Term
| Identify guidelines for analyzing ethics cases |
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Definition
a. Identify Pertinent Clinical and Social Facts
b. Identify Alternative Resolutions of the Ethical
Problem(s) or Issue(s), Each of which is Consistent with Known Clinical and Social Facts
c. Identify the Best Resolution of the Ethical Problem(s) or Issue(s)
d. Justify the Conclusion that the Chosen Resolution is the Best
i. Assess each alternative from the perspective of the relevant ethical standards and values: Which values and standards does each alternative sustain and/or undermine?
ii. Present reasons for concluding that the favored alternative is the best—i.e., is superior overall in sustaining and not undermining the relevant ethical standards and values.
e. Eg, Does the action uphold or violate the patient’s
i. Respect for autonomy (self-determination)
ii. well-being
iii. Is the physician acting Honesty/telling the truth |
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Term
| Identify and explain the components of informed consent |
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Definition
1) Decision-making capacity
Note – patients authorization can be obtained only if they are competent, and this DMC can vary depending on the decision to be made and their often fluctuating mental state
b. Comprehension
c. Voluntariness
NOTE- “Neutrality” is not required from physicians or family.
d. Assent
Patient accepts medical intervention |
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Term
| Identify a physician’s roles and responsibilities in relation to informed decision making |
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Definition
a.They need to provide:
i. An explanation of the patient's current medical condition
ii. An explanation of the nature of a recommended or proposed treatment as well as alternative treatment options (including non treatment)
iii. An explanation of the expected benefits and risks associated with each treatment option (including non treatment) and probabilities, if known
iv. The goal: to facilitate patient understanding
b. Physicians should also help patients by addressing their fears and helping patients identify their values and priorities |
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Term
| Identify the values underlying confidentiality |
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Definition
1) Trust
2) Privacy
3) Autonomy |
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Term
| Identify the scope of confidentiality |
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Definition
1) Information can be shared with other members of the health care team without breaching confidentiality. This includes for treatment, payment, and health care operations according to (HIPPA)
2) LIMITS and MANDATED REPORTS
i. Gunshot wounds
ii. Specified STDs and other infectious diseases
iii. Suspected child abuse |
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Term
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Definition
All 3 Branches of Gov’t Make Law
1) Legislature- Statutes
2) Executive- Regulations (requires statutory basis)
3) Judicial- Cases (case law or common law) |
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Term
| What is the difference between civil and criminal law? |
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Definition
1) Civil- private parties prosecute based on violations
2) Criminal (state prosecutes)- Crime is a wrong against the state and prosecution by the state |
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Term
1) What is Tort Law (3 examples)
2) What is the function of Tort law |
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Definition
Tort involves harm done by an individual to be remedied by an individual (example of civil law). Examples include intentional harm, negligence and strict liability.
2) Tort law ESTABLISHES precedent (binding in-state)
Deterrence
Retribution
Compensation
Loss Spreading
Punishment + Rehab |
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Term
| What constitutes medical negligence? |
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Definition
Bad outcome is NOT ENOUGH! Must have 4 elements
i. Duty – must have doctor-patient relationship with injured party which establishes the duty to give reasonable care
ii. Breach – the lack of reasonable care provided based on the professional custom or standards
iii. Causation - Harm to the patient must be caused by the doctor’s conduct
iv. Damages – The patient must suffer from bodily harm and can be compensated for medical expenses, lost wage, as well as pain and suffering and punitive damages |
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Term
| What are 2 obligations of informed consent |
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Definition
1.Duty to obtain consent- Failure to do so is a battery
2.Duty to disclose information to patient- Failure to do so is negligence |
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Term
| What is the extent of the right to refuse treatment (RRT)? |
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Definition
Virtually absolute
1) not limited to incurable patients (eg, State v. McAfee – refusal of ventilator, in today’s readings)
2) includes curable patients too (eg, Fosmire v. Nicoleau – refusal of blood transfusion, in today’s readings) |
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Term
| What is the significance of Dax's case? |
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Definition
| Severe burn victim who wished to die and was not allowed to. Good example of the dangers of medical paternalism |
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Term
| What are two reasonable standards to follow when determining whether information should be disclosed to a patient? |
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Definition
1. “Materiality” standard: What a reasonable patient would find material to making a decision (Pa.)
2.“Customary” standard: What a reasonable physician would disclose (as in malpractice law) |
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Term
| What are a few exceptions to the general rule of informed consent? |
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Definition
1) Emergency- try and get consent in absence of disclosure
2) Incompetency
3) Waiver- BUT: Patient must know that he/she has the right to information and right to decide before waiver is valid
4) Therapeutic privilege - some information can be withheld if it causes unneeded distress |
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Term
| Understand government involvement in regulating and financing artificial reproductive technology |
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Definition
1) NO insurance support
2) Does not fun research (poor evidence-based treatment)
Doesn’t allow time to evaluate impact on medium to long term outcomes (patient and offspring) |
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Term
| What are a few exceptions to the general rule of informed consent? |
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Definition
1) Emergency- try and get consent in absence of disclosure
2) Incompetency
3) Waiver- BUT: Patient must know that he/she has the right to information and right to decide before waiver is valid
4) Therapeutic privilege - some information can be withheld if it causes unneeded distress |
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Term
| Understand how the supreme courts decision in planned parenthood vs casey (1992) modified Roe’s constitutional framework |
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Definition
1) 3 central provisions:
“informed consent” and 24 hour waiting period
Parental consent for minors
Husband notification for married women
2) substantially revises Roe
The right from the outset is only a right to stop the state from imposing an undue burden
The state’s interest in protecting fetal life is present from the onset
Viability is the key marker for when the state can ban abortion entirely, with a life/Health exception
3) The Casey Framework
Before viability, restrictions on abortions only violate the right if they impose an undue burden
But even restrictions that do not impose an undue burden still must have an adequate exception for medical emergencies
After viability, the state can ban abortion to protect fetal life
As long as there is an exception for the life/health of the woman |
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Term
| What is "dilation and evacuation" |
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Definition
Partial-birth abortion
i) Cervical dilatation
ii) Fetus positioned for a footling breech
iii) Fetus is partially pulled out, starting with the feet, as far as the neck
iv) The brain and material inside the skull is evacuated so that a dead but otherwise intact fetus can be delivered to the vagina |
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Term
| Stenberg v. Carhart (2000) What it is and why was the decision made? |
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Definition
1) The Court struck down Nebraska’s law preventing “partial birth abortion” unless necessary to save a woman’s life
The law made it a felony for a doctor to intentionally deliver a living unborn child or a substantial portion thereof into the vagina for the purpose of a procedure which the doctor knows will kill the unborn child
2) i) The Court held the law unconstitutional for 2 reasons
the law lacked an adequate exception for preservation of the woman’s health; some expert testimony showed alternatives would increases women’s health risks
the law was vague about whether it applied to D&E (most common second trimester |
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Term
| What is the partial-abortion act (2003)? Gonzales v. Carhart? |
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Definition
ii) Prohibits intact dilation and extraction
Provides that any physician who knowingly performs a partial birth abortion may be fined and/or imprisoned for up to two years.
Gonzales v. Carhart (2007) upheld the act |
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Term
| What types of "advance directives" are relevant for the right to refuse treatment? |
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Definition
1) Living Wills
2) Health care powers of attorney |
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Term
| What are the major differences between passively and actively withholding treatment? |
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Definition
1) Passive
Legal to withhold and withdraw care, including artificial nutrition and hydration (ANH is a medical treatment)
Double effect is legal
2) This is criminal (includes active euthanasia by lethal injection and assisted suicide by lethal prescription).
Even if legal, it is against the medical ethical standard (??) |
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Term
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Definition
| It is considered "Passive hastening of death" if a physician prescribes a medication that is meant to relieve pain in a chronically ill patient, and it also has the side-effect of hastening death. |
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Term
| Where is "active hastening of death" practiced legally and what are the restrictions? |
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Definition
Oregon (Federal gov left it up to states)
- must be 18 years old
- a resident of oregon
-capable of making and communicating health-care decisions
- Diagnosed with a terminal illness that with lead to death within 6 months
- must have 2 oral requests to physician
- a written request, signed by 2 witnesses
- confirmation of physician (determination of capability)
- physician must "request" patient to inform next-of-kind |
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Term
| What are some threats to professionalism? |
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Definition
1) Financial self-interest
2) Demand for efficiency
3) Commodification of care
4) Fear of malpractice |
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Term
| What are the functions of professional associations? What are some threats? |
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Definition
1) Guarantee quality
2) Advise public
3) Protect professional association members
1) Conflict of interest
2) Political lobbies |
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Term
| What can be examples of "threats to physician accountability"? |
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Definition
1. lack of consequences
2. excessive consequences
3. failure of self-regulation |
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Term
| What was the Tuskegee syphilis study and why does it a good example of "threats to professionalism"? |
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Definition
Course of untreated syphilis in African American sharecroppers
- poor people offered "free medical care"
- guaranteed burial when they died
- CONTINUED AFTER TREATMENT BECAME AVAILABLE |
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Term
| What are examples of Ethical threats to professionalism during WW11? |
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Definition
Germany- exposed prisoners to extremes of temperature, mutilating surgery and deliberate infection.
Japan- exposed prisoners to frostbite, vivisection, plague, and biological weapons testing. |
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Term
| How can one be "ethical" (hint: three main points). |
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Definition
Respect for
1) Persons
2) Beneficence- "do unto others"
3) Justice |
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Term
| What is the Nuremberg Code (1948)? |
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Definition
1) Voluntary consent is essential
2) Minimization of potential harm
3) Favorable risk/benefit ratio
4) Qualified investigators
5) Appropriate design |
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Term
| What is the National Research Act? |
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Definition
| Identified basic principles that should underlie research in biomedical research |
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Term
| In which areas of medicine is substance abuse the highest? |
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Definition
| Anesthesiology, ER, Psych (best access!) |
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Term
| If one suspects a colleague of substance abuse, what is the correct course of action? |
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Definition
Most hospitals have confidential physician health or wellness committees.
Treatment in centers usually involves 2-3 day acute detoxification under medical supervision and attendance at 12 step support meetings. |
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Term
| What are the four generations currently participating in medical education? |
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Definition
1) Traditionalists (born 1925-1945)
Practical, patient, loyal, hardworking, respectful to authority
2) Baby Boomers (born 1946-1964)
Traditional upbringing, work hard for personal satisfaction, $ , title and recognition are important. Equate professionalism with work ethic- job above all else.
3) Gen X (born 1965-1980)
- 2 career families: parents are workaholics
- Time and leisure are priorities
- Cynical about authority
- Unclear gender roles
4) Millenials (born 1981-present)
- Hopeful
- Meaningful work important
- Tech-savvy
-Less self-reliant
- Education |
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Term
| What important tenants of professionalism can be subject to differential, "generational" interpretations? |
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Definition
1) Altruisms
2) Excellence
3) Accountability
4) Duty
5) Honor and Integrity
6) Respect for others |
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Term
| What is a QALY and how is it applied? |
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Definition
| How much you must spend to extend life by a year weighted by their quality of life |
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Term
| Why can "generalizing expertise" be problematic? |
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Definition
| Physicians are not qualified nor prepared to make certain decisions about withdrawing care (their moral code insists that they always provide the best care possible!). |
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Term
| Provide a typology for medical errors. |
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Definition
1) Diagnostic
2) Treatment
3) Preventive |
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Term
| What are some policies that exist defining health care providers' responsibilities regarding informing patients and families of medical errors? |
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Definition
1) JCAHO -patient should be informed of unanticipated outcomes
2) NQF-disclosure of unanticipated outcomes
i. Provide facts about the event
ii. Express regret
iii. Apologize if caused by error or system failure
3) National disclosure standards
i. Canada and Australia legally require informing patient of errors
d. 7 states (PA) require that institutions disclose serious unanticipated outcomes
i. PA notify patient in writing within 7days after a serious event
ii. Data is not usable as evidence of liability |
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Term
| What did the implementation of error-reporting policies in the VA hospital in Louisville KY tell us about the utility of such policies? |
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Definition
They are ethical and fiscally correct (limited the number of cases that went to court and the amount of money paid).
Includes
i. Disclosure and no fault compensation for out of pocket expenses
ii. Training for doctor
iii. Coaching for doctor
W |
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Term
| How does the acronym "SPIKES" relate to delivering bad news? |
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Definition
Setting
Perception
Invitation
Knowledge
Empathy
Summary-Support and Strategize |
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