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Ethics > Quiz Reiew > Flashcards

Quiz Reiew Flashcards

1
Q

What are the basic ethical principles?

A 
Autonomy
Beneficence
Non-maleficence
Justice
Veracity 
(Fidelity)
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2
Q

To be autonomous means to have ______ or to function ______.

A

Self-governance

Independently

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3
Q

In health care, autonomy is the right of the patient or research subject to have _______.

A

Self-determination

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4
Q

Autonomy:

Patients should be told the _______ about their condition

A

TRUTH

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5
Q

Autonomy: Patients should be ______ about risks and benefits of treatments.

A

INFORMED

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6
Q

Autonomy: Individuals are _________ tx even if all best information indicates that tx would be most beneficial

A

ALLOWED TO REFUSE

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7
Q

Autonomy does or does not negate responsibility?

A

DOES NOT

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8
Q

Autonomy: _______ is responsible for following applicable policies and procedures

A

Patient

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9
Q

Patient responsibilities under autonomy:

A
  • Keeping appointments
  • Ask more information if do not understand something
  • Respect others, respect property
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10
Q

Provider autonomy: Autonomous professional practice is granted through __________.

A

Licensure laws

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11
Q

Provider autonomy: Health professionals must maintain ability to exercise ___________ within their scope of practice.

A

Independent judgement

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12
Q

Provider autonomy:

Patient’s right of autonomy should __________ at the price of physical therapist’s parallel right of autonomy.

A

not be permitted

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13
Q

Barriers to autonomy: (3)

A
  1. Barriers to participation in certain networks
  2. Restrictions on patient provider communication in the form of gag clauses
  3. Independent judgement compromised by organizational policy
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14
Q

What is a gag clause

A

Does not allow PT to talk to patient

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15
Q

Therapeutic exception/privilege (ONE exception)- what is it?

A

Physician feels it is too harmful for patient to know the full risk

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16
Q

Care carried out by health care provider that is in the best interest of the patient.

A

beneficence

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17
Q

Beneficence is manifestation of the provider’s _________ owed to his/her patients

A

Fiduciary duty

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18
Q

Bringing about positive good is _____.

A

Beneficence

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19
Q

Doing/intending no harm

A

Non-maleficence

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20
Q

Equity or fair treatment

A

Justice

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21
Q

______ maximizes fairness to all patients and potential patients

A

Justice

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22
Q

_____ applies to health care providers, disciplines, organizations, and delivery

A

Justice

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23
Q

What is distributive justice?

A

How equitably are health care services distributed at societal level?

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24
Q

Issues of distributive justice (4)

A
  1. Universal health care coverage
  2. Prevention/tx of AIDS
  3. Rationing health care interventions at end of life
  4. Heroic measures with premature births
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25
Q

What is comparative justice?

A

How is healthcare delivered at individual level?

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26
Q

What are issues of comparative justice? (2) What study shows this?

A
  1. Reimbursement and denial of care involving individual patients
  2. Disparate tx of patients on basis of age, disability, gender, race, ethnicity, religion
    - -> Tuskegee Syphilis Study (1932-72) was breach of professional ethics
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27
Q

Federal law is based on _______

A

Individual justice

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28
Q

What is the federal anti-dumping law

A

Emergent patients and women in active labor must be stabilized before transferring to “charity facility”

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29
Q

Which ethical principle is not considered by all bioethicists to be foundational ethical principle?

A

Veracity

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30
Q

What is “an element of respect for persons”

A

Veracity

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31
Q

Antithetical to concept of medical paternalism-

A

Veracity

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32
Q

What is a therapeutic privilege in regards to veracity

A

Acceptable deception but rarely invoked (practitioner determines pt would be unable to handle information given to them)

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33
Q

What is a dual relationship?

A

professional has more than one role with patient

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34
Q

What is fidelity?

A

Loyalty

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35
Q

_____ defines fidelity as patient-caregiver relationship

A

Veatch (person?)

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36
Q
  1. PT as a health care provider has special position of trust in relation to the patient
  2. Patients interests are placed above all others
  3. Includes financial and other interests of the provider

–> what are these known as?

A

Fiduciary duties

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37
Q

What are the 3 components of RIPs model?

A

The realm
The individual process
The situation

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38
Q

What 3 parts make up the realm in RIPS?

A

Individual
Organizational/institutional
Societal

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39
Q

What 5 components make up the individual process in RIPS?

A 
Moral sensitivity
Moral judgement
Moral motivation
Moral courage
Moral potency
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40
Q

What 5 components make up the situation in RIPs model?

A 
Issue/problem
Dilemma
Distress
Temptation
Silence
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41
Q

______ (test) determines what level moral judgements are made

A

The defining issues test (DIT)

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42
Q

What does a higher score on the DIT mean?

A

Higher moral judgement ability

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43
Q

What is the average score for graduate students on the DIT?

What is the average for PTs in NJ on the DIT?

A

60

40

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44
Q

______ is a much more powerful predictor than _____ when predicting ethical decision making skills.

A

Education

Age

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45
Q

What are the 4 components of determinants of moral behavior?

What is this referred to as?

A

Moral sensitivity
Moral judgement
Moral motivation
Moral character

The Four Component Model

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46
Q

________ is the awareness of how our actions affect other people.

A

Moral sensitivity

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47
Q

A person without moral ______ fails to act morally because it does not occur to them that what they are doing may affect another person.
Ex: smoking is a legally mandated ______

A

Sensitivity

Sensitivity

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48
Q

________ is when the person is aware of possible lines of action and how people would be affected by each line of action
Ex: act of terrorism is justified in terms of revenge for previous wrongs is narrow in scope and often targeted at innocent people

A

Moral judgement

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49
Q

What is the component of the determinants of moral behavior that the DIT seeks to measure?

A

Moral judgement

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50
Q

A competing value completely compromised moral values as they are generally accepted by reasonable people (how we account for evil people)
- Moral values are not placed higher than other values

These fall under which of the determinants of moral behavior?

A

Moral motivation

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51
Q

Moral motivation: Other values such as ________ of protecting one’s organization replace concern for doing what is right

A

Self-actualization

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52
Q

5 roles of PTs (found in code of ethics)

A 
Patient client management
Teaching
Research
Consultation
Administration
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53
Q

Physicians must be competent, must use competence in patient’s best interest, and are both intellectually and morally obliged to act as advocates for the sick –> These are the components of __________

A

Patient-Physician Covenant

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54
Q

What are the 3 foundations of ethical behavior?

A

Morality
Values
Duties

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55
Q

Relationships between people and how individuals can best live in peace and harmony with one another is ______

A

Morality

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56
Q

______ initially come from parents, then from peer group and friends, ultimately you choose who you want to be with

A

Values

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57
Q

Language that describes actions in response to claims on you that are either self imposed or imposed by others is _____

A

Duties

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58
Q

______ describe the actions required of you if you are to play your part in building a society where people can live in peace and harmony with others

A

Moral duties

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59
Q

On occasion, the values and duties of a person come into conflict with the morality of the subgroup they are a part of. This is _______

A

Moral conflict

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60
Q

institution permits abortions per Roe v Wade. Individual may be loyal to institution but have personal prohibition against abortion- this is an example of _____

A

Moral conflict

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61
Q

______ means soundness, reliability, wholeness, and integration of moral character

A

Moral Integrity

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62
Q

_______ is fidelity in adherence to moral norms

A

Integrity

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63
Q

_______ is the character trait of being faithful to moral values and standing up to their defense

A

Integrity

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64
Q

An individual acts __________ if he or she is motivated to do what is right because it is right, has tried with due diligence to determine what is right, intends to do what is right, and exerts an appropriate level of effort to do so (Beauchamp and Childress)

A

Conscientiously

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65
Q

Internal sanction that comes into play through critical reflection

A

Conscience

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66
Q

Conflicts of conscience sometimes emerge because of the demands of patients or institutions within which we work

A

Conscientious objection

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67
Q

What are the 4 categories of moral action?

A

actions that are…

  1. Right and obligatory
  2. Wrong and prohibited
  3. Optional and morally neutral
  4. Optional but morally meritorious and praiseworthy
68
Q

Right to refuse treatment is ____ after all reasonable options and consequences of refusal of tx have been explained

A

Inviolate

69
Q

Right to refuse is ______ (absolute or not absolute)?

A

Not absolute

70
Q

Informed consent prevents _______ (non-maleficence) and preserves ______

A

Harm

Autonomy

71
Q

Obligation to obtain consent resides normally with _______ with independent authority

A

Health care practitioner

72
Q

Nature and purpose of the proposed tx, material risks and consequences of proposed tx, alternatives, and consequences of refusal of tx are known as ______

A

Disclosure requirements

73
Q

There are exceptions for research to disclose if suspected risk or harm is perceived as low
T/F

A

FALSE- have to disclose. No exceptions.

74
Q

Is there an exception for duty to disclose for minor procedures?

A

YES- indicated in blanket consent provided

Ex: blood draw, chest x-ray, nursing care

75
Q

Emergency treatment: Consent is implied by law from existence of emergency. T/F

A

TRUE

76
Q

What is therapeutic exception?

A

Physician feels it is too harmful for patient to know full risk

77
Q

What is a waiver for?

A

Patient doesn’t want to know all of the information- must be documented in medical record and pt is given opportunity to change mind

78
Q

Individual must have decision-making capacity to _______

A

Give consent

79
Q

Ability to understand the nature and consequences of the procedure or tx the patient is about to undergo = ______

A

Competence

80
Q

Under the age of consent (18) except for emancipated minors, individuals with conservators (person appointed for them), elderly with reduced competence with surrogate
…. these are examples of ______

A

Incompetence

81
Q

Surrogate decision making depends on _____

A

State

82
Q

Surrogate decision making:

Substituted judgement standard has 2 components

A
  1. Appointed by court

2. Knew patient when they were competent

83
Q

Surrogate decision making:

Best interest standard is ?

A

What is in best interest for patient now

84
Q

What happened in Canterbury v. Spence?

A

Consequences of tx:
Physician failed to inform young patient’s mother about risk of paralysis associated with surgery to remove vertebrae. Curt ruled physician violated duty to disclose.

85
Q

What happened in Truman v. Thomas?

A

Consequences of refusing tx:
Physician failed to inform patient of material risks of refusing recommended Pap smears between years of 1964-1969. Patient dx with cervical cancer 1969 and died in 1970.

86
Q

What is “government mandated justice”?

A

EMTALA- Emergency Medical Treatment and Active Labor ACt of 1986
Federal law based on individual justice

87
Q

What is “anti-dumping” law

A

Can’t “dump” patient on another facility until stabilized/safe

88
Q

______ is an example of acceptable deception, although rarely invoked.

A

Therapeutic privilege

89
Q

7 core values of the Code of Ethics

A
  1. Accountability
  2. Altruism
  3. Compassion/caring
  4. Excellence
  5. Integrity
  6. Professional duty
  7. Social responsibility
90
Q

What changed about the preamble in the new Code of Ethics documents?

A

Preamble captures what contemporary PTs do and their unique ethical obligations

91
Q

What is new about the format of the new Code of Ethics documents?

A

Extended beyond former basic principles to clarify intent, meaning, and application of foundational principles

92
Q

Preamble: Code of Ethics for PT delineates the ethical obligations of all PTs as determined by the ________ of the ______

A

House of Delegates of the American Physical Therapy Association

93
Q

Purposes of the Code of Ethics: (5)

A
  1. Define ethical principles
  2. Provide standards of behavior and performance that form basis of professional accountability to public
  3. Provide guidance for PTs facing ethical challenges
  4. Educate PTs, students, other HC professionals, regulators, public
  5. Establish standards by which APTA can determine if PT has been unethical
94
Q

New Code of Ethics built on the 5 roles (____list them), core values, and multiple realms (3- list)

A

Roles:

  1. PCM
  2. Consultation
  3. Education
  4. Research
  5. Administration

Realms:

  1. Individual
  2. Organizational
  3. Societal
95
Q

New Code of Ethics: Special obligation to empower, educate, and enable those with ______ and activity _______

A

Impairments

Limitations

96
Q

What are the 3 components of an ethical problem?

A
  1. Moral Agent
  2. Course of action
  3. Desired outcome
97
Q

In ethical distress, the focus is on the _____

A

Agent (person involved and engaged in problem)

98
Q

In ethical distress, person knows ______ but there is a structural barrier in way of doing what is right

A

Course of action to take

99
Q

Psychological discomfort that is felt when you are blocked from being the kind of person you want or from doing what is right is called ______

A

Ethical distress

100
Q

What are the 3 types of ethical decisions?

A
  1. Ethical problem
  2. Ethical distress
  3. Ethical dilemma
101
Q

What are the types of barriers to ethical decisions?

A

Type A: barrier that keeps you from doing what you know is right (institutional, financial)
Type B: something is wrong but you’re not sure what it is

102
Q

Common type of problem that involves 2 or more morally correct courses of action that cannot both be followed

A

Ethical dilemma

103
Q

Which principle sets the tone for the patient-therapist relationship?

A

Principle 1: PTs shall respect the inherent dignity and rights of all individuals
Core values: compassion, integrity

104
Q

Making judgement based on prior experience is ____

A

Prejudice

105
Q

What is positive prejudice?

A

Holding someone/something up due to preconceived notion

Ex: “golden halo” around certain groups… everyone that comes from certain college is academically gifted

106
Q

What is a negative prejudice?

A

Judgement based on prior experience or experience of other people or rumor

107
Q

______ is thinking the way you do something is they way it should be done and is the best way to do it

A

Ethnocentrism

108
Q

3 ethical principles that support respect for persons

A
  1. Autonomy- want to make sure people are treated with respect and have enough info to make own decisions
  2. Beneficence- regardless of personal opinions, try to find out as much as possible about person and provide with what we can
  3. Veracity- be truthful and honest
109
Q

The principles to govern medical research are called _____

A

Nuremberg Code

110
Q

The _________ is the basis for IRB rules/regulations- set forth ethical principles that serve as guidelines for IRB decisions. Attempts to clarify conflict that exists of priority of basic ethical principles inherent to research.

A

Belmont Report

111
Q

3 ethical principles identified in the Belmont Report

A
  1. Autonomy- informed consent
  2. Beneficence- research has to have some benefit
  3. Justice- fair procedures/outcomes
112
Q

Elements of informed consent that are required (Beauchamp & Childress) (3)

A
  1. Threshold elements (preconditions)
  2. Information elements
  3. Consent elements
113
Q

What are threshold elements?

A

Competence, voluntariness

114
Q

What are information elements?

A

Disclosure of information
Recommendation of plan
Understanding of disclosure and information

115
Q

What are consent elements?

A

Decision

Authorization

116
Q

Children and consent:

  1. _______ determine the age of legal impotency
  2. parent’s guardian consent
  3. US dept of health and human services- ______ must be provided by child
A

States

Assent

117
Q

Dignity and dying-
Regardless of age, mental and physical health status, prior occupation and gender preference WE have a _______ with patients and to some extent to their families to provide sound and appropriate care based on public trust and service.

A

Social contract

118
Q

True authority is with the _____ or _____ for decision making

A

Patient, legal surrogate

119
Q

Goals of care during end of life care are from _____ to _____

A

Cure to comfort

120
Q

__________ and __________ are part of larger effort to restore somebody to health or maintain them at a certain level of functioning

A

Artificial nutrition and hydration

121
Q

What is the difference between food and drink vs artificial hydration and nutrition?

A
  • Food and drink are a means of human care

- Artificial nutrition and hydration are addressing a medical condition and are a clinical treatment

122
Q

Requirement for ______ to initiate or withdraw treatment. Patient must make decision with knowledge of burdens vs. benefits of treatment.

A

Consent

123
Q

T/F: According to clinical evidence, artificial hydration eases discomfort of terminal illness

A

FALSE

124
Q

Treatment indications: withold vs. withdraw

What are the components ethical equality?

A
  • Withdrawing a tx that offers no benefit

- Withholding a tx that is not indicated

125
Q

If an intervention is determined to be of more harm than benefit, it is ethical to withhold or withdraw. Withholding is ______, withdrawing is ______.

A

Passive

Active

126
Q

4 components in transition between life and end of life

A
  1. Source of authority for decision making
  2. Establish effective communication
  3. Re-evaluate situation during critical points
  4. Recognition of patient rights
127
Q

Legally making your wishes known (3 ways)

A
  1. Appointment of Health Care Representative
  2. Advanced directive
  3. Living will
128
Q

If an individual cannot project a decisive stand on end of life decisions they can delegate it to a ________ or ______ or to a ______. First person to make decision would be _______.

A

Surrogate, family member, neutral party

Oldest child

129
Q

__________ allows hopelessly ill persons to die with comfort, control, and dignity.

A

Comfort care

130
Q

U.S. And European perspective-

Fear of _______ in US can be factor in prolonging the dying process.

A

malpractice

131
Q

U.S. And European Perspective:

In Europe, physician has duty to support patient when there is a reasonable ________

A

Chance of improvement

132
Q

Making the means available to patient who is capable of suicide and acts on their own is _________

A

Assisting with suicide

133
Q

_________ is when the physician makes the means available at the patient’s request and serves as the actual agent of death

A

Voluntary euthanasia

134
Q

Active euthanasia is _______ throughout the US

A

Illegal

135
Q

Only _____ states have laws explicitly prohibiting assisted suicide

A

36

136
Q

Approximately 6000 deaths/day in US are either ______ or _____ assisted

A

Planned

Directly

137
Q

__________ of pain relieving medications that relieve pain and hasten death

A

double effect

138
Q

Assisting death without killing:

Discontinuing of or failure to start potentially _________

A

Life prolonging treatments

139
Q

Up to 37% of physicians responding to anonymous surveys reported secretly taking active steps to ________

A

Hasten patients death

140
Q

Assisted suicides decline in Oregon- Oregon has had ________ suicide law since 1997

A

Physician-assisted

141
Q

Patients who died from assisted suicide in Oregon were older, highly educated, and mostly had _______

A

Cancer

142
Q

Supporters of assisted suicide state that permitting _____ honors patient _______

A

Autonomy

Integrity

143
Q

Opponents of assisted suicide state that patient _____ is not a supreme moral value and is not sufficient to justify _______

A

Autonomy

Assisted death

144
Q

Final decision Supreme Court 1997 regarding patient’s right to die

A

“Patient does not have the right to die”

145
Q

3 Models of Dying
US permits only ____ and ____ of treatment.
Netherlands permits voluntary ___________.
Germany rejects _____ but permits __________.

A

Withdrawal and withholding
Active euthanasia
Non-physician-assisted suicide

146
Q

Withdrawing tx does not mean ________

A

Withdrawing care

147
Q

Palliative care is caregiving for 3 groups of patients

A
  1. Persistent Vegetative State (PVS)
  2. Minimally conscious state (MCS)
  3. Hospice
148
Q

What does futility refer to

A

Generally recognized as continuing tx when there is no hope for recovery

149
Q

Brain death: Whole brain standard is the irreversible cessation of ______ and ______ function, and of all functions of the entire brain including the __________.

A

Circulatory and respiratory

Brain stem

150
Q

Definition of death

A

Permanent cessation of functioning of the organism as a whole

151
Q

Tests for death (2)

A
  1. Cardiorespiratory standard is traditional approach

2. Neurological standard = battery of tests/procedures

152
Q

In NJ, every patient/resident is presumed to ______ to resuscitation unless there have been directions on the contrary.

A

Consent

153
Q

T/F: For a patient/resident without capacity or an agent, the highest member on surrogate list may consent to DNR if conditions are met.

A

TRUE

154
Q

6 types of surrogates

A
  1. Judicially appointed committee or appointed guardian
  2. Spouse
  3. Parent
  4. Son/daughter at least 18 yo
  5. Brother/sister at least 18 yo
  6. Close friend
155
Q

Conditions for DNR (at least 1 of these 4 must be met)

A
  1. Patient permanently unconscious
  2. Patient terminally ill
  3. Burdens outweigh benefit
  4. CPR would be medically futile
156
Q

_________ provides legal support for ethical right of autonomy to make decisions about their own health care

A

Patient Self-Determination Act (PSDA)

157
Q

______ set the parameters for appropriate interaction between professionals and the unlicensed

A

Professional boundaries

158
Q

What is a dual relationship?

A

When the professional has more than one role with a patient

159
Q

What is a power gradient?

A

Real or perceived advantage that one person has over another

160
Q

Is the PT always the one with the power in the power gradient?

A

NO

161
Q

Unequal treatment, harassment, inappropriate sexual behavior, inappropriate business relations, substance abuse, whistle blowing… all examples of

A

Power gradient issues

162
Q

Rationalization of behaviors even though they may not be good behaviors

A

Benign neglect, blind hindsight

163
Q

Required to report ______ abuse in NJ regardless of who you are or what your status is

A

Child

164
Q

Not mandatory to report _____ abuse for general public, but it is for PTs

A

Elder (>65)

165
Q

The repeated mistreatment of one or more employees with malicious mix of humiliation, intimidation, and sabotage of performance are signs of ______

A

Bullying

166
Q

Just going to let it happen once, just a little bit… usually follows with more –> known as

A

Slippery slope

Ethics (2 decks)

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