Week 20

Question 2

what is the definition of veracity

Answer 2

truthfulness or honesty; esp. when consistent or habitual; OR Habitual truthfulness

Question 3

what is the medical rationale (According to Kerrudge) to tell the truth?

Answer 3

Respect of persons; Fully informed decisions; Help maintain tract in Doctor-Patient relationship

Question 4

what is the definition of lying according to Stanford encyclopaedia of philosophy?

Answer 4

To lie is to make an assertion that is believed to be false to some audience with the intention to deceive the audience about the content of that assertion

Question 5

interestingly what kind of children and adults don?t understand why people should lie?

Answer 5

Autistic children and adults; due to their limited understanding of social behaviour they do not understand why people would lie

Question 6

describe the theory of mind

Answer 6

Ability to automatically and spontaneously attribute mental states to others; & predict what they will do from this

Question 7

what did Janet say about keeping ideas inside?

Answer 7

Keeping ideas inside & inaccessible marks the realisation of the boundary between self & others

Question 8

which is more important for self-boundary development; Lying or Secrecy?

Answer 8

Secrecy more important than lying for self-boundary development (lying can be imitated)

Question 9

sharing secrets with intimates can be? Because?

Answer 9

An early means of developing connectedness; Connectedness implies separate selves; Emerging sense of privacy leads to group formation

Question 10

Primate groups with greater cooperation also have? Because?

Answer 10

Higher rates of deception because cooperation itself permits the evolution of the liar

Question 11

Lying works well if?

Answer 11

Lying works well if liars don?t get too common or too brazen. If they do; the cooperative edifice collapses.

Question 12

Society depends on?

Answer 12

truthfulness

Question 13

Lies are inherently hard to? And prone to?

Answer 13

Lies are hard to sustain and prone to backfiring

Question 14

Lying confers what on the liar? It removes what from the deceived?

Answer 14

Lying confers power on the liar & removes power from the

deceived

Question 15

describe the Kantian position of lying. What are some issue with this position?

Answer 15

Truthfulness is a duty; No lie can be justified; The problem is that this can create a conflict of duties (lying to a Nazi) or Lying to save life

Question 16

describe the utilitarianism position on lying

Answer 16

Generally good not to lie; but exceptions depend on consequences; White lies arguably harmless or beneficial

Question 17

what are some examples of withholding the truth? Is this considered lying?

Answer 17

risks of treatment ? therapeutic privilege; placebos in research; poor performance of colleague; non-disclosure of medical error; Yes it is considered lying

Question 18

what are some examples of deceiving or defrauding?

Answer 18

up-coding; Medicare fraud; false certificates; exaggerated certification

Question 19

describe the origins of confidentiality; breaching confidentiality is? Breaching must be minimised to?

Answer 19

Fidelity rooted in psychological importance of secrets for formation of groups; Breaching confidentiality is to break a promise: a form of lying; Breaching must be minimised to maintain trust

Question 20

why is there no explicit direction on veracity with a sick or dying patient?

Answer 20

information is an element of therapeutic armamentarium; & variable use of information can be used to minimise harm; harm minimisation justifies withholding information; bad news etc.

Question 21

why is veracity when dealing with the sick and dying more prevalent and demanded now?

Answer 21

more patient autonomy; more educated patient; team treatment (more involvement with others who may have deferent opinions about the subject)

Question 22

describe therapeutic privilege

Answer 22

A therapeutic privilege (or therapeutic exception) refers to an uncommon situation whereby a physician may be excused from revealing information to a patient when disclosing it would pose a serious psychological threat; so serious a threat as to be medically contraindicated.

Question 23

what is the court case that strictly limited therapeutic privilege?

Answer 23

Rogers v Whitaker; Whitaker saw an ophthalmic surgeon to correct a childhood injury; surgeon did not disclose a risk of total sight loss; patient lost all sight (not sure how that relates)

Question 24

what case determined that Therapeutic ?privilege? is not a privilege but an obligation not to harm

Answer 24

Battersby v Tottman

Question 25

what is the general guidelines suggested for veracity with a patient who is sick or dying?

Answer 25

duty of veracity should not always be to tell the bald truth; staged disclosure often helpful; “professional optimism? acceptable ? but limits; withholding apologies no longer legally tenable

Question 26

what are some types of certificates or forms we as doctors may fill out?

Answer 26

Sickness; Insurance assessments; WorkCover’s; Driving licences; Death certification; Cremation forms; Mental health legislation; Social security / Centrelink ? disability & other pensions; Notifications; Request forms (imaging; pathology); Medicare claims

Question 27

society licenses doctors to certify a range of things; this is based on? That is based on; this social power presupposes?

Answer 27

based on trust in doctors to make judgments; this trust is based on medical expertise and professional integrity; This social power presupposes veracity

Question 28

false certification is a ________ and is subject to _________

Answer 28

False certification is a crime & subject to discipline

Question 29

what are some pressures that are placed on doctors to falsify or exaggerate certificates?

Answer 29

patient pressure; time pressure; easier path to follow

Question 30

there is an ethical and legal requirement to disclose errors; where do these come from?

Answer 30

Good Medical Practice (ethical); Civil Liability Act 2003 (Legal)

Question 31

Telling the truth to patients means?

Answer 31

Providing information that is materially relevant to individual patients

Question 32

According to the Good medical Practice (Code of conduct for doctors in Australia); what should a doctor do when an adverse event is recognised?

Answer 32

Once an adverse event is recognised; doctors are to explain ?to the patient as promptly and fully as possible what has happened and the anticipated short-term and long-term consequences?.

Question 33

The Good Medical Practice is silent on?

Answer 33

apologies

Question 34

Describe Open Disclosure (according to the Nation open disclosure framework)

Answer 34

Open disclosure is the open discussion of adverse events that result in harm to a patient while receiving health care with the patient; their family and carers.

Question 35

The elements of open disclosure are (according to the Nation open disclosure framework)?

Answer 35

an apology or expression of regret; which should include the words ?I am sorry? or ?we are sorry?; a factual explanation of what happened; an opportunity for the patient; their family and carers to relate their experience; a discussion of the potential consequences of the adverse event; an explanation of the steps being taken to manage the adverse event and prevent recurrence

Question 36

An Apology or expression of regret should? (according to the National Open Disclosure Framework)

Answer 36

as early as possible; to patient; family; carers; should include the words ?I am sorry? or ?we are sorry?; must not contain speculative statements on causes of event; admission of
liability or apportioning of blame; wherever possible; people directly involved in the adverse event should provide apology or expression of regret; sincerity is the key element for success? skills are often not innate; and may need to be practised; results of reviews and investigations must not be pre-empted.

Question 37

Their can be two meaning of “Sorry” what are they? What is the meaning the NODF supports?

Answer 37

regret / sympathy / sorrow for something bad happening (NODF Supported); apologising in terms of taking responsibility / being accountable

Question 38

Lying is a powerful self-interested social strategy; but a habit of lying is difficult to maintain for most people
BECAUSE
lying leads to inconsistency; unexpected results; and consequent exposure as a liar.

A. Assertion is true; Reason is true; Correct causative link.
B. Assertion is true; Reason is true; Incorrect causative link.
C. Assertion is true; Reason is false.
D. Assertion is false; Reason is true.
E. Assertion is false; reason is false.

Answer 38

Assertion is true; Reason is true; Correct causative link.

Question 39

List five general social/medical purposes served by different types of medical certification. Give an example for each general purpose.

Answer 39

1. Justification of absence of inability to attend/work: sickness certificates
2. Pursuit of public health goals: statistics; certification of diseases etc.
3. Provision of entitlements: social security/disability certification
4. Ensuring safety: driving license certification eg for elderly; people with medical conditions
5. Financial recompense: Medicare claim forms
6. Treatment of the mentally ill: involuntary treatment certification
7. Others

Question 40

Briefly describe three (3) ways in which the Australian Commission on Safety and Quality in Health Care?s conception of apologising to patients after medical error (in its Open Disclosure Standard) may be criticised (in the context of an individual doctor’s error).

Answer 40

1. It encourages apologising to the patient in the sense of expressing regret; not taking responsibility for the medical error or expressing remorse; this is an inadequate sense of apology.
2. By shielding clinicians from having to make genuine apologies; in the sense of (1) above; it fails to respond in a morally and emotionally satisfactory way; to the patient?s harm and suffering.
3. By shielding clinicians from having to make genuine apologies; in the sense of (1) above; it prevents them from adequately working through the experience of having harmed a patient.

Question 41

Apology laws; which provide protection to doctors against litigation in the context of medical error and patient harm; are equated with expressions of regret and/or sorrow in some jurisdictions
BECAUSE
patients prefer that doctors not be forced to accept blame for errors.
A. Assertion is true; Reason is true; Correct causative link.
B. Assertion is true; Reason is true; Incorrect causative link.
C. Assertion is true; Reason is false.
D. Assertion is false; Reason is true.
E. Assertion is false; reason is false.

Answer 41

Assertion is true; Reason is false.