WEEK 25 part 2

Question 1

List 4 moral principles applied to deal with moral dilemmas

Answer 1

1. Respect for Autonomy
2. Non-Maleficence
3. Beneficence
4. Justice

Question 2

Principles are common in all kind of theories. Based on their common morality: list 4

Answer 2

1. Pluralistic
2. Universal accepted
3. Common sense moral judgment
4. ordinary shared moral beliefs.

Question 3

Describe the balancing/weighing of principles

Answer 3

o “The process of finding reasons to support beliefs about which
moral norms should prevail.”
o Compare the relative weights and strengths of the principles
o Based on good reasons, not intuition
o Useful for reaching judgments for particular cases

Question 4

Respect for autonomy define

Answer 4

Patients’ “rights to hold views, to make choices and to take
actions based on their values and beliefs.”

Question 5

Obligations arising out of this principle of respect for autonomy.
list them

Answer 5

1. Informed consent
2. Confidentiality
3. Truth telling
4. Effective communication

Question 6

one word.
Both an ethical and legal requirement

Answer 6

informed consent

Question 7

list and explain elements of informed consent

Answer 7

PRECONDITIONS
o Competence (to understand and decide)
o Voluntariness (in deciding)
INFORMATION ELEMENTS
o Disclosure (of material information)
o Recommendation (of a plan)
o Understanding (of 3 & 4)
CONSENT ELEMENTS
o Decision (for/against a plan)
o Authorisation (of the chosen plan)
o Time-consuming process
o Capacity/competence assessment may be required
o Competent patient can:
communicate a choice
understand information provided
appreciate the consequences
reason about the options

Question 8

Explain confidentiality

Answer 8

Maintaining a patient’s confidentiality is a cornerstone of the doctor-patient relationship

Question 9

List factors where confidentiality can be breached.

Answer 9

National Health Act no 61 of 2003 - can be breached:
- Patient’s written consent
- Court order or any law requires
- Non-disclosure represents serious threat to public health

Question 10

Explain TRUTH TELLING

Answer 10

HPCSA General Ethical Guidelines: Truthfulness a core value for good practice & the basis of trust
o Must not conceal the truth from a patient (unless they explicitly do not wish to be told the diagnosis)
o Disclosure of medical error & importance of good documentation of clinical notes

Question 11

Explain effective communication

Answer 11

Patient centered care and good communication skills ethical requirement for maintaining the doctor-patient relationship
o Complexities of South African multilingual & multicultural context
o Role of interpreters & ethical challenges with confidentiality

Question 12

what is meant by non-maleficence

Answer 12

Requires that we “first do no harm”
Prima facie (not absolute

Question 13

Rules arising from non-maleficence

Answer 13

Do not kill
Do not cause pain or suffering
Do not incapacitate (prevent from functioning in the normal way)

Question 14

Non-maleficence does not require us to act beneficently.
True or False

Answer 14

True

Question 15

Traditionally ______ unacceptable in medicine

Answer 15

Killing

Question 16

one word.
Casual action that results in death(intentional and wrong)

Answer 16

Traditionally killing

Question 17

what is meant by Rule of double effect

Answer 17

intention vs foreseeable unintended negative consequences

Question 18

What is meant by letting die

Answer 18

Avoiding intervention so that death occurs due to underlying disease/ organ failure/ injury (less wrong/acceptable)

Question 19

Accidental killing or self-defense
are examples of?

Answer 19

Problematic! Vague and morally confusing

Question 20

Non-maleficence also requires us to minimize ____ of harm

Answer 20

Risk

Question 21

Patients must be informed of material risk. Give the Material risk.

Answer 21

-reasonable person would attach significance if warned of it
-Doctor should have reasonably aware that patient would attach significance to if warned of risk.

Question 22

Risk may occur without harmful intent - casual agents may still be _____ or ______ responsible

Answer 22

Legally or morally

Question 23

What is meant by standard of Due Care

Answer 23

Taking appropriate care to avoid causing harm, as a reasonable and prudent person would.

Question 24

Negligence is the absence of?

Answer 24

Due Care

Question 25

Negligence can be intentional and inadvertent. To show that you understand this terms. Explain them using examples.

Answer 25

1. Intentional- eg failing to change a dressing as scheduled
2. Inadvertent- eg forgetting that patient doesn’t want to know gender of a baby.

Question 26

Negligence shown if:

Answer 26

1, Professional has duty of care to affected party
2. Duty breached
3. Harm experienced by affected party
4. Harm caused by the breach of duty

Question 27

what sis meant about Malpractice

Answer 27

if the negligence fail to follow professional standards of care

Question 28

What is meant by beneficence

Answer 28

Requires that we protect and defend the rights of patients, help patients, (act in their best interests).

Question 29

Beneficence prevent or reduces harm.
True or false

Answer 29

True

Question 30

List the implications of beneficence

Answer 30

1. Clinical competence
2. Balancing risks, benefits and costs
3. Paternalism

Question 31

Describe paternalism

Answer 31

Intentional overriding of person’s known preferences , in order to benefits or avoid harm to the person.

Question 32

Describe active paternalism.

Answer 32

Doctor overrides patient’s right to decline intervention.
-Hard: despite informed, voluntary and autonomous decision e.g refusal to respect advance directive.
-Soft: nom-autonomous decisions/ non-voluntary conduct e.g severe depression preventing rational decision-making.

Question 33

What is Passive Paternalism

Answer 33

Doctor refuses an intervention in the patient’s best interests. Easier to justify than active paternalism – doctor not obliged if patient’s request goes against acceptable standard treatment. Medical futility – if an intervention truly will not produce clinical benefit – cancels obligation to perform procedure. “Clinically non-beneficial interventions” preferred term.

Question 34

Fair treatment

Answer 34

Justice

Question 35

List obligations in 3 areas:

Answer 35

1. Respect morally acceptable laws – Legal justice
2. Respect patients’ rights – Rights-based justice
3. Ensure fair distribution of limited resources –
   Distributive justice.

Question 36

Legal and Rights-based justice: working knowledge of
relevant laws. List those act

Answer 36

o National Health Act No. 61 of 2003
o The Children’s Act No. 38 of 2005
o Mental Health Act No. 17 of 2002
o Bill of Rights, South African Constitution
o Patients’ Rights Charter

Question 37

What is meant by distributive justice

Answer 37

“Fair, equitable and appropriate distribution of benefits and burdens
determined by norms that structure the terms of social co-operation.”

Question 38

list theories of justice

Answer 38

o Utilitarian (maximise utility)
o Libertarian (individual rights)
o Communitarian (communal good)
o Egalitarian (fair equal opportunity)
o Capabilities theories (quality of life depends on what able to achieve – 10 core
capabilities)
o Wellbeing theories (justice requires sufficient well-being in health, personal
security, reasoning, respect, attachment and determination)