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Ethics block 1

_______ goods are good goals by themselves Saving a patient’s life when the patient consents is a plausible example of something ________ good Intrinsic goods, intrinsically
______ goods are good as a means to accomplishing a good goal For example, scalpels are _______ that are good means for accomplishing goals such making incisions But a scalpel is not good in itself Instrumental goods, instruments
The physician has ______ _______ used to help the patient medical expertise
The patient chooses the _____ that the physician’s medical expertise helps accomplish goals
___-______ avoiding doing harm to patients Non-Maleficence
______ doing good to patients Beneficence
_______ _______ (free choice) – respecting the values that individual patients choose Patient Autonomy
_______ ensuring a fair distribution of goods, resources, and burdens Justice
[theory] Respecting people and their choices and doing one’s duty. Always treat persons as ends, and never solely as means Kant/Deontology
[theory] Bringing about good consequences for everyone Consequentialist/Utilitarian
An _____ is something valuable (like a goal) Typically, ______ are intrinsically valuable end, ends
According to Kant, persons are_____ ______ because they have free choice – i.e. because they are autonomous intrinsically valuable
It is okay to treat someone as a way to achieve your goal as long as you still _____ their _____ _____ ! respect their free choice!
3 Cases of not allowing free choices: [1]Force,[2]Coercion (a threat of force),[3]Deception, or lack of information
_______ is necessary in order for a patient to make a truly free choice Information
Justice for Kant’s theory is about ______ being agreed to freely by both parties. [With no force, coercion, or deception] transactions
A problem with Kant’s theory is that it implies that it is never _____to _____ someone acceptable to deceive someone
A problem with Kant’s theory implies that one should never _______ with a person’s_____ _____ even if it would save their life. interfere with a person’s free choice
________ is a type of ethical theory that focuses on the good and bad consequences of one’s action. It says one should consider the effects of one’s actions on everyone (both in the present and the future) Consequentialism
Consequentialism has two main parts _____ _______ and maximizing ________ consequences Considering everyone and maximizing good vs. bad consequences
One simple value theory is that pleasure=good and pain=bad This value theory is called ______ hedonism
_______ is the version of consequentialism that uses the value theory of hedonism (pleasure=good and pain=bad) Utilitarianism
________ says to do the action that results in the maximum sum of pleasure vs. pain for everyone Utilitarianism
The standard unit of pleasure = 1 ______ 1 Hedon
Utilitarianism is actually very commonly used to set ____ based on cost benefit analysis policies
one problem with Utilitarianism is that it sometimes requires us to do ____ ____ too much
one problem with Utilitarianism is that it sometimes requires us to do something ____ ____ ethically wrong
Excessive ____ _____ to human subjects in research that will benefit many people is another example of how Utilitarianism might require one to do something that is actually wrong relative risk
Physicians should (in terms of non-maleficence) avoid taking advantage of their patients,[1]By not ......[2]By not ......., [3]By _______ and ......... [1]By not having improper relationships [2]By not charging excessive fees [3]By minimizing and disclosing conflicts of interest
The primary limitation to autonomy/free choice is the prevention of____ to ____ harm to others
_______is then a limiting factor on patient autonomy, which is required by the fact that we live in a society with many autonomous people, and we all have to get along by not harming each other and by distributing resources fairly Justice
________ was the dominant theory, where physicians simply made treatment decisions based on what the physician judged was in the patient’s best interests Paternalism
The new current standard is the_______ _______ A patient with standard levels of understanding and who can effectively deliberate on information “Reasonable Patient”?
Essentially, the patient retains ultimate authority for the choice of treatment, but a more thorough_______ takes place conversation
Author Lo says, “________ respects patient autonomy, and indeed, enhances it by improving the patient’s understanding of the situation.” Persuasion
physician may withhold information if it would severely harm the patient (ex. the physician is virtually certain the patient would kill themselves). was used in the past to withhold risks of a procedure to get the patient to agree to the procedure Therapeutic Privilege
_______ : If a patient has asked to not be informed or if a patient has asked the physician to make the choice because the patient does not want to make the choice This is should generally be avoided for serious cases Waiver
______ ______ justifies a physician making a unilateral decision (not based on the patient’s choice) to withhold or withdraw an intervention. An intervention is ______ ______ if it will accomplish no relevant medical goals.[antibiotics for virus] Strict Futility
A physician is not justified in unilaterally refusing or withdrawing an intervention if it is only futile in the ______ sense loose
Violation of informed consent counts as ______ Battery
Failing to inform a patient of risks is ______ Negligence
4 Guidelines for communication: 1.Honesty, 2.Collaboration, 3.Respect, 4.Consideration/politeness
An _______ is someone who interprets one spoken language into another spoken language interpreter
A _________ is someone who translates one written language into another written language translator
If no professional is available, then you may use an ____ ____ interpreter (an employee, yourself, or a family member) ad hoc
_____is about a patient’s right to disclose or not disclose information to a physician Privacy
_________ is the requirement that a physician not share patient information with others Confidentiality
__________is about the measures that should be taken to ensure information remains confidential This applies to spoken, written, and electronic information Security
Exceptions to HIPAA (the Health Insurance Portability and Accountability Act) are when sharing information is [3] things : [1]Necessary for treatment or diagnosis [2]Authorized by the patient [3]Required to protect others or in cases of abuse
PHI = Protected Health Information, which is any health information combined with or containing an ______ identifier [18 of them]
_____ _____ = Any person or organization that provides treatment, payment, or operations in healthcare. [Typically clinics, offices or hospitals Covered Entity
_____ _____ = Any person or organization that assists a covered entity in the provision of treatment, payment, or operations in health care Business Associate
Conditions that are _______ _______ where the physician not only has permission to breach confidentiality, but is also legally required to do so mandatory reports
Most STDs must also be reported to the department of public health so that they can engage in “_____ ______ ”. Patient names will not be revealed to previous partners who are informed that they are at risk “partner tracing”
In general, if law enforcement personnel ask for information about a patient, it should only be provided if they have a ______ warrant
Only a court can declare someone______ ______, which is an different issue than detaining or committing a person legally incompetent
Both _____ and _____ abuse are reportable because the possible victims have very little ability to escape the abuse child, elder
The only consistent requirement amongst states is that patients must self-report _____(there is then some period of time they stay off the road). So physicians can only tell patients they should self-report to the DMV. seizures
In order for a patient to make a decision in a rational way, the patient must be able to do [2] things? [1]Understand information about the situation and [2] Use reasoning to make a decision
_______is a symptom of Alzheimer's/dementia. It's also known as “late-day confusion.” their confusion and agitation may get worse in the late afternoon and evening. In comparison, their symptoms may be less pronounced earlier in the day. Sundowning 
patients who have diminished capacity to make decisions [1]Patients born with mental deficiencies [2]Patients with mental illness [3]Children [4] Patients with dementia
Physicians can usually detain patients for ~______, which allows time for psychiatric testing and a court hearing Detaining patients typically requires that a patient is a serious risk to themselves or others 48 hours
Parents and legal guardians cannot refuse _________ for a child life (or limb) saving treatment
The ____ _____ _____allows a physician to make particular case by case judgments about whether minors are mature enough to consent to treatment (based on their decision making ability) mature minor doctrine
These are all about independence from parents Having a child is generally not sufficient. Step questions assume that children in thse three categories count as full emancipation [1]Married [2]Self-supporting and living independently [3]Serving in the military
In general, a person acting in ____ ______ can give consent for treatment of a minor if a legal guardian is not available within the time treatment needs to be given. loco parentis
________ and ________ are similar documents, outlining the situations in which patients have chosen to accept or reject certain treatments Living wills, Physician Orders for Life Sustaining Treatment (POLST)
A patient can appoint a health care _____ to make decisions when the patient is not competent This is often called a _______ proxy, durable medical power of attorney
Typically, ______ are the first default surrogate. spouses
Surrogates have a duty to make decisions based on:three things [1]Decide based on the patient’s expressed wishes in any other advance directives/ wills [2] surrogate’s beliefs about the what the patient would have chosen, including the surrogate’s knowledge of the patient’s values [3] patient's “Best Interests”
______involve lack of awareness and lack of wakefulness Comas
__________ involve cycles of wakefulness and sleep, and likely involve no awareness Some studies show there may be responses to stimuli Vegetative states
Vegetative states are classified as persistent vegetative states if they last longer than approximately _______ – or if there are signs of relevant types of irreversible brain damage one month
__________ case where ruled that ________'s right to privacy included a right to refuse treatment that could be chosen by her father [surrogate]. In re Quinlan v. New Jersey Supreme Court (1976) ruled that
1988 _________ case Ruling denied the parent’s request because no living will was present and the evidence of what _____would have wanted was weak ________ wanted “clear and convincing evidence” Cruzan v. Missouri Supreme Court
In this 2003 case , ______ passed a law allowing the governor to issue a stay to prevent removing feeding tubes (if there was no advance directive and the family disagreed) Schiavo v. Florida Court
So only ~_____% of patients who receive CPR survive to be discharged from hospitals 17%
A ____________is a form or patient identification device developed by the Department of Health to identify people who do not wish to be resuscitated in the event of respiratory or cardiac arrest. Do Not Resuscitate Order (DNRO)
case of brain dead girl California ruled her legally dead due to being brain dead. family moved her to New Jersey law permits those who do not agree, religious convictions that the heart is still the sole indicator of death Mcmath
Texas case______: law forbids the removal of life support from a pregnant woman Munoz
If a person suffers irreversible____________ (the irreversible death of all brain tissue other than the brain stem), typically thought of as the death of a person [what makes you, YOU!] – not the death of an organism as a whole higher brain death
definitions of death are based on the idea of _____– NOT on permanence irreversibility
irreversible death of all brain tissue (including the brain stem. This is the current legal definition of death (in almost all countries – Japan was one of the last countries to adopt this) Whole Brain Death
4 wheeler accident->______eventually made a fairly complete recovery. 36 hours is probably too soon after serious head trauma, as edema in the brain won’t subside for several days Dunlap
is the idea that one can do something that has foreseeable consequences w/out intending those consequences. typically one could have a main intention, such as relieving suffering, even though there is a second effect that one foresees, such as death. doctrine of double effect
The __________ then implies that a physician could provide medication with the intention of relieving pain, with a non-intended foreseeable consequence of hastening death doctrine of double effect
involves a physician providing the means for a patient to kill themselves, which the patient then uses to kill themselves (typically a prescribed drug) Physician assisted suicide
(from the Greek – eu meaning good, and thantos meaning death) is the physician administering a treatment that kills the patient “Active” Euthanasia
A non-voluntary case of euthanasia would be where a patient is ________________, and the physician kills them not competent to make a choice
A ________ is where a patient freely chooses to have a physician kill them, and the physician then kills them voluntary case of euthanasia
_________ is legal in California, Oregon, Vermont, Washington, Colorado, and Montana, (in the US) and in Switzerland Physician assisted suicide
Letting die by removing or withholding life sustaining treatment is _____ almost everywhere legal
______ is legal in the Netherlands (since 2002), Belgium, Luxembourg, and Canada Euthanasia
two major arguments (For) Pro-Euthanasia are : [1]Patient Autonomy [2] Good Consequences
A protocol developed by Dutch physicians for the euthanasia of infants. The infant’s parents consent to the euthanasia Groningen Protocol
Currently, in the U.S.A., _________ bodily material taken for legitimate clinical purposes, but not used up in tests, can be used in research without the patient’s consent or knowledge non-identifiable
Informed Consent should make sure to warn about the “_______ ______” (patients may believe that experimental treatments are superior because they are new Therapeutic Misconception
Informed Consent also requires a ______ that the subject can withdraw from the study at any time proviso
_________and______ should be avoided as the primary target for the study subjects Lower socio-economic classes , minorities
Children must also be included in studies Informed consent must be obtained from children’s parents, and the children should “______” assent
In a two arm clinical trial, neither arm of the trial should be subjected to a treatment that is believed to be worse than the other treatment So, ________is a balance of beliefs – or uncertainty Equipoise
The Nuremburg Code, the Declaration of Geneva, and the Declaration of Helsinki focused mainly on 3 things?: [1]Informed consent from study participants [2]Likely relative benefit to study participants [3]A tertiary requirement to benefit the public through sound research
(a major U.S. medical ethics document focusing on research guidelines) was released in 1978 The Belmont Report
There was a 2013 U.S. Supreme Court decision forbidding the patenting of ____ (but allowing the patenting of_______) genes, cDNA)
The study must not be ____________ There must be a rational expectation that the study will provide statistically significant results underpowered
Created by: SabaMDJuan