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Medical ethics > Week 3 > Flashcards

Week 3 Flashcards

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USMLE® Step 1 flashcards
1
Q

What is dignity?

A

Human dignity is the basic value of human beings entitling them to respect

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2
Q

Who is Josef Mengele?

A
  • Assigned to Auschwitz
  • performed research protocols using twins as test subjects throughout the
    1930s.
  • performed a broad range of agonizing and often lethal experiments
    mostly with children twins
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3
Q

What was the outcome of world wars?

A

The human being needs to be protected.

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4
Q

Explain dignity fully.

A

A state, quality or manner worthy of esteem and respect; and (by extension) self-respect
* Dignity in care means the kind of care that supports and promotes, and does not undermine, a
person’s self-respect regardless of any difference
* “being treated like I am somebody”
This includes:
* Respect
* Privacy
* Autonomy
* Self-worth

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5
Q

What are the principles of dignity?

A
  • Dignity in care is inseparable from the wider context of dignity as a
    whole
  • Dignity is about treating people as individuals
  • Dignity is not just about physical care
  • Dignity thrives in the context of equal power relationships
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6
Q

When is human dignity at risk?

A
  • In sickness
  • Decline /towards death
  • Childhood
  • Elderly
  • In prison
  • People with disabilities
  • People lacking capacity
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7
Q

Why does dignity become at risk?

A

When individuals become more vulnerable and their rights get compromised.

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8
Q

What is the aim of The Universal Declaration of Human Rights?

A

Aims to militate against oppression of people (especially minorities)

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9
Q

What do human rights do?

A

place a duty on the state & healthcare providers to
comply with minimum standards.
* Rights impose moral and legal constraints on collective social goals
(Savulescu et al, 2020)
* Claims for state provisions; Healthcare as major ethical duty

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10
Q

What is the aim of medical ethics?

A
  • Focus on doctor-patient relationship
  • Doctor’s duties of care
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11
Q

What are legal rights?

A

Human rights in national legal frameworks.

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12
Q

What is civil law?

A

Civil law concerns dealings between private individuals or groups

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13
Q

What is criminal law?

A

concerns matters serious enough to be considered
offences against the whole community

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14
Q

What is the entitlement of the patient?

A
  • The Doctor treats a Patient
  • A Patient is a Person
  • Each Person is entitled to enjoy all HUMAN RIGHTS
  • Respect and give recognition - HUMAN DIGNITY
  • In one word-BENEFICENCE meaning to do the good for his or her patient
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15
Q

Examples of patient rights being compromised.

A
  • Leaving a patient in soiled sheets
  • Leaving trays of food when the patient needs help to eat
  • Using excessive force to restrain someone in care
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16
Q

Summary

A
17
Q

Summary part 2

A
18
Q

What are the 4 principles of healthcare ethics?

A
  • autonomy,
  • beneficence,
  • non-maleficence,
  • and justice.
19
Q

What is the framework of principles?

A
  • principles are general norms that leave
    considerable room for judgement in many
    cases
  • Not precise action guides
20
Q

What is respect for autonomy?

A
  • self-rule, self-determination
  • ability to think, to decide and to act on the basis of such
    thought and decision, freely and independently
  • a medical practitioner cannot impose treatment on an
    individual for whatever reason
  • Respect for autonomy requires health professionals to
    help patients come to their own decisions and to respect
    and follow those decisions
21
Q

What does patient autonomy depend on?

A

-capacity
-necessity
-risk to others

22
Q

What is beneficence?

A
  • refers to the moral importance of
    doing good to others (patients)
  • performing deeds of “mercy,
    kindness, friendship, charity and the
    like”
  • people take actions to benefit and
    promote the welfare of other people.
  • process of ranking the available treatment options
23
Q

What are the rules of beneficence?

A

❑ Protect and defend
the rights of others
❑ Prevent harm from
occurring to others
❑ Remove conditions
that will cause harm
to others
❑ Help persons with
disabilities
❑ Rescue persons in
danger

24
Q

Autonomy vs Beneficence?

A
  • Who should be the judge of what is best for the patient?
  • Assessment of health professional vs patient’s own views
  • Divergence between medical interest/medical benefit
    and patient’s best interests/wishes/preferences
  • Medical interests; treatment and prevention of disease
  • Best interests; broader concept to
    physical, mental and social well-being
  • Include patient perspective
25
Q

What is non-maleficence?

A
  • It states that health professionals should avoid harm on
    patients
  • Most medical treatments have some chance of doing harm. It
    does not follow that such treatment should always be avoided
  • The potential benefits and harms and their probabilities need
    to be weighed up to decide what is overall in the patient’s best
    interests
26
Q

Non-maleficence vs. Beneficence

A
27
Q

What is justice?

A
  • Health professionals have to make decisions about
    distribution of time, money, clinical resources
  • The principle of justice emphasizes two points:
  • Patients in similar situations should have access to the
    same healthcare
  • In determining what level of care should be available for
    one set of patients, we must take into account the effect
    of such use of resources on other patients
  • fair distribution of resources (distributive justice)
  • Benefits and burdens should be distributed fairly
    among members of a society and with respect for
    people’s needs/rights (social justice/rights based
    justice)
28
Q

What are the two principles of John Rawl’s theory of justice?

A

(1) everyone should
be given equal liberty regardless of their adversities
(2) differences among people should be recognised
by making sure the least-advantaged people are given
opportunities for improvement.
(Equal access to healthcare services)

29
Q

How do the 4 principles interact with eachother?

A
  • The four principles are non-hierarchical.
  • For ethical clinical reasoning, one may be required to take
    all principles into account when they are applicable to the
    clinical case under consideration.
  • Yet, when two or more principles apply, we may find that
    they are in conflict
30
Q

What is the contribution of the 4 principles approach?

A
  • Identifies key principles for ethical clinical practice
  • “common morality”
  • Draws attention to the values/rights/norms underlying moral
    dilemmas
  • Reflects doctor’s duties
  • Allows for multiple moral considerations
31
Q

What are the criticisms for the 4 principles approach?

A
  • Strictly adhering to the same principles/guidelines for different
    situations can be problematic
  • the principles are nonspecific, appearing to simply remind the
    decision maker of considerations that should be taken into account
  • there is no agreed upon method for resolving conflicts when two
    different principles conflict about what ought to be done
    *The four principles should not be treated as a general moral theory,
    but rather, they assist in reflecting on moral problems and in
    moving to an ethical resolution.
32
Q

What is the structured case analysis model?

A
  • Summarise the case
  • State the moral dilemma(s)
  • State the assumptions being made or to be made
  • Analyse the case with reference to
  • ethical principles
  • consequences
  • Professional codes / virtuous healthcare practitioner
  • the law
  • Acknowledge justifiable ethical solutions and those that
    are not justifiable
  • State preferred approach with explanation
33
Q

What steps do ethical analysis compromise?

A
  1. Determine whether the issue at hand is an ethical one.
  2. Consult authoritative sources (medical association codes of
    ethics and policies, respected colleagues etc).
  3. Consider alternative solutions in light of the
    principles/duties/values/likely consequences
  4. Discuss your proposed solution with those whom it will affect.
  5. Make your decision and act on it, with sensitivity to others
    affected.
  6. Evaluate your decision.
34
Q

What is the clinical ethics committee?

A
  • Multidisciplinary and independent groups
  • Membership includes;
    = Different health professionals (majority members); Members of
    hospital management/administration; Legal member; Medical ethics
    academic; Religious representatives; Lay members
  • aim to provide support for decision-making on ethical issues
    arising from several aspects of patient care.
    = provide discussion and/or advice about complex or controversial cases
    = not take over responsibility for a clinical decision; this responsibility
    remains with the doctor/the clinical team
35
Q

What is the function of clinical ethics committees?

A

Their primary functions are
-case consultation
Urgent and non-urgent cases
-ethics education
-policy development and review
interpretation of national guidelines

36
Q

What are the frequent issues for consultation with CEC?

A
  • Withholding to withdrawing life sustaining treatment
  • consent and capacity
  • refusal of treatment and restraint issues
  • pandemic response

Medical ethics (13 decks)

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