Week 5 Bioethics (L40, L42, L44, L46, L48) Flashcards
list some useful criteria used when assessing evidence and context
currency, relevance, accuracy, authority (who completed it), purpose (question experiment is asking)
what are the 3 types of peer reviewed reports (include trial / study types)
- Publication: original research report, RCTs, case studies
- Review: meta-analysis, literature review
- Summarization: manuals, textbooks, clinical support tools
list some challenges to Informed Consent
- anxiety, pain
- bias, value judgments
- language
- time
- cultural difference
- exhaustion
list the requirements for ethical research
- valuable
- scientifically valid
- fair subject selection
- favorable benefit to harm ratio
- ethical review (IRB)
- Respect for Persons
- Informed Consent
list the goals of public health (not ethics)
- promote health: prevent disease / disability
- study determinants of health
- develop, implement, evaluate interventions
- alter social conditions affecting morbidity and mortality
list the goals of public health Ethics
1) balance competing interests
2) provide justification for public health policies and decisions
(social ethics, social responsibility, public trust)
list the 7 criteria for duty to act for physicians
1) expertise
2) proximity
3) effectiveness
4) lower risk or cost
5) unique (no others available)
6) severity
7) public trust
describe the components and reason for RCR
(responsible conduct of research)
- using established professional norms and ethical principles to conduct research
- critical for integrity of findings
- uphold public trust
- must be taught to future researchers - commitment to RCR training
describe how conflicts of interest affect / challenge RCR
- disrupts objectivity
- clash with academic, social, health, and other priorities
- may report unreliable results
- people / animals may die
- threatens public trust
list the 3 responsibilities doctors/researchers have to their subjects
1) research is important, has equipoise (researchers are uncertain of outcomes)
2) research is well designed and implemented
3) risks and harms are minimized
much of the ethical principles of research in the US are derived from…..
Belmont Report (prompted by issues with Tuskegee Syphilis Study, 1932-72)
define therapeutic misconceptions and the groups that are at most risk
-subject’s belief that enrolling in research study provides direct benefit for their disease when it may not
At risk groups: elderly, those with poor health status, those with lower levels of education
list some groups that are vulnerable to research involvement b/c they lack freedom / capacity to choose
- children / minors
- intellectually disabled
- elderly
- prisoners
- extremely poor
compare inducement v coercion
Inducement: reasons to participate in study (altruism, $$, food, ect)
Coercion: person assumes unacceptable risk b/c of undue pressure to participate
list the 5 themes for the future of medicine
- population growth / climate change
- science and technology
- bioengineering and bioenhancement
- personalized medicine (genomics)
- commodification of medicine
how does physician burnout relate to empathy and professionalism
- too much empathy can lead to burnout and unprofessionalism
- burnout erodes empathy and professionalism
list the 3 pillars of medical education (include their associated competences)
- medical knowledge (cognitive competence)
- clinical skills (relational and integrative competence)
- moral development (moral competence)
define moral distress
emotional state- arises from situation where one feels the ethically correct action is different from policy or procedures
what are the 3 signs of physician burnout
1) emotional exhaustion
2) impersonal attitude towards patients and coworkers
3) perceived lack of accomplishment
list some causes/drivers of burnout
- excessive workload
- inefficient environment / inadequate support
- loss of autonomy / flexibility
- problems with work-life integration
- loss of meaning in work
list some effects of physician burnout
- medical errors
- depression / other mental health problems
- poorer patient care
discuss the challenges to (or questions of) the Bioethical Principles in terms of ‘Start of Life’
- Autonomy: how to separate best interests of mother and fetus
- Beneficence: is living with profound life long impairment a benefit
- Non-maleficence: is life with impairment a harm
- Distributive justice: do all children get a fair chance
in the legal view, when does a fetus derive moral status
birth
define the concept of personhood in regards to the ‘Start of Life’
bridge that connects the fetus with the right to life
an individual plan of care includes the following:
-food / drink
-pain and Sx control
-psychological, social, spiritual support
(it is agreed, coordinated, compassionate)
compare Hospice and Palliative Medicine
- Palliative Care: interdisciplinary care, focusing on improving quality of life for Pts with serious illness and for their families
- Hospice: palliative care delivered under Medicare hospice benefit w/ < 6 mo prognosis
list the 5 key Sxs to control in advanced illnesses to optimize QOL
(QOL- quality of life)
- pain
- nausea, vomiting
- agitation
- dyspnea
- retained respiratory secretions (RTS)
list the 3 goals for care of the dying adult
- clinically assisted feeding / hydration (by mouth as long as possible)
- review and adjust meds prn (anticipatory changes)
- bad death that was avoidable = FAILURE
according to WHO, describe the 3 step Analgesic Ladder
Mild Pain- ASA, tylenol, NSAIDs
Moderate Pain- ASA, tylenol + opioids (codeine, oxycodone, tramadol)
Severe Pain- morphine, methadone, fentanyl, non-opioid analgesics
define Physician Assisted Dying: Passive and Active
Passive: Pt refuses Tx, physician sanctions refusal
Active: high dose opioids-double effect, intent must be to relieve suffering not to end life; Palliative sedation to unconsciousness (PSU)
define euthanasia
- painless killing of Pt from incurable and painful disease or incurable coma
- Physician prescribes and administers method of death
(T/F) in the USMLE physician assisted suicide is considered acceptable
F- considered to be incorrect and ethically unacceptable (even though legal is a few states)
list the 3 limits to the refusal of treating of patient by a physician (legal duty to treat)
- discrimination by race, religion, disability, gender, etc
- already agreed (to take patient insurance or apart of insurance network)
- other prior agreement (on-call, agreed to treat ED Pts)
list common reasons for refusing to treat patients (legal duty to treat)
- practice is full
- lack of required expertise
- Pt can’t pay
- Pt is disruptive / doesn’t follow Tx (‘blacklisted’)
list the 6 exceptions to duty of Informed Consent
1) information is well-known to Pt
2) emergency (4 criteria)
3) therapeutic privilege (disclosing risk => upset Pt)
4) waiver (Pt doesn’t want to know)
5) public health
6) conscious based objections (ex. refusing abortion due to religion)
list the 4 criteria of an emergency for informed consent to be bypassed
- urgent immediate need
- Pt lacks capacity
- no opportunity for consent from surrogate
- no known objection
list the reasons of terminating physician-patient relationship
Easy: mutual consent, Pt dismisses physician, Tx is no longer needed
Hard: ‘firing’ a Pt
list common reasons for ‘firing’ a patient
noncompliance, failure to pay, verbal abuse/threats, drug seeking, failure to keep appts, violating policies, lack skills for adequate Tx, lack resources
