Term
| Truth telling with cancer pts |
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Definition
1. treatment has improved
2. less stigmatization
3. better understanding of death and dying
4. more are told because they're needed for research
5. medical literature promotes honesty |
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Term
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Definition
Cons: lack of honesty, danger to doctor patient relationship
Pros: might work in situations with high response, if the patient insists on a medication, and if the only alternative is continued illness |
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Term
| Basic goals of medicine (8) |
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Definition
1. protecting health
2. preventing disease
3. preventing untimely death
4. relieving symptoms
5. curing disease
6. improving functional status
7. educating/counseling patients
8. avoiding harm |
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Term
| Active killing vs Allowing to die- how is there a difference? |
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Definition
1. beneficence- consequences of permitting active killings?
2. the duty to avoid killing in medicine
3. letting die is the request of the patient, active killing is never part of patient autonomy |
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Term
| Active killing vs. Allowing to die- how is there not a difference? |
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Definition
| 1. consequentialists- argue that there is no difference because the end result is the same |
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Term
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Definition
1. deductive approach (top-down)
2. principles applied come from traditional ethical theories |
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Term
| Principalism pros and cons |
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Definition
Pros- each principle is based on moral theory, not one principle has supremacy, no prima facie obligations/no absolutes
Cons- too mechanistic, no pre-established theoretical weights |
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Term
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Definition
1. case based approach
2. stresses the particularity of cases rather than theory |
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Term
| Principles of Biomedical Ethics |
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Definition
1. Respect for autonomy
2. Beneficence
3. Non-maleficence
4. Justice |
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Term
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Definition
1. free action
2. authenticity
3. effective deliberation
4. moral reflection
patient preferences, free from duress or force/manipulation |
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Term
| Infringement on autonomy could be justified... |
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Definition
1. harm principle- preventing the person from harming others
2. paternalism principle- prevents a vulnerable person from harming themselves (extreme paternalism- act to benefit that person)
3. legal moralism- prevents a person from acting immorally
4. social welfare principle- acting for the benefit of others |
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Term
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Definition
-inherent in the role of health care professionals
-should physicians have to sacrifice their own self interest and welfare for the sake of beneficence? |
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Term
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Definition
-"interference of a state or another person with another person against their will, and defended or motivated by a claim that the person interfered with will be better off or protected from harm"
-protecting patients from themselves
-used mainly in the ER |
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Term
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Definition
Prohibitions on surgery, giving deadly drugs, and abortifacients
"the physician should benefit the patient according to ability and judgement"
art as a calling, loyalty to one's professional group, and beneficence/non-maleficence (do no harm) |
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Term
| ACGME professionalism requirements |
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Definition
1. demonstrate respect, compassion, and integrity; responsiveness to the needs of patients and society that supersedes self interest; accountability to patients/society, commitment to excellence
2. commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent and business practices
3. demonstrate sensitivity and responsiveness to patients' culture, age, gender, and disabilities |
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Term
| Charter on professionalism- Commitment to... (9) |
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Definition
1. professional competence
2. honesty with patients,
3. confidentiality
4. maintaining appropriate relations with patients
5. improving quality of care
6. a just distribution of finite resources
7. scientific knowledge
8. maintaining trust by managing conflicts of interest
9. professional responsibilities |
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Term
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Definition
philosophically- an understanding of how suffering, disease, and illness are affected by multiple levels of organization, from the societal to the molecular
practical- a way of understanding the patient's subjective experience as an essential contributor to accurate diagnosis, health outcomes, and humane care
(biomedical model- opposite) |
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Term
| Patient-centered interviewing |
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Definition
| patients express what is most important to them, including personal concerns and symptoms. Physician allows the patient to lead the conversations |
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Term
| Doctor-centered interviewing |
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Definition
| physicians take charge to get symptoms, details, and other data to identify the disease. personal concerns are ignored and discouraged to make purely a disease diagnosis. |
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Term
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Definition
1. understanding
2. evaluation
3. reasoning |
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Term
| Legal incompetence and legal incapacity |
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Definition
-incompetence: when a person has been judged by a court to be completely unable to take care of himself
-incapacity: used to designate those whose individual limitations do not restrict their cognitive abilities or live activities |
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Term
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Definition
-the individual abilities of the patient
-the requirement of the task at hand
-the consequence likely to flow from the decision |
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Term
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Definition
1. a patient is judged capable based on the outcome of his decision
2. a patient is judge based on his category or status
3. recognition of the patient's functional ability as a decision maker |
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Term
| Who makes the decision for the incapacitated? |
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Definition
1. designated proxy
2. family member
3. institutional committee
4. the court |
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Term
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Definition
-first case to move toward informed consent
-woman did not want surgery to remove her fibroid tumor, physician removed it anyway during another surgery
-patient sued for damages, did not win because no harm was done
-Justice Cordoza: physician acting with no consent has committed assault
-no mention of informed consent |
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Term
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Definition
-pt paralyzed during a translumbar aortography
-sued Stanford for failure to provide info about associated risks |
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Term
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Definition
-patient slipped on the day after ruptured disc and became paralyzed
-sued hospital/physician for failing to disclose possible risk of paralysis
-gives principles to physicians about what to tell patients when covering risks |
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Term
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Definition
-Situation: understanding of the medical situation
-Treatment: understanding of the treatment, risks, and benefits
-Alternatives: alternative treatments
-No treatment: consequences of refusing treatment
-Decision: an ability to define what values are important and weigh competing values to reach a decision
-Articulate a decision: communicated to doctor
-Reasonable
-Durable |
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Term
| Exceptions to informed consent |
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Definition
1. legal requirements
2. emergencies where circumstances do not allow for disclosure
3. therapeutic privilege: the doctor feels like disclosure would present a threat to the patient's wellbeing
4. waivers: pt can waive the right to have a say in deciding treatment
5. lack of mental stability, psychological problems |
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Term
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Definition
-man who killed his former girlfriend, Tarasoff, after threatening to do it in a psychotherapy session
-Family sued the therapist, the court decided the in this case the therapist had the power to stop the murder
-now: clinicians are required to consider how big of a threat the patient is |
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Term
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Definition
argues that confidentiality in medicine is decrepit
-physicians also have an obligation to society
-more technology requires bigger teams to treat a patient
-diagnoses now factor in psychological, social, and economic problems |
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Term
| Main barriers in communication |
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Definition
1. anxiety
2. futility
3. time
4. reluctance to bother the doctor
5. language
6. memory |
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Term
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Definition
| not global. capacity is decision specific, time specific, can fluctuate, and can enhance in specific situations |
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Term
| Moore vs Regents of the University of California |
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Definition
| doctors have a duty to inform patients of research interests deriving from treatment, that a person's consent to treatment requires complete information |
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Term
| Behringer vs. The Medical Center of Princeton |
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Definition
| physician must disclose his HIV positive status to patients during the informed consent |
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Term
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Definition
| patient did not have full informed consent, no risks, and physician's past alcohol abuse was not revealed |
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Term
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Definition
-permanent/irreversible cessation of breathing and heartbeat and the absence of pulse/blood flow
-reflexes are not there, pupils are fixed |
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Term
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Definition
coma/absence of spontaneous breathing or reflexes
flat EEG
loss of function in brainstem and higher brain |
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Term
| problems with whole brain death |
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Definition
-EEGs can still show brain activity
-hypothermic
-Orthodox Jews object to the definition |
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Term
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Definition
permanently comatose with working brainstem
NOT a criterion for death |
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Term
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Definition
| unreceptive and unresponsive to stimuli |
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Term
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Definition
-permanent loss of higher brain function with working brain stem
-capable of involuntary movements
-lack of mechanisms for sensory input or feeling |
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Term
| Harvard Criteria for whole brain death |
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Definition
-unreceptive and unresponsive to all stimuli
-no spontaneous movement of breathing
-absent reflexes
-isoelectric EEG |
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Term
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Definition
came home drunk, took drugs, put on a ventilator with no improvement for months
lived for 10 years after the ventilator |
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Term
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Definition
PVS after she was resuscitated after a car accident
No recovery after 4 years on a feeding tube
should they remove the tube? what is clear and convincing evidence? |
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Term
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Definition
broke her hip, placed on a ventilator
physicians tried to wean her, failed and she suffered brain damage
physicians wanted to take her off, family did not
must doctors do what patients/family ask even when it's seen as futile? |
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Term
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Definition
anencephalic baby
hospital thought tmt was futile, wanted a DNR
mother refused the DNR and demanded they ventilate
definition of death? was the baby alive? was it futile? |
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Term
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Definition
coma after intestinal surgery
family wanted to remove everything after two days
complaints as to how it was handled, whether it was too soon or not
was tmt futile? what was the evidence that he wouldve wanted tubes removed? |
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Term
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Definition
Robert Wenland, comatose for 14 months and woke up with serious problems and needed a feeding tube
He said he did not want to die but was answering other questions wrong and family wanted to remove feeding tube
died of pneumonia while the case was being deliberated |
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Term
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Definition
cardiac arrest and massive brain damage in 1990
8 years later the husband wanted to remove the feeding tube, parents did not because they thought Terri was conscious
discrepancies as to whether or not she was pvs or semi conscious
is nutrition and hydration morally obligatory to those in vegetative states? was she conscious?
JP2 said it was morally obligatory |
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Term
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Definition
leukemia, guardian recommended against it because burdens outweighed benefits
court agreed that extraordinary measures should not be used if the pt will not recover |
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Term
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Definition
PVS after inhaling a balloon
family asked that the respirator be removed but the lawyer required that the hospital continue tmt
father removed the son from the ventilator and threatened approaching people with a gun
after the autopsy it was revealed that samuel was brain dead when he arrived at the hospital
lawyer/law's responsibility vs patient interests |
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Term
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Definition
terrible past medical history, fell into a coma before surgery
daughter said to do everything, physicians disagreed and one tried to wean her from the ventilator
daughter sued for neglect and emotional distress, jury sided with doc and physicians because rescucitation would have been futile
do advance directives (DNR) trump everything? |
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Term
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Definition
| morally required, common, simple, cheap |
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Term
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Definition
| morally expendable, uncommon, complex, expensive |
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Term
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Definition
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Term
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Definition
| burdens outweigh benefits |
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