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Ethics Midterm - M1

midterm for Ethics and legal topics

moral agent someone who can make the decision over whether something is wrong or right
standing descriptor for someone who has something to gain or lose from decision
morally relevant fact that would change the moral agents decision if they knew about it or the fact changed
competence can only be ruled by a judge
decision-making capacity can be determined by a pyschiatrist
deontology focus on duty
virtue theory focus on character
beneficence doing good (maximizing benefits)
non-maleficence do no harm (minimizing harm)
clinical judgement process by which discerning clinicians,faced with uncertainty, attempt to make consistently good decisions
emergent causing immediate serious (and often irreversible) consequences
non-emergent progressive, not immediately life-threatening
autonomy value that promotes respect for others' right to self-determination - NOT just giving the patient what they want but acknowledging them as individuals
justice promotes fairness
universality if everyone did X, would X be acceptable? If we do X for some folks, shouldn't we do it for all folks?
humanity are people treated as 'ends' or 'means' in doing some action
battery doctor treats competent patient without their consent
tort law touch without consent is battery
informed consent authorization free of coercion or influence by someone with adequate info and capacity to understand risk and benefits of their consent or refusal
Substituted Decision Maker (SDM) person given power of consent for individuals who can't make the decision for themselves
ansiognosia major impediment of insight due to a neuropsychological deficit (no self knowledge)
confabulation false memory due to fantasy or shame in clear conscious
evidence-based medicine using results of controlled studies to develop recommendations that will most like affect outcomes
judgement election to act
insight awareness as to one's situation
medical humanities philosophy devoted to helping MDs develop their non-clinical moral perception
epistemology study of what you know and how you know it
What is the criteria that defines someone as "persistent vegetative state" no cortical fxn (unconscious) preserved brainstem fxn (can breath and have circulation) in this state for 1 month
brain-death no cortical or brainstem stem fxn = EEG has no activity
locked-in-syndrome conscious but have no motor fxn
severe dementia may be virtually unresponsive but are conscious and have some motor fxn
3 concepts in case analysis who questions (empirical vs ethical) Facts/relevence
consequentialism the consequences of an action determine rightness or wrongness
4 approaches to ethically complex cases consequentialism deontology virtue ethics principilism
principlism seeking balance amoung autonomy, benefience, nonmaleficeince, and justice
exceptions to autonomy patient has compromised decision-making abilities; patient is bad steward of health or makes decisions with bad outcomes; patients preferences infringe on rights of others or put other in danger; minor
direction of bias with regards to patient decision making people underestimate their likely happiness when confronted with negative life conditions (and as a result may refuse life-support treatments when in good health)
5 key elements affecting health beliefs, patient preferences, and patient/MD relationship physiology, thoughts (beliefs and assumptions about illness), emotions, behaviors (dictated by physiology), environment (family,culture, stressors)
criteria for informed consent patient must be competent and informed of: rationale, alternatives, risks, benefits
when does decisional incapacity occur? patient can't comprehend/retain info related to decision or patient can't use info and weigh in balance as part of process at arriving at a decision
when is deceptive placebos ethical? condition they treat has a high response to placebos, alternative is no alleviation in illness or a drug with known toxicity, patient wishes to be treated, patient insists on a prescription
who can refuse treatment? adults who are competent, informed, and not mentally impaired
What are the exceptions to patient refusal of treatment? communicable diseases (quarantine), pregnant women (could harm fetus)
5 patient rights under HIPPA to receive notice of privacy practices; to access his/her health records; to request restrictions on how MD uses/discloses health record; to request amendments to health record; to obtain a report of certain disclosures the provider may have made
what is the "silent" patient right under HIPPa to complain to the feds!
what is your best protection against assertion of failure to obtain informed consent dictated chart note
types of disclosures under HIPPA treatment (should only be disclosed to those a part of pt's healthcare team), payment, health care operations, legally mandated disclosures, written authorization
limits to right to access looking up your own record or a family members, satisfy personal curiosity about a pt you know or the condition of a pt you are not treating, looking up pt room number to socially visit them
What did the US conference of Catholic bishops directive state in terms of hydration and nutrition to the dying patient not morally obligatory either when they bring no comfort or when they cannot be assimilated
Patient Self-Determination Act requires that patients be informed of the right to execute advance directives upon admission
advance directive legal document that states choices about medical treatment or name someone (proxy) to make decision about medical treatment if you are unable to make these decisions for yourself
living will legally binding statement signed by competent person and witnessed that tells others their directions for life support treatment - evidence of person't intent
durable power of attorney establishes a person to act as agent if pt can't. applies to all medical decisions and includes specific instructions to agent one what treatments should be refused or desired
principle of double-effect adequate pain management in the care of a dying pt may cause unintended and unavoidable side effects that may shorten the pts life
best interest standard proxy must determine highest net benefit amoung options by assigning weight of patients interests in each option and their perspective on quality of life
principle of proportionate care treatment is ethically mandatory (if consented to) to the extend that it is likely to confer greater benefits than burdens upon patient (preservation of life is more of a benefit than a burden to pt)
euthanasia action aimed at a patient's death (at that pt's specific request)- active when action is aimed at ending pt life, passive if neglect is aimed at ending pt life
Is withdrawing/withholding treatment that is no longer needed or refused by pt passive euthanasia NO
what is the gold standard in regards to the dying patient morphine
PAS Physician Assitance in Suicide - assitane in death by patient where pt has final responsibility and legal in some states
5 components of profesionalism competency, honesty, respect, compassion, service above self interest
Created by: c.phill