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Legal and Ethics Issues for PAs > Reproductive and Pediatric Ethics > Flashcards

Reproductive and Pediatric Ethics Flashcards

1
Q

What are the 5 core categories involving reproductive ethics

A
  1. contraception
  2. assisted reproductive technologies
  3. termination of pregnancy
  4. genetics/congenital conditions
  5. maternal-fetal conflict
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2
Q

Discuss contraception: what contraception is, pt’s rights, and duties of providers

A
  • prevention of pregnancy using IUDs, pills, tubal ligation, or injections
  • women/adolescents have right to make decision about contraception use/methods
  • providers have duty to provide info about contraception options so pt can make informed decision
  • when pt “conscientiously objects” and providers do NOT agree w/ contraception do NOT have to provide Rx; best scenario is to be transparent regarding policies
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3
Q

What are some ethical issues that may emerge about contraception

A
  • women forced to use contraception
  • women forced to become sterilized against their will
  • disagreement b/w partners
  • disagreements b/w pt and clinician
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4
Q

What are some ethical issues that may emerge about assisted reproductive technologies

A
  • medical risks to mother
  • donor/surrogate rights
  • pre-implantation genetic diagnostic screening
  • donation/destruction of embryonic tissue
  • # of embryos implanted vs selective reduction
  • finances/success rates
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5
Q

What are some ethical issues that may emerge about pregnancy termination

A
  • pro-choice vs. pro-life (woman’s autonomy vs. fetus autonomy)
  • Roe vs. Wade=right to make own choice regarding pregnancy termination
  • Planned Parenthood vs. Casey= upheld initial Roe ruling but stipulated states may ban abortions after point of fetal viability (23-24 weeks)
  • Hyde Amendment + barring use of federal funds to pay for abortions expect to save mothers life and in cases of rape/incest
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6
Q

Discuss maternal-fetal conflict: what is maternal-fetal conflict, and duties of providers

A
  • when caring for pregnant pts must consider risks/benefits/outcomes for both mom and baby
  • as fetus gets to viability (23-24 weeks) more compelling to consider/advocate for fetus
  • concern for fetus should NOT lead to inappropriately withholding effective therapies for mom
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7
Q

What are some ethical issues that may emerge about maternal-fetal conflict

A
  • lifestyle conflicts (smoking, drinking, illicit drug use)
  • tx refusal by pregnant pt
  • pt declared “brain dead”
  • when fetus is considered “a person”
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8
Q

Which organization feels health providers and policy makers need to use advocacy of health behavior rather than punative action to manage maternal-fetal conflict

A

-ACOG

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9
Q

What are some reasons to have prenatal diagnostic testing done

A
  • possible heritable condition in 1 or both parents
  • FMHx of 1 or more heritable conditions
  • high risk population group (Ashkenazi Jewish)
  • couples are blood relatives
  • couple are anxious about reproductive risks
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10
Q

What impact can prenatal diagnostic testing have on potential or having current or future pregnancies

A

-depending if testing shows non-significant/significant genetic risks parents may/may not decide to have kids

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11
Q

Who can give consent for a child

A
  • parent’s presumed appropriate decision maker
  • have ethical/legal obligation to obtain parental permission to perform recommended medical interventions
  • parents do NOT have absolute power to refuse care though
  • ultimate goal = parental permission + child’s assent
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12
Q

When are parents not considered to have decision making power

A
  • in cases where typical supportive-loving parent-child relationship is not present
  • would need to get court appointed guardian
  • emergencies
  • clinician can act in pts best interest if parent is no available and delay of tx would lead to significant harm
  • reach age 18 in majority of states
  • minor status (emancipated minors)
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13
Q

When can clinicians break confidentiality of minors

A
  • if danger to self or others
  • if in dangerous situation (abuse or neglect)
  • for absence notes (need to miss school; no need to disclose dx or reasoning)
  • for note to use meds at school
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14
Q

What should be done when provider and parent disagree

A
  • try and persuade parent/guardian to accept effective/appropriate care
  • further response depends on specific case (may involve court or ethics committee)
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15
Q

What should be done when child refuses tx

A
  • response depends on:
  • seriousness of clinical situation
  • effectiveness of tx
  • side effects of tx
  • side effects of NOT receiving tx
  • reasons behind refusal
  • parents preferences on tx
  • difficult to force long term tx (inhalers, insulin)
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16
Q

Describe typical gestation, term gestation, and pre-term

A
  • typical gestation= 40 weeks
  • term gestation=37 weeks
  • pre-term= born prior to 37 weeks
  • early= before 34 weeks
  • late=b/w 34-37 weeks
17
Q

Describe low birth weight, very low birth weight, and extreme low birth weight

A
  • low BW = <5.5lbs
  • very low BW= <3.3lbs
  • extreme low BW= <2.2lbs
18
Q

How has increased access to highly specialized NICUs affected low birth weight infant survival/mortality rates

A

-has led to shift from high mortality rate to high morbidity rate

19
Q

What are the factors to consider when providing aggressive care to very low borth weight infants or critically ill infants

A
  • chance that therapy will be successful
  • risks associated w/ tx and non-tx
  • degree to which therapy, if successful, will extend life
  • pain/discomfort associated w/ therapy
  • anticipated QOL for the newborn w/ and w/o tx
20
Q

What are the ethical issues surrounding very low birth rate babies

A
  • significant acute/chronic medical conditions
  • parental autonomy
  • best interest of infant
  • financing/rationing of care
  • autonomy of provider
21
Q

What is Baby Doe Regulation of 1985

A
  • allows withholding of care in infants <1 y/o if:
  • infant is irreversibly comatose
  • tx would prolong dying
  • tx would be futile in terms of survival
  • tx would be ineffective in correcting all nonthreatening conditions
22
Q

What is Born Alive Infant Protection Act of 2002

A
  • complete explusion of infant at any stage of development that has a heartbeat, pulsation of umbilical cord, breath, or voluntary muscle movement
  • law offers protection for these cases
23
Q

What are mature minors

A
  • depending on state can make own medical decisions
  • can seek evaluation/tx for physical/sexual abuse, substance abuse, STIs, contraception, pregnancy, and mental illness w/o parental consent
24
Q

What are emancipated minors

A
  • conditions vary by state

- usually when child had married, been in armed forces, or been pregnant

25
Q

What are emancipated minors based on PA law

A
  • at least 16 y/o who have:
  • left parental household
  • established themselves as separate entities
  • capable of acting independently w/o parental conduct
  • an orphan who is at least 16 y/o and acts responsibly
  • minor who is married
26
Q

What is Mature Minor Doctrine of 1967

A
  • allows minors w/ adequate decisional capacity and understanding of their condition the right to consent to tx w/o parental permission
  • requires minor to be at least 16 y/o in most states; sometimes as young as 14 y/o
27
Q

What is Doctrine of Parens Patriae

A
  • state may act as parental authority for child’s best interest
  • allows for abused/neglected kids to be removed from their situations
28
Q

T/F - All states and DC allow young people to consent to STI services

A

True though some states still require parental notification if not 12 or 14 y/o or older

29
Q

T/F - 18 states, including NJ, PA, and DE, allow but do not requirea physician to inform a child’s parents that they are seeking/recieving STI services when deemed in pt’s best interest

A

True

30
Q

T/F - 32 states and DC explicit allow all individuals younger than 18 y/o to consent to prenatal care

A

True

31
Q

T/F - 21 states do NOT require parental permission to consent to abortion

A

False, 21 states require at least 1 parent provide consent before a child (<18 y/o) can obtain an abortion

Legal and Ethics Issues for PAs (8 decks)

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