitarianism
c. Beneficence
d. Non-maleficence
e. Justice

A

b. Utilitarianism

work for analyzing ethical problems. The four principles must be applied in the appropriate con- text and should have equal importance (allowing conflicts to arise). They are:
* Autonomy—freedom of the patient to choose and be an advocate for their own health.
* Beneficence—what is considered to be of the patient’s best interest.
* Non-maleficence—the harm that may come to a patient because of a specific deci- sion/treatment (“first do no harm”).
* Justice—thelegalaspectsthatimpactupon the ethical scenarios.

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6
Q

A mother does not want her son, a 12-year-old bright, good athlete without neurological def- icits, to know that his cerebellar astrocytoma has only been partially removed. She thinks that knowing this fact would place her son in emotional jeopardy, because a second proce- dure could diminish his sporting abilities. Over time, the follow-up MRI showed a slow but clear progress of the tumor requiring fur- ther surgery. Which one of the following eth- ical principles are most relevant?
a. Autonomy and beneficence
b. Beneficence and justice
c. Autonomy and justice
d. Justice and non-maleficence
e. Autonomy and non-maleficence

A

a. Autonomy and beneficence

When parents request information to be kept from their children, it may be legally permissible, but at the same time compromises the right of the child to autonomy. Therefore, a careful assess- ment of the following aspects is obligatory:
(1) The ability of the minor to fully understand the situation and to anticipate and evaluate future consequences.
(2) Whether the parental surrogate decision- making is in the best interests of the child or is it obstructing beneficence.
After assessment of these aspects, it is the duty of the physician to form a personal opinion (with help from ombudsmen or other authoritative persons or bodies, as needed), based on the con- cept of beneficence, and to try to act accordingly to work with the parents to take the right approach.

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7
Q

A 45-year-old female presents with WFNS grade I subarachnoid hemorrhage on evening. Vascular imaging reveals a 1.2 cm left supracli- noid internal carotid artery aneurysm. The operating neurosurgeon specializes in func- tional neurosurgery and elects to perform a clipping the following morning as there is no aneurysm surgeon available for a further 36 h. During the dissection around the aneu- rysm, an intraoperative rupture occurs and the surgeon struggles to obtain proximal con- trol leading to intraoperative hypotension from blood loss and prolonged cerebral ische- mia from temporary clipping. Postoperatively the patient wakes up on the neurointensive care unit with complete hemiplegia and global aphasia. Which one of the following factors is LEAST relevant to this surgical complication?
a. Task factors
b. Individual factors
c. Team factors
d. Patient factors
e. Organizational factors
f. Situational factors

A

f. Situational factors

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8
Q

A34-year-oldwomanhasalonghistoryofepi- lepsy since the age of 24. She only has seizures when she sleeps, and her last seizure was 3 weeks ago. She is known to be compliant with every medication she’s been given. She retains the driving license which she applied for last year. Which one of the following is most accurate?
a. She must stop driving because her seizures are not well controlled
b. She may be able to continue driving as her seizures only occur during sleep
c. She must stop driving immediately as she has not been seizure free for 1 year
d. The doctor must inform the DVLA and stop her driving
e. She must give up driving indefinitely

A

b. She may be able to continue driving as her seizures only occur during sleep

When patients have their first seizure, they should inform the licensing agency and must stop driving. In this case, patient has been diagnosed
with epilepsy for at least 10 years and during that time she is only known to have seizures during her sleep. She is also very compliant with her doctor’s treatments. Given she has reapplied for the license recently, the licensing agency may be satisfied she does not pose any danger to the public.

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9
Q

A7-year-oldboypresentswithareducedGCS and CT head scan shows significant intraven- tricular hemorrhage and hydrocephalus. You discuss the imaging and the plan for an emer- gency external ventricular drain with the father but he is not willing to proceed if there is any chance his son will be left a “vegetable.” What is the next step in management?
a. Call social services
b.Obtainacourtordertoproceedwithsurgery
c.Do not performs urgery as lackin g parental consent
d. Proceed to surgery in the best interests of the child
e. Keep the child sedated and ventilated on
NICU until consent is gained

A

d. Proceed to surgery in the best interests of the child

In an emergency where you consider that it is the child’s best interests to proceed, you may treat the child, provided it is limited to that treatment which is reasonably required in that emergency. Therefore, in this case, the surgery should be per- formed. In the UK this is governed by the Family Reform Act 1969

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10
Q

Which one of the following is NOTrequired for a valid advanced decision?
a. Mental capacity present when made
b. It applies to the situation where it is being
considered
c. You must be aged 25 or over
d. Must be signed by you and a witness if you wish to refuse life-sustaining treatments
e. Must have been made without harassment by anyone else

A

c. You must be aged 25 or over

An advance decision to refuse treatment (Living Will; advance directive) is legally binding as long as it complies with the Mental Capacity Act 2005, applies to the situation and is valid; it aims to take the place of best interest decisions made for you by other people. Advance decisions are valid if:
* youareaged18oroverandhadthecapacityto make, understand and communicate your decision when you made it
* youspecifyclearlywhichtreatmentsyouwish to refuse
* you explain the circumstances in which you wish to refuse them
* it is signed by you and by a witness if you want to refuse life-sustaining treatment
* you have made the advance decision of your own accord, without any harassment by anyone else
* you haven’t said or done anything that would contradict the advance decision since you made it (for example, saying that you have changed your mind)

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11
Q

Frasier guidelines are best described as clar- ifying circumstances surrounding which one of the following?
a. Competenceofachildtoconsenttomedi- cal treatment without parental involvement
b. Competenceofachildtoconsenttomen- tal health disorder treatment without
parental involvement
c. Competence of a child to consent to contraceptive advice and treatment without parental involvement
d. Competence of a child to withhold con-
sent to medical treatment without paren-
tal involvement
e. Competence of a child to withhold con-
sent to mental health disorder treatment without parental involvement

A

c. Competence of a child to consent to contraceptive advice and treatment without parental involvement

The House of Lords case Gillick versus West Norfolk and Wisbech Area Health Authority
[1985], was presided over by Lord Scarman and Lord Frasier and regarded legal action taken against the advice given to doctors in a health cir- cular that they could prescribe contraception to minors at their discretion. Victoria Gillick felt prescribing contraception in under 16s was illegal because the doctor would commit an offence of encouraging sex with a minor, and that it would be treatment without parental consent. The case had two main outcomes relevant to health professionals:
1. The concept of “Gillick competence”: which declared the parental right to deter- mine whether or not their minor child below the age of 16 will have medical treatment ter- minates if and when the child achieves suffi- cient understanding and intelligence to understand fully what is proposed (Lord Scarman).
2. Frasier Guidelines which outline the criteria which must be met for doctors to lawfully provide contraceptive advice and treatment to under 16s without parental consent.

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12
Q

You are a junior doctor in the Emergency Department (ED). A 5-year-old boy who has been in ED four times previously this year with several episodes of trauma that did not seem related. Today, the child is brought with a complaint of “slipping into a hot bathtub” with a small burn wound on his lower leg. Which one of the following would you do next?
a. Admit the child to remove him from pos- sibly dangerous environment
b. Phone the patient’s family doctor
c. Report your concerns to the local social
services
d. Accept the parent’s explanation
e. Ask the parent whether there has been
any abuse

A

c. Report your concerns to the local social
services

The British Medical Association guidance for doctors who have concerns about a child state “where a doctor has a reasonable belief that a child is at serious risk of immediate harm, he or she should act immediately to protect the inter- ests of the child, and this will involve contacting one of the three statutory bodies with responsibil- ities in this area: the police, the local authority social services or the NSPCC, and making a full report of their concerns.”

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13
Q

A 14-year-old boy presents with precocious puberty and headaches. Cranial imaging reveals a pineal region mass with hydroceph- alus. An endoscopic third ventriculostomy is planned and discussed with the family, but the boy refuses to have the operation. He is aware that without surgery, death is likely.
What is the next appropriate step in management?
a. Gain parental consent and proceed to surgery
b. Apply to High Court for wardship
c. Respect the boy’s decision and do not
operate
d. Proceed to treat in best interests under
Mental Capacity Act 2005
e. Call child protection services

A

a. Gain parental consent and proceed to surgery

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14
Q

A 7-year-old boy is a Jehovah’s Witness and was involved in a RTA (road traffic accident). He is in hemorrhagic shock and requires emer- gency blood transfusion but his mother refuses to give parental consent. Which one of the fol- lowing is the most appropriate next step?
a. Call child protection services
b.Give blood anyway as this is an emergency situation
c. Do not give blood transfusion due to lack of parental consent
d. Contact the courts by telephone
e. Get advice from the Hospital Liaison
Committee for Jehovah’s Witnesses

A

b.Give blood anyway as this is an emergency situation

Section 8 of the Family Reform Act 1969 states that in an emergency where you consider that it is in the child’s best interests to proceed, you may treat the child, provided it is limited to that treatment which is reasonably required in that emergency. Therefore, the child should be given the transfusion. Traditionally, where young children are concerned, the power to give or withhold consent to medical treatment on their behalf lies with those with parental responsibility. Legally, except in an emergency, parental consent is necessary to perform any medical procedure on
a child. Two commonly used arguments when parents refuse treatment are parental rights to raise children as they see fit and religious freedom. Courts throughout the Western world recognize parental rights, but these rights are not absolute. Parental rights to raise children are qualified by a duty to ensure their health, safety, and wellbeing. Parents cannot make deci- sions that may permanently harm or otherwise impair their healthy development. If treatment refusal results in a child suffering, parents may be criminally liable. However, before any harm comes to the child the courts are usually asked to exercise their power under the doctrine of parens patriae which allows state interference to
protect a child’s welfare. This principle applies whether or not the child is in imminent danger, as parents are always required to make decisions in the child’s best interests.

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15
Q

A 16-year-old girl is a Jehovah’s Witness. She refuses a lifesaving blood transfusion. She is aware of and understands the consequences. What is the next step in management?
a. Gain parental consent to give blood
b. Give blood anyway as it is an emergency situation
c. Give blood anyway as she is not competent
d. Do not give blood transfusion but involve courts
e. Call child protection

A

d. Do not give blood transfusion but involve courts

The rights of adolescents to refuse medical treat- ment vary throughout the world and this judicial inconsistency creates confusion among health- care workers. In England and Wales, mature minors (Gillick competent or over 16) may con- sent to, but not refuse, treatment, with the courts using the “best interests” test to override the opinions of adolescents. In 1969, the Family Law Reform Act set the age of consent for medical treatment at 16 but did not specifically deal with parental-child conflict. The implication, how- ever, is that a child’s consent to a procedure over- rides parental opinion. The logical inference from Gillick is that competent children are com- petent to both accept and refuse treatment; yet subsequent decisions suggest that a child’s refusal may be overridden by a proxy’s consent to that treatment and that the child’s refusal, while important, may not be conclusive. Where treat- ment refusal was religion based, there was con- cern about the child’s freedom of choice in the context of a religious upbringing in addition to concerns about whether the child fully grasped the implications of treatment refusal. Thus, while a child’s refusal should be considered, it is likely that the court will override the refusal in the child’s best interests. In Scotland, although the Age of Legal Capacity (Scotland) Act does not specifically refer to treatment refusal, the infer- ence is that a child deemed competent could refuse, as well as consent to, treatment. In North America, the situation for mature minors is state/ province dependent.

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16
Q

Hilary is a 30-year-old schizophrenic patient. She has an abscess in her chest. But she is refusing treatment for it. She is also refusing to take her medication for schizophrenia for the last 2 weeks. She is thought to have full capacity, and understands the effects and con- sequences of not being treated for her chest abscess or taking any antipsychotic medica- tion. Which one of the following is true?
a. She can be detained for treatment of both her abscess and her schizophrenia
b. She can be detained for treatment of her abscess only
c. She can be detained for treatment of her mental health disorder only
d. She cannot be detained as she is competent
e. She cannot have capacity as she has a mental health disorder

A

c. She can be detained for treatment of her mental health disorder only

The Mental Capacity Act 2005 can only be used to give treatment to somebody aged over 16 without their consent if that person is assessed as lacking capacity to make a specific decision at that partic- ular time, and if treatment would be in their “best interests.” Mostly, the doctor who will be respon- sible for giving the medical treatment will be responsible for making the “best interests” deci- sion and in order to reach this decision, he or she must work through a process and statutory checklist which is contained in the Mental Capac- ity Act 2005. If hospital staff want to detain some- one for treatment under the Mental Capacity Act, they need to use the “Deprivation of liberty safe- guards” procedure. This should not be used to detain someone for treatment for a mental health problem—this is the role of the Mental Health Act 1983 (2007). This law allows people living in England and Wales who have a “mental disorder” to be admitted, detained and treated for their men- tal disorder in hospital without their consent (even if they have capacity/are competent)—either for their own health or safety, or for the protection of other people. This can be done under various sections of the Mental Health Act 1983 (2007):

17
Q

A 44-year-old victim of a car accident with a severe closed head injury was admitted to the ICU. The patient rapidly deteriorated and was declared brain dead within 24 h. He is not on the organ donor register. Which one of the following statements is most accurate?
a. It is not possible for others to consent on behalf of a deceased patient
b. Organ donation is not valid if the potential donor is not on the register
c. It is not possible for childrentocon sent to organ donation even if they are Gillick competent
d. Organ donation is not an option in this situation
e. Family members cannot legally veto organ donation if the patient is on the organ donor register

A

e. Family members cannot legally veto organ donation if the patient is on the organ donor register

Organ donation is possible posthumously when no prior consent has been given, if a person in a “qualifying relationship” (ranked by the Human Tissue Act 2004) consents to it. It is possible to carry an organ donor card, which will make it much easier to confirm consent to organ dona- tion if it is found on the person, but it is not nec- essary. According to the Human Tissue Act 2004, it is legal to preserve bodies after death, e.g., by ventilating the patient, to continue perfusion to the organs until consent for donation is estab- lished. Competent minors can also consent to posthumous organ donation, and those with parental responsibility should be informed of such a decision by the child. Although relatives can no longer legally veto consent to organ dona- tion, in reality, hospitals will respect the wishes of relatives and organ donation is unlikely to pro- ceed if there is disagreement.

18
Q

Disclosure of confidential information with- out patient consent may occur under certain circumstances. Which one of the following is unlikely to meet the criteria for such disclosure?
a. Discussion with a competent patient’s family member
b. Terrorist act
c. Notifiable infectious disease
d. Criminal act
e. Significant risk of harm to others

A

a. Discussion with a competent patient’s family member

The patient needs to give permission for their information to be disclosed to their family, although in some cultures this may not be the norm. All of the other options may require a doctor to disclose information depending on the situation.

19
Q

Which one of the following remains valid when the principal dies?
a. Durable power of attorney
b. Ordinary power of attorney
c. Specific powers of attorney
d. General powers of attorney
e. Last will and testament

A

e. Last will and testament

A power of attorney is a document in which one competent person (the principal) appoints another person (the attorney-in-fact) to act for him or her. It becomes invalid when the principal dies and cannot be used to bequeath property upon the death of the principal (this is the func- tion of the last will and testament).

20
Q

A patient under your care recently diagnosed with glioblastoma multiforme and under- gone gross total resection has threatened to seriously harm their partner, who he believes is having an affair. He is being discharged today, but as you leave the room to seek advice from another colleague regarding his comments you turn to see him place a large serrated kitchen knife into his bag. Which one of the following may become relevant?
a. Tarasoff decision
b. Doctrine of double effect
c. Waiver
d. Virtuism
e. Categorical imperative

A

a. Tarasoff decision

Physicians cannot disseminate confidential infor- mation about their patient without consent. This principle applies to speaking with families, friends, the court, or other doctors (only commu- nication for the purpose of patient care is accept- able). Exceptions to confidentiality are generally focused on preventing harm and include the following:
1. Tarasoffdecision:physician–patientconfiden- tiality must legally be breeched if the patient has threatened to harm another person. The healthcare provider should try to detain the patient, contact the police, and warn the potential victim.
2. Child abuse/elder abuse.
3. Dangerous driving: patients must be reported
to the Department of Motor Vehicles if they experience a seizure or otherwise present a danger (e.g., visual loss).
4. Reportable diseases: many diseases must be reported to local authorities (and to the patient’s partner in the case of STDs).
5. Waiver: the patient may waive confidentiality so discussions can be held with family mem- bers or disclosures made to the insurance company.

21
Q

In the USA, the Emergency Medical Treat- ment and Active Labor Act makes all of the provisions except for which one of the following?
a. Transfer of a stable patient for non- emergency care
b. Right to request a medical screening examination to exclude an emergency medical condition
c. Transfer of an unstable patient when the treating physician feels the benefits out- weigh the risks
d. Treatment of an emergency medical con- dition until it is resolved or stabilized
e. Duty to report inappropriate transfers

A

a. Transfer of a stable patient for non- emergency care

Hospitals have three main obligations under EMTALA:
* Any individual who comes and requests must
receive a medical screening examination to determine whether an emergency medical condition exists. Examination and treatment cannot be delayed to inquire about methods of payment or insurance coverage.
* If an emergency medical condition exists, treatment must be provided until the emer- gency medical condition is resolved or stabi- lized. If the hospital does not have the capability to treat the emergency medical con- dition, an “appropriate” transfer of the patient to another hospital must be done in accor- dance with the EMTALA provisions.
* Hospitals with specialized capabilities are obli- gated to accept transfers from hospitals who lack the capability to treat unstable emergency medical conditions.
* A hospital must report instances when it may have inappropriately received an individual who has been transferred in an unstable emer- gency medical condition from another hospital.
EMTALA governs how patients are transferred from one hospital to another. Under the law, a patient is considered stable for transfer if the treating physician determines that no material deterioration will occur during the transfer between facilities. EMTALA does not apply to the transfer of stable patients; however, if the patient is unstable, then the hospital may not transfer the patient unless:
* A physician certifies the medical benefits expected from the transfer outweigh the risks OR.
* A patient makes a transfer request in writing after being informed of the hospital’s obliga- tions under EMTALA and the risks of transfer.
In addition, the transfer of unstable patients must be “appropriate” under the law, such that (1) the transferring hospital must provide ongoing care within its capability until transfer to minimize transfer risks, (2) provide copies of medical records, (3) must confirm that the receiving facil- ity has space and qualified personnel to treat the condition and has agreed to accept the transfer, and (4) the transfer must be made with qualified personnel and appropriate medical equipment.

22
Q

In those aged under 18 years, which one of the following circumstances would parental con- sent for treatment still usually be required?
a. Emancipated minor
b. Decision regarding birth control
c. Decision regarding substance abuse treatment
d. Decision regarding a life or limb threatening conditions
e. Decision regarding tethered cord release

A

e. Decision regarding tethered cord release

Traditionally, US minors (under 18) have no legal rights and remain under parental jurisdic- tion until they reach the age of majority. Over the past century, however, legislation has altered this, allowing minors to obtain treatment for spe- cific conditions without parental consent and, in some states, make medical treatment decisions. In general, the need for parental consent should nearly always be respected but in life- or limb- threatening emergencies, treatment should not be delayed despite parental objection. In urgent situations, legal options can be pursued to make the child a ward of the court (e.g., parents cannot refuse life-saving therapy for a minor with can- cer). Established exceptions to the need for parental consent in minors are:
1. Emancipated minors: married, serving in the military, self-supporting, or parents to children.
2. Reproductive health: sexually transmitted dis- eases (STDs), birth control, prenatal care.
3. Substance abuse treatment.

23
Q

The principle of doing good or improving the welfare of patients.

Ethical concepts:
a. Autonomy
b. A positive right
c. A negative right
d. Beneficence
e. A categorical imperative
f. Justice
g. Non-maleficence
h. Virtue ethics
i. Futility
j. Utilitarianism

A

d. Beneficence

24
Q

The idea that we should create laws that max- imize benefit.

Ethical concepts:
a. Autonomy
b. A positive right
c. A negative right
d. Beneficence
e. A categorical imperative
f. Justice
g. Non-maleficence
h. Virtue ethics
i. Futility
j. Utilitarianism

A

j. Utilitarianism

25
Q

Respecting decisions made by those capable of making decisions.

Ethical concepts:
a. Autonomy
b. A positive right
c. A negative right
d. Beneficence
e. A categorical imperative
f. Justice
g. Non-maleficence
h. Virtue ethics
i. Futility
j. Utilitarianism

A

a. Autonomy

26
Q

Doctor tells patient they need a blood test and patient holds out arm and rolls up sleeve.

Consent:
a. Written consent
b. Valid consent
c. Invalid consent
d. Implied consent
e. Valid advance directive
f. Invalid advance directive
g. Gillick competence
h. Assent
i. Dissent
j. Competence k. Capacity

A

d. Implied consent

27
Q

On the insistence of a close relative, an 80- year-old man with advanced dementia signs a form stating he does not want medical treat- ment if he becomes unwell.

Consent:
a. Written consent
b. Valid consent
c. Invalid consent
d. Implied consent
e. Valid advance directive
f. Invalid advance directive
g. Gillick competence
h. Assent
i. Dissent
j. Competence
k. Capacity

A

f. Invalid advance directive

AD must be made by a person with capac- ity, be specific and not as a result of coercion

28
Q

A patient with learning difficulties who is unable to read or write has the nature and pur- pose of a lumbar puncture explained to him in terms which he can understand and agrees to be treated.

Consent:
a. Written consent
b. Valid consent
c. Invalid consent
d. Implied consent
e. Valid advance directive
f. Invalid advance directive
g. Gillick competence
h. Assent
i. Dissent
j. Competence
k. Capacity

A

b. Valid consent

29
Q

Deliberately ending the life of a person who is incapable of expressing any wishes about whether they want to live or die, motivated by a consideration of that person’s best interests.

Medically assisted dying:
a. Suicide
b. Physician-assisted suicide
c. Murder
d. Attempted murder
e. Voluntary euthanasia
f. Non-voluntary euthanasia
g. Involuntary euthanasia
h. Doctrine of double effect

A

f. Non-voluntary euthanasia

30
Q

Deliberately ending the life of an elderly per- son who is gravely ill to make the hospital bed available who can get more use of it.

Medically assisted dying:
a. Suicide
b. Physician-assisted suicide
c. Murder
d. Attempted murder
e. Voluntary euthanasia
f. Non-voluntary euthanasia
g. Involuntary euthanasia
h. Doctrine of double effect

A

c. Murder

31
Q

A competent, able bodied person has a pro- gressive illness which will render her incapable at a later stage. She seeks medical assistance for medication with which she may end her own life.

Medically assisted dying:
a. Suicide
b. Physician-assisted suicide
c. Murder
d. Attempted murder
e. Voluntary euthanasia
f. Non-voluntary euthanasia
g. Involuntary euthanasia
h. Doctrine of double effect

A

b. Physician-assisted suicide

32
Q

A competent patient who is in pain and distress but unable to take his own life asks his doctor to administer a lethal injection.

Medically assisted dying:
a. Suicide
b. Physician-assisted suicide
c. Murder
d. Attempted murder
e. Voluntary euthanasia
f. Non-voluntary euthanasia
g. Involuntary euthanasia
h. Doctrine of double effect

A

e. Voluntary euthanasia

33
Q

A doctor increases the dosage of painkillers/ sedation, at appropriate levels to control symptoms in the knowledge that this may have a life shortening side effect. The doctor is adamant that she only intends the pain- killing effect of the medication and not side effect.

Medically assisted dying:
a. Suicide
b. Physician-assisted suicide
c. Murder
d. Attempted murder
e. Voluntary euthanasia
f. Non-voluntary euthanasia
g. Involuntary euthanasia
h. Doctrine of double effect

A

h. Doctrine of double effect

34
Q

To treat equals equally and unequals unequally according to morally relevant inequality.

Ethical theory:
a. Altruism
b. Aristotelian justice
c. Communitarianism
d. Consequentialism
e. Deontology
f. Hippocratic oath
g. Libertarianism
h. Principalism
i. Utilitarianism
j. Virtuism

A

b. Aristotelian justice

35
Q

The right not to be killed and to possess property.

Ethical theory:
a. Altruism
b. Aristotelian justice
c. Communitarianism
d. Consequentialism
e. Deontology
f. Hippocratic oath
g. Libertarianism
h. Principalism
i. Utilitarianism
j. Virtuism

A

g. Libertarianism

36
Q

Take from each according to ability and give to each according to need.

Ethical theory:
a. Altruism
b. Aristotelian justice
c. Communitarianism
d. Consequentialism
e. Deontology
f. Hippocratic oath
g. Libertarianism
h. Principalism
i. Utilitarianism
j. Virtuism

A

c. Communitarianism

37
Q

A rational person who makes a decision behind a veil of ignorance will look after the least well off.

Ethical theory:
a. Altruism
b. Aristotelian justice
c. Communitarianism
d. Consequentialism
e. Deontology
f. Hippocratic oath
g. Libertarianism
h. Principalism
i. Utilitarianism
j. Virtuism

A

e. Deontology

38
Q

Act to maximize welfare for the greatest num- ber at the least cost.

Ethical theory:
a. Altruism
b. Aristotelian justice
c. Communitarianism
d. Consequentialism
e. Deontology
f. Hippocratic oath
g. Libertarianism
h. Principalism
i. Utilitarianism
j. Virtuism

A

i. Utilitarianism