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TERM 3- Postmidterm > Week 5 Bioethics (L40, L42, L44, L46, L48) > Flashcards

Week 5 Bioethics (L40, L42, L44, L46, L48) Flashcards

1
Q

list some useful criteria used when assessing evidence and context

A

currency, relevance, accuracy, authority (who completed it), purpose (question experiment is asking)

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2
Q

what are the 3 types of peer reviewed reports (include trial / study types)

A
  • Publication: original research report, RCTs, case studies
  • Review: meta-analysis, literature review
  • Summarization: manuals, textbooks, clinical support tools
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3
Q

list some challenges to Informed Consent

A
  • anxiety, pain
  • bias, value judgments
  • language
  • time
  • cultural difference
  • exhaustion
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4
Q

list the requirements for ethical research

A
  • valuable
  • scientifically valid
  • fair subject selection
  • favorable benefit to harm ratio
  • ethical review (IRB)
  • Respect for Persons
  • Informed Consent
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5
Q

list the goals of public health (not ethics)

A
  • promote health: prevent disease / disability
  • study determinants of health
  • develop, implement, evaluate interventions
  • alter social conditions affecting morbidity and mortality
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6
Q

list the goals of public health Ethics

A

1) balance competing interests
2) provide justification for public health policies and decisions

(social ethics, social responsibility, public trust)

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7
Q

list the 7 criteria for duty to act for physicians

A

1) expertise
2) proximity
3) effectiveness
4) lower risk or cost
5) unique (no others available)
6) severity
7) public trust

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8
Q

describe the components and reason for RCR

A

(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
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9
Q

describe how conflicts of interest affect / challenge RCR

A
  • disrupts objectivity
  • clash with academic, social, health, and other priorities
  • may report unreliable results
  • people / animals may die
  • threatens public trust
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10
Q

list the 3 responsibilities doctors/researchers have to their subjects

A

1) research is important, has equipoise (researchers are uncertain of outcomes)
2) research is well designed and implemented
3) risks and harms are minimized

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11
Q

much of the ethical principles of research in the US are derived from…..

A

Belmont Report (prompted by issues with Tuskegee Syphilis Study, 1932-72)

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12
Q

define therapeutic misconceptions and the groups that are at most risk

A

-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

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13
Q

list some groups that are vulnerable to research involvement b/c they lack freedom / capacity to choose

A
  • children / minors
  • intellectually disabled
  • elderly
  • prisoners
  • extremely poor
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14
Q

compare inducement v coercion

A

Inducement: reasons to participate in study (altruism, $$, food, ect)

Coercion: person assumes unacceptable risk b/c of undue pressure to participate

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15
Q

list the 5 themes for the future of medicine

A
  • population growth / climate change
  • science and technology
  • bioengineering and bioenhancement
  • personalized medicine (genomics)
  • commodification of medicine
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16
Q

how does physician burnout relate to empathy and professionalism

A
  • too much empathy can lead to burnout and unprofessionalism

- burnout erodes empathy and professionalism

17
Q

list the 3 pillars of medical education (include their associated competences)

A
  • medical knowledge (cognitive competence)
  • clinical skills (relational and integrative competence)
  • moral development (moral competence)
18
Q

define moral distress

A

emotional state- arises from situation where one feels the ethically correct action is different from policy or procedures

19
Q

what are the 3 signs of physician burnout

A

1) emotional exhaustion
2) impersonal attitude towards patients and coworkers
3) perceived lack of accomplishment

20
Q

list some causes/drivers of burnout

A
  • excessive workload
  • inefficient environment / inadequate support
  • loss of autonomy / flexibility
  • problems with work-life integration
  • loss of meaning in work
21
Q

list some effects of physician burnout

A
  • medical errors
  • depression / other mental health problems
  • poorer patient care
22
Q

discuss the challenges to (or questions of) the Bioethical Principles in terms of ‘Start of Life’

A
  • 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
23
Q

in the legal view, when does a fetus derive moral status

A

birth

24
Q

define the concept of personhood in regards to the ‘Start of Life’

A

bridge that connects the fetus with the right to life

25
Q

an individual plan of care includes the following:

A

-food / drink
-pain and Sx control
-psychological, social, spiritual support
(it is agreed, coordinated, compassionate)

26
Q

compare Hospice and Palliative Medicine

A
  • 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
27
Q

list the 5 key Sxs to control in advanced illnesses to optimize QOL

A

(QOL- quality of life)

  • pain
  • nausea, vomiting
  • agitation
  • dyspnea
  • retained respiratory secretions (RTS)
28
Q

list the 3 goals for care of the dying adult

A
  • clinically assisted feeding / hydration (by mouth as long as possible)
  • review and adjust meds prn (anticipatory changes)
  • bad death that was avoidable = FAILURE
29
Q

according to WHO, describe the 3 step Analgesic Ladder

A

Mild Pain- ASA, tylenol, NSAIDs

Moderate Pain- ASA, tylenol + opioids (codeine, oxycodone, tramadol)

Severe Pain- morphine, methadone, fentanyl, non-opioid analgesics

30
Q

define Physician Assisted Dying: Passive and Active

A

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)

31
Q

define euthanasia

A
  • painless killing of Pt from incurable and painful disease or incurable coma
  • Physician prescribes and administers method of death
32
Q

(T/F) in the USMLE physician assisted suicide is considered acceptable

A

F- considered to be incorrect and ethically unacceptable (even though legal is a few states)

33
Q

list the 3 limits to the refusal of treating of patient by a physician (legal duty to treat)

A
  • 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)
34
Q

list common reasons for refusing to treat patients (legal duty to treat)

A
  • practice is full
  • lack of required expertise
  • Pt can’t pay
  • Pt is disruptive / doesn’t follow Tx (‘blacklisted’)
35
Q

list the 6 exceptions to duty of Informed Consent

A

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)

36
Q

list the 4 criteria of an emergency for informed consent to be bypassed

A
  • urgent immediate need
  • Pt lacks capacity
  • no opportunity for consent from surrogate
  • no known objection
37
Q

list the reasons of terminating physician-patient relationship

A

Easy: mutual consent, Pt dismisses physician, Tx is no longer needed

Hard: ‘firing’ a Pt

38
Q

list common reasons for ‘firing’ a patient

A

noncompliance, failure to pay, verbal abuse/threats, drug seeking, failure to keep appts, violating policies, lack skills for adequate Tx, lack resources

TERM 3- Postmidterm (11 decks)

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