Quiz Reiew Flashcards
1
Q
What are the basic ethical principles?
A
Autonomy Beneficence Non-maleficence Justice Veracity (Fidelity)
2
Q
To be autonomous means to have ______ or to function ______.
A
Self-governance
Independently
3
Q
In health care, autonomy is the right of the patient or research subject to have _______.
A
Self-determination
4
Q
Autonomy:
Patients should be told the _______ about their condition
A
TRUTH
5
Q
Autonomy: Patients should be ______ about risks and benefits of treatments.
A
INFORMED
6
Q
Autonomy: Individuals are _________ tx even if all best information indicates that tx would be most beneficial
A
ALLOWED TO REFUSE
7
Q
Autonomy does or does not negate responsibility?
A
DOES NOT
8
Q
Autonomy: _______ is responsible for following applicable policies and procedures
A
Patient
9
Q
Patient responsibilities under autonomy:
A
- Keeping appointments
- Ask more information if do not understand something
- Respect others, respect property
10
Q
Provider autonomy: Autonomous professional practice is granted through __________.
A
Licensure laws
11
Q
Provider autonomy: Health professionals must maintain ability to exercise ___________ within their scope of practice.
A
Independent judgement
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
13
Q
Barriers to autonomy: (3)
A
- Barriers to participation in certain networks
- Restrictions on patient provider communication in the form of gag clauses
- Independent judgement compromised by organizational policy
14
Q
What is a gag clause
A
Does not allow PT to talk to patient
15
Q
Therapeutic exception/privilege (ONE exception)- what is it?
A
Physician feels it is too harmful for patient to know the full risk
16
Q
Care carried out by health care provider that is in the best interest of the patient.
A
beneficence
17
Q
Beneficence is manifestation of the provider’s _________ owed to his/her patients
A
Fiduciary duty
18
Q
Bringing about positive good is _____.
A
Beneficence
19
Q
Doing/intending no harm
A
Non-maleficence
20
Q
Equity or fair treatment
A
Justice
21
Q
______ maximizes fairness to all patients and potential patients
A
Justice
22
Q
_____ applies to health care providers, disciplines, organizations, and delivery
A
Justice
23
Q
What is distributive justice?
A
How equitably are health care services distributed at societal level?
24
Q
Issues of distributive justice (4)
A
- Universal health care coverage
- Prevention/tx of AIDS
- Rationing health care interventions at end of life
- Heroic measures with premature births
25
What is comparative justice?
How is healthcare delivered at individual level?
26
What are issues of comparative justice? (2) What study shows this?
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
27
Federal law is based on _______
Individual justice
28
What is the federal anti-dumping law
Emergent patients and women in active labor must be stabilized before transferring to "charity facility"
29
Which ethical principle is not considered by all bioethicists to be foundational ethical principle?
Veracity
30
What is "an element of respect for persons"
Veracity
31
Antithetical to concept of medical paternalism-
Veracity
32
What is a therapeutic privilege in regards to veracity
Acceptable deception but rarely invoked (practitioner determines pt would be unable to handle information given to them)
33
What is a dual relationship?
professional has more than one role with patient
34
What is fidelity?
Loyalty
35
_____ defines fidelity as patient-caregiver relationship
Veatch (person?)
36
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?
Fiduciary duties
37
What are the 3 components of RIPs model?
The realm
The individual process
The situation
38
What 3 parts make up the realm in RIPS?
Individual
Organizational/institutional
Societal
39
What 5 components make up the individual process in RIPS?
```
Moral sensitivity
Moral judgement
Moral motivation
Moral courage
Moral potency
```
40
What 5 components make up the situation in RIPs model?
```
Issue/problem
Dilemma
Distress
Temptation
Silence
```
41
______ (test) determines what level moral judgements are made
The defining issues test (DIT)
42
What does a higher score on the DIT mean?
Higher moral judgement ability
43
What is the average score for graduate students on the DIT?
| What is the average for PTs in NJ on the DIT?
60
| 40
44
______ is a much more powerful predictor than _____ when predicting ethical decision making skills.
Education
| Age
45
What are the 4 components of determinants of moral behavior?
| What is this referred to as?
Moral sensitivity
Moral judgement
Moral motivation
Moral character
The Four Component Model
46
________ is the awareness of how our actions affect other people.
Moral sensitivity
47
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 ______
Sensitivity
| Sensitivity
48
________ 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
Moral judgement
49
What is the component of the determinants of moral behavior that the DIT seeks to measure?
Moral judgement
50
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?
Moral motivation
51
Moral motivation: Other values such as ________ of protecting one's organization replace concern for doing what is right
Self-actualization
52
5 roles of PTs (found in code of ethics)
```
Patient client management
Teaching
Research
Consultation
Administration
```
53
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 __________
Patient-Physician Covenant
54
What are the 3 foundations of ethical behavior?
Morality
Values
Duties
55
Relationships between people and how individuals can best live in peace and harmony with one another is ______
Morality
56
______ initially come from parents, then from peer group and friends, ultimately you choose who you want to be with
Values
57
Language that describes actions in response to claims on you that are either self imposed or imposed by others is _____
Duties
58
______ 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
Moral duties
59
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 _______
Moral conflict
60
institution permits abortions per Roe v Wade. Individual may be loyal to institution but have personal prohibition against abortion- this is an example of _____
Moral conflict
61
______ means soundness, reliability, wholeness, and integration of moral character
Moral Integrity
62
_______ is fidelity in adherence to moral norms
Integrity
63
_______ is the character trait of being faithful to moral values and standing up to their defense
Integrity
64
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)
Conscientiously
65
Internal sanction that comes into play through critical reflection
Conscience
66
Conflicts of conscience sometimes emerge because of the demands of patients or institutions within which we work
Conscientious objection
67
What are the 4 categories of moral action?
actions that are...
1. Right and obligatory
2. Wrong and prohibited
3. Optional and morally neutral
4. Optional but morally meritorious and praiseworthy
68
Right to refuse treatment is ____ after all reasonable options and consequences of refusal of tx have been explained
Inviolate
69
Right to refuse is ______ (absolute or not absolute)?
Not absolute
70
Informed consent prevents _______ (non-maleficence) and preserves ______
Harm
| Autonomy
71
Obligation to obtain consent resides normally with _______ with independent authority
Health care practitioner
72
Nature and purpose of the proposed tx, material risks and consequences of proposed tx, alternatives, and consequences of refusal of tx are known as ______
Disclosure requirements
73
There are exceptions for research to disclose if suspected risk or harm is perceived as low
T/F
FALSE- have to disclose. No exceptions.
74
Is there an exception for duty to disclose for minor procedures?
YES- indicated in blanket consent provided
| Ex: blood draw, chest x-ray, nursing care
75
Emergency treatment: Consent is implied by law from existence of emergency. T/F
TRUE
76
What is therapeutic exception?
Physician feels it is too harmful for patient to know full risk
77
What is a waiver for?
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
Individual must have decision-making capacity to _______
Give consent
79
Ability to understand the nature and consequences of the procedure or tx the patient is about to undergo = ______
Competence
80
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 ______
Incompetence
81
Surrogate decision making depends on _____
State
82
Surrogate decision making:
| Substituted judgement standard has 2 components
1. Appointed by court
| 2. Knew patient when they were competent
83
Surrogate decision making:
| Best interest standard is ?
What is in best interest for patient now
84
What happened in Canterbury v. Spence?
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
What happened in Truman v. Thomas?
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
What is "government mandated justice"?
EMTALA- Emergency Medical Treatment and Active Labor ACt of 1986
Federal law based on individual justice
87
What is "anti-dumping" law
Can't "dump" patient on another facility until stabilized/safe
88
______ is an example of acceptable deception, although rarely invoked.
Therapeutic privilege
89
7 core values of the Code of Ethics
1. Accountability
2. Altruism
3. Compassion/caring
4. Excellence
5. Integrity
6. Professional duty
7. Social responsibility
90
What changed about the preamble in the new Code of Ethics documents?
Preamble captures what contemporary PTs do and their unique ethical obligations
91
What is new about the format of the new Code of Ethics documents?
Extended beyond former basic principles to clarify intent, meaning, and application of foundational principles
92
Preamble: Code of Ethics for PT delineates the ethical obligations of all PTs as determined by the ________ of the ______
House of Delegates of the American Physical Therapy Association
93
Purposes of the Code of Ethics: (5)
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
New Code of Ethics built on the 5 roles (____list them), core values, and multiple realms (3- list)
Roles:
1. PCM
2. Consultation
3. Education
4. Research
5. Administration
Realms:
1. Individual
2. Organizational
3. Societal
95
New Code of Ethics: Special obligation to empower, educate, and enable those with ______ and activity _______
Impairments
| Limitations
96
What are the 3 components of an ethical problem?
1. Moral Agent
2. Course of action
3. Desired outcome
97
In ethical distress, the focus is on the _____
Agent (person involved and engaged in problem)
98
In ethical distress, person knows ______ but there is a structural barrier in way of doing what is right
Course of action to take
99
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 ______
Ethical distress
100
What are the 3 types of ethical decisions?
1. Ethical problem
2. Ethical distress
3. Ethical dilemma
101
What are the types of barriers to ethical decisions?
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
Common type of problem that involves 2 or more morally correct courses of action that cannot both be followed
Ethical dilemma
103
Which principle sets the tone for the patient-therapist relationship?
Principle 1: PTs shall respect the inherent dignity and rights of all individuals
Core values: compassion, integrity
104
Making judgement based on prior experience is ____
Prejudice
105
What is positive prejudice?
Holding someone/something up due to preconceived notion
| Ex: "golden halo" around certain groups... everyone that comes from certain college is academically gifted
106
What is a negative prejudice?
Judgement based on prior experience or experience of other people or rumor
107
______ is thinking the way you do something is they way it should be done and is the best way to do it
Ethnocentrism
108
3 ethical principles that support respect for persons
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
The principles to govern medical research are called _____
Nuremberg Code
110
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.
Belmont Report
111
3 ethical principles identified in the Belmont Report
1. Autonomy- informed consent
2. Beneficence- research has to have some benefit
3. Justice- fair procedures/outcomes
112
Elements of informed consent that are required (Beauchamp & Childress) (3)
1. Threshold elements (preconditions)
2. Information elements
3. Consent elements
113
What are threshold elements?
Competence, voluntariness
114
What are information elements?
Disclosure of information
Recommendation of plan
Understanding of disclosure and information
115
What are consent elements?
Decision
| Authorization
116
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
States
| Assent
117
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.
Social contract
118
True authority is with the _____ or _____ for decision making
Patient, legal surrogate
119
Goals of care during end of life care are from _____ to _____
Cure to comfort
120
__________ and __________ are part of larger effort to restore somebody to health or maintain them at a certain level of functioning
Artificial nutrition and hydration
121
What is the difference between food and drink vs artificial hydration and nutrition?
- Food and drink are a means of human care
| - Artificial nutrition and hydration are addressing a medical condition and are a clinical treatment
122
Requirement for ______ to initiate or withdraw treatment. Patient must make decision with knowledge of burdens vs. benefits of treatment.
Consent
123
T/F: According to clinical evidence, artificial hydration eases discomfort of terminal illness
FALSE
124
Treatment indications: withold vs. withdraw
| What are the components ethical equality?
- Withdrawing a tx that offers no benefit
| - Withholding a tx that is not indicated
125
If an intervention is determined to be of more harm than benefit, it is ethical to withhold or withdraw. Withholding is ______, withdrawing is ______.
Passive
| Active
126
4 components in transition between life and end of life
1. Source of authority for decision making
2. Establish effective communication
3. Re-evaluate situation during critical points
4. Recognition of patient rights
127
Legally making your wishes known (3 ways)
1. Appointment of Health Care Representative
2. Advanced directive
3. Living will
128
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 _______.
Surrogate, family member, neutral party
| Oldest child
129
__________ allows hopelessly ill persons to die with comfort, control, and dignity.
Comfort care
130
U.S. And European perspective-
| Fear of _______ in US can be factor in prolonging the dying process.
malpractice
131
U.S. And European Perspective:
| In Europe, physician has duty to support patient when there is a reasonable ________
Chance of improvement
132
Making the means available to patient who is capable of suicide and acts on their own is _________
Assisting with suicide
133
_________ is when the physician makes the means available at the patient's request and serves as the actual agent of death
Voluntary euthanasia
134
Active euthanasia is _______ throughout the US
Illegal
135
Only _____ states have laws explicitly prohibiting assisted suicide
36
136
Approximately 6000 deaths/day in US are either ______ or _____ assisted
Planned
| Directly
137
__________ of pain relieving medications that relieve pain and hasten death
double effect
138
Assisting death without killing:
| Discontinuing of or failure to start potentially _________
Life prolonging treatments
139
Up to 37% of physicians responding to anonymous surveys reported secretly taking active steps to ________
Hasten patients death
140
Assisted suicides decline in Oregon- Oregon has had ________ suicide law since 1997
Physician-assisted
141
Patients who died from assisted suicide in Oregon were older, highly educated, and mostly had _______
Cancer
142
Supporters of assisted suicide state that permitting _____ honors patient _______
Autonomy
| Integrity
143
Opponents of assisted suicide state that patient _____ is not a supreme moral value and is not sufficient to justify _______
Autonomy
| Assisted death
144
Final decision Supreme Court 1997 regarding patient's right to die
"Patient does not have the right to die"
145
3 Models of Dying
US permits only ____ and ____ of treatment.
Netherlands permits voluntary ___________.
Germany rejects _____ but permits __________.
Withdrawal and withholding
Active euthanasia
Non-physician-assisted suicide
146
Withdrawing tx does not mean ________
Withdrawing care
147
Palliative care is caregiving for 3 groups of patients
1. Persistent Vegetative State (PVS)
2. Minimally conscious state (MCS)
3. Hospice
148
What does futility refer to
Generally recognized as continuing tx when there is no hope for recovery
149
Brain death: Whole brain standard is the irreversible cessation of ______ and ______ function, and of all functions of the entire brain including the __________.
Circulatory and respiratory
| Brain stem
150
Definition of death
Permanent cessation of functioning of the organism as a whole
151
Tests for death (2)
1. Cardiorespiratory standard is traditional approach
| 2. Neurological standard = battery of tests/procedures
152
In NJ, every patient/resident is presumed to ______ to resuscitation unless there have been directions on the contrary.
Consent
153
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.
TRUE
154
6 types of surrogates
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
Conditions for DNR (at least 1 of these 4 must be met)
1. Patient permanently unconscious
2. Patient terminally ill
3. Burdens outweigh benefit
4. CPR would be medically futile
156
_________ provides legal support for ethical right of autonomy to make decisions about their own health care
Patient Self-Determination Act (PSDA)
157
______ set the parameters for appropriate interaction between professionals and the unlicensed
Professional boundaries
158
What is a dual relationship?
When the professional has more than one role with a patient
159
What is a power gradient?
Real or perceived advantage that one person has over another
160
Is the PT always the one with the power in the power gradient?
NO
161
Unequal treatment, harassment, inappropriate sexual behavior, inappropriate business relations, substance abuse, whistle blowing... all examples of
Power gradient issues
162
Rationalization of behaviors even though they may not be good behaviors
Benign neglect, blind hindsight
163
Required to report ______ abuse in NJ regardless of who you are or what your status is
Child
164
Not mandatory to report _____ abuse for general public, but it is for PTs
Elder (>65)
165
The repeated mistreatment of one or more employees with malicious mix of humiliation, intimidation, and sabotage of performance are signs of ______
Bullying
166
Just going to let it happen once, just a little bit... usually follows with more --> known as
Slippery slope
