Term
| Name 10 ethical considerations relevant for case discussion. |
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Definition
1) Beneficence
2) Nonmaleficence
3) Autonomy
4) Justice
5) Sanctity of Life
6) Family norms
7) Relationship between patient and provider
8) Professional integrity of providers
9) Cost effectiveness
10) Religious/cultural values |
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Term
| What are the five components of decision-making capacity? |
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Definition
• Ability to understand information about illness
• Ability to evaluate therapeutic options
• Applying values to the analysis
• Communicating the decision
• Arriving at a consistent choice over time |
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Term
| Provide two of the ten myths about decision-making capacity and explain why they are false |
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Definition
• Decision making capacity and competency are the same
o Incompetency is determined by a judge, DCM is not
• Lack of DMC can be presumed when patient’s go against medical advice
o A person is not incapacitated when they don’t do what you want them to do |
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Term
| Name the three components to informed consent |
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Definition
• Decision making capacity
• Disclosure
• Voluntariness |
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Term
| Name and define the two disclosure standards |
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Definition
• Professional practice – what a group of HCPs agree to be told to the patient
• Reasonable person – what a reasonable person would want to know |
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Term
| Name and explain the three exceptions to the informed consent requirement |
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Definition
• Emergency: consent is assumed based on the assumption that the patient would want treatment
• Therapeutic exception: knowledge about the procedure would cause harm to the patient
• Waiver of consent: patient doesn't want to know |
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Term
| Name the generally accepted ethical requirements for breaking confidentiality |
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Definition
High probability of risk of serious harm
Benefit will result from breaking confidentiality
Breach is generalizable
Last resort |
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Term
| What is the Health Insurance Portability Accountability Act (HIPAA)? |
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Definition
| • Privacy regulations from federal government |
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Term
| What are two things true of confidentiality? |
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Definition
• Confidentiality is a process of communicating secret intimate knowledge (either through words or examination ) in a relationship of trust
• Confidentiality is a kind of promise that the information given will not be disclosed with the patient’s or surrogate’s permission. |
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Term
| What are the generally accepted ethical bases for the principle of truth-telling? |
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Definition
• Patient cannot make autonomous decisions if they are not given all of the information needed to make the decision.
• Patients are not able to protect what’s in their best interest if information is not given to them. |
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Term
| Why shouldn’t a PA provide healthcare to their patients while impaired? |
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Definition
| • It violates the ethical obligation of the provider to do no harm. The provider has a fiduciary relationship to the patient. |
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Term
| What are the three ways romantic and sexual relations with your patients detract from the patient-provider relationship? |
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Definition
• Exploits vulnerability of the patient
• Impairs provider’s judgment
• May be detrimental to patient’s wellbeing |
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Term
| Name two of the five ethically acceptable reasons to terminate a patient-provider relationship? |
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Definition
• Doesn’t pay the bills
• Is abusive |
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Term
| What ethical consideration should one consider as paramount when considering whether to accept a gift from industry? (review slide 40) |
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Definition
| • “Is this the best thing for my patient?” |
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Term
| Name the two widely recognized types of death |
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Definition
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Term
| Provide the definition of brain death |
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Definition
| • The absence of all critical brain function, including the brainstem |
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Term
| What are advance directives |
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Definition
| • Statements that patient’s with decision making capacity make regarding how treatment decisions should be made in the event that the patient should become incapacitated. |
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Term
| Name at least two benefits and one drawback for using living will. |
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Definition
• It lets your wishes be known
• Less stress on your family
• Can’t predict all the situations a person may be in |
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Term
| Name and explain the three standards of decision making surrogates should use when making decisions on behalf of a patient. |
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Definition
• Patient expressed wishes – the patient tells you his wishes
• Substituted judgment – inferences of judgments of how people lived their lives or certain things people said
• Best interest – if you don’t know the patient’s wishes, what would be the best for the patient? |
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Term
| What does DNR stand for? And when does it apply? |
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Definition
| • Do not resuscitate, it applies when a patient arrests |
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Term
| If a patient does not have a DNR order in place and they arrest, how should you proceed? |
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Definition
| • Full code (no slow codes, no show codes, no “blue light specials”) |
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Term
| Why is it claimed that there is no moral difference between withholding and withdrawing treatment? |
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Definition
| • Everything is the same, any argument you can put for one, you can put for the other, no difference between arguments |
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Term
| Define physician assisted suicide |
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Definition
| • Clinical facilitation of a patient’s death by providing the means and or information that enables the patient to perform an act that results in self inflicted death |
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Term
| Define euthanasia and explain the distinction between the two types? |
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Definition
• Euthanasia – relieving suffering with the intent to cause death
• Types
o Voluntary – act is performed at the request of the patient
o Nonvoluntary – act is performed without the request of the patient |
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Term
| What is the difference between euthanasia and physician assisted suicide? |
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Definition
• Physician assisted suicide – the patient is the agent
• Euthanasia – the physician is the agent |
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Term
| What is the difference between physician assisted suicide and withdrawing/withholding life sustaining interventions? |
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Definition
• Withdrawing/withholding – underlying condition kills you (like taking someone off a ventilator)
• Physician assisted suicide – lethal agent administered is what kills you |
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Term
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Definition
| • Futility exists when: there is a goal, there is an action aimed at achieving the goal, and there is virtual certainty that the action will fail |
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Term
| What is the difference between macro and micro allocation |
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Definition
• Macro is broad level
• Micro is smaller level |
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Term
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Definition
| • Allocating resources, some people that would benefit from the resources won’t get them |
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Term
| Provide the four categories of principles of rationing |
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Definition
• Treating people equally
• Favoring the worst off
• Maximizing total benefit
• Promoting and rewarding social usefulness |
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Term
| Explain and give an example of at least 5 of the 8 principles of rationing scarce resources |
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Definition
• Lottery – Each individual has the same chance of receiving the intervention
• First come, first served – whoever gets there first gets the scarce intervention, everyone has the same chance of getting there first
• Sickest first – The scarce intervention goes to the person who would be worse off without it
• Youngest first – the scarce intervention is given to the ones who are the youngest because they have more life to live
• Save the most lives – scarce intervention is given out based on how many lives can be saved |
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Term
| Explain the difference between controlled and uncontrolled donation after cardiac death |
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Definition
• Uncontrolled – sudden, we don’t know it’s going to happen, i.e. – cardiac death from a car accident
• Controlled – we control the timing of the death, i.e. – a ventilator is removed |
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