Bioethics

Front 1

two cultural developments at the root of the modern importance of bioethics

Back 1

(1) the awesome advance of biomedical research as attended by the resultant development of biomedical technology
(2) the practice of medicine in an increasingly complicated institutional setting

Front 2

define utilitarianism

Back 2

making a decision that does the greatest amount of good for the greatest amount of people

Front 3

define act utilitarianism

Back 3

a person ought to act so as to produce the greatest balance of good over evil, everyone considered. Commitment to the proposition that the interests of everyone affected by an action are to be weighed in the balance along with the interests of the agent. “situation ethics”. To maximize utility one is considered to go above and beyond the call of duty. Unrestricted. Rule of thumb

Front 4

define rule utilitarianism

Back 4

a person ought to act in accordance with the rule that, if generally followed, would produce the greatest balance of good over evil, everyone considered. Individual actions are morally right if they follow set rules that produce the greatest amount of good over evil. Restricted

Front 5

Kant’s “second formulation” of the categorical imperative

Back 5

act in such a way that you always treat humanity, whether in your own person or in the person of any other, never simply as a means, but always at the same time as an end

Front 6

define the concept of “prima facie” duties

Back 6

literally means “at first glance”. It is described as a conditional duty, and can be overridden by another prima facie duty that in a particular set of circumstances is more stringent.

Front 7

define autonomy

Back 7

the right to “self determination”. Decision makers determine for themselves what will be done to their body.

Front 8

four conditions of autonomous decisions/actions

Back 8

(1) it must be intentional
(2) it must be based on sufficient inderstanding
(3) it must be sufficiently free of external constraints
(4) it must be sufficiently free of internal constraints

Front 9

six liberty limiting principles

Back 9

a person’s liberty is justifiably restricted to:
(1) prevent that person from harming others (the harm principle)
(2) prevent that person from offending others (the offense principle)
(3) prevent that person from harming him/herself (the principle of paternalism)
(4) benefit that person (the principle of extreme paternalism)
(5) prevent that person from acting immorally (the principle of legal moralism)
(6) benefit others (the social welfare principle)

Front 10

define paternalism

Back 10

the interference with a person’s liberty of action justified by reasons referring exclusively to the welfare, good, happiness, needs, interests, or values of the person being coerced

Front 11

two plausible justifications for paternalistic interventions (weak paternalism)

Back 11

(1) when intervention is responsive to the welfare of an individual whose autonomy is significantly diminished
(2) when temporary constraint is necessary to prevent a person from acting in a self-harming and presumably non-autonomous manner until it can be determined whether the individual is, in fact, acting autonomously

Front 12

according to the Presidential Commission, three properties of health care that lead to the ethical conclusion that it should be distributed equitably three interpretations of “equitable access” to health care

Back 12

(1) equity as equality – providing everyone with the same level of health care
(2) equity as access solely according to benefit or need – everyone must receive all health care the is of any benefit to them
(3) equity as an adequate level of health care – everyone have some access to some level of care: enough care to achieve sufficient welfare, opportunity,information, and evidence of interpersonal concern to facilitate a reasonably full and satisfying life

Front 13

Thomasma’s six step methodology

Back 13

(1) describe all the medical facts of the case – research any medical facts not presented but possibly relevant to outcome
(2) describe the relevant values (goals, interests) of the physicians, patients, house staff, and society
(3) determine the principle value clash – the distinction between classes of cases is made at his point thus establishing a philosophical taxonomy
(4) determine possible courses of action which could protect as many of the values in the case as possible
(5) choose a course of action – involves ethical judgment about the relative ranking of goods. Attempt to preserve the conflicting values in the case
(6) defend this course of action based on the value it professes

Front 14

three typical functions of an ethics committee

Back 14

(1) case consultation and review
(2) policy development and review
(3) education

Front 15

three categories of skills needed in ethics consultation

Back 15

(1) ethical assessment
(2) process skills
(3) interpersonal skills

Front 16

four types of information needed for case analysis according to Jonsen, et.al.

Back 16

(1) medical indications
(2) patient preferences
(3) quality of life
(4) contextual features

Front 17

Childress and Siegler’s five metaphors of relationship between hps and pts

Back 17

(1) paternal/parental – (model: paternalism) health-care provider is mainly the decision maker due to moral authority within an asymmetrical and hierarchical relationship
(2) partnership – autonomy for the sick patient cannot exist outside of a good and properly functioning doctor-patient relationship and the relationship between them is inherently a partnership. Participants must have equal power, be mutually independent, and engage in a activity satisfying to both in some ways
(3) rational contractors – health care professionals and their patients are related or should be related to each other by a series of specific contracts
(4) friendship – the patient expresses trust and confidence in the health care professional with the health care professional’s friendship for the patient should consist above all in desire to give effective technical help.
(5) technician – health care professional is viewed as the expert engineer

Front 18

according to Ackerman, what is modern medicine’s definition of the essential feature of respect for autonomy?

Back 18

there is a notion of respect for autonomy that identifies it with noninterference. Providing adequate information and competent care that accords with the patient’s wishes

Front 19

Why does Ackerman disagree with modern medicine’s definition of the essential feature of respect for autonomy?

Back 19

Noninterference fails to respect patient autonomy because it does not take into account the transforming effects of illness. The autonomy of those who are ill is limited by constraints – physical, cognitive, emotional, and social. overriding patients’ treatment-related preferences, maintaing that the real respect for the autonomy of patients requires physicians actively to attempt to neutralize the impediments that interfere with patients’ choices, helping them restore control over their lives

Front 20

according to Pelligrino, describe three autonomy compromising elements of the the experience of illness

Back 20

(1) anxieties created by illness, and other psychological constraints including denial, depression, guilt, and fear
(2) social constraints may prevent patients from acting upon their considered choices
(3) various social and cultural expectations may affect choices made

Front 21

what is Ackerman’s goal for medicine in relation to the autonomy of patients?

Back 21

“development” of the patient – helping to resolve the underlying physical (or mental) defect, and social constraints in order to restore autonomous functioning

Front 22

define the central tension discussed in Macklin’s article regarding medicine in a multicultural society

Back 22

respect for cultural diversity requires physicians to be generally tolerant/respectful of patients’ differing beliefs and practices. In some cases tolerance can lead to harm of patients/family members, while in other cases tolerance apparently conflicts with what mainstream Western ethics regard as autonomy-based rights of the patient

Front 23

define/distinguish the four models of relationships according to the Emanuels

Back 23

(1) the paternalistic model – physician-patient interaction ensures that patients
receive interventions that best promote their health and well-being. Shared
objective criteria for determining what is best so physician can discern what is
in the patients best interest with limited patient participation
(2) the informative model – objective of patient-physician interaction is for the
physician to provide the patient with all of the relevant information for the
patient to select medical interventions he/she wants and for the physician to
execute selected interventions
(3) the interpretive model – the objective of the physician-patient interaction is to
elucidate the patient’s values and what he/she actually wants and to help the
patient select the available medical interventions that realize these values
(4) the deliberative model – the objective of physician-patient interaction is to
help the patient determine and choose the best

Front 24

according to Justice Clark in the Tarasoff case, three medically significant reasons for confidentiality

Back 24

(1) without the promise of confidentiality, people needing treatment will be
deterred from seeking it
(2) effective therapy requires the patient’s full disclosure of his/her innermost
thoughts (without the assurance that the thoughts disclosed will not be
revealed by the therapist, the patient could not overcome the psychological
barriers standing in the way of such revelations)
(3) successful treatment itself requires a relationship of trust between psychiatrist
and patient

Front 25

five of the reasons proposed by Edwards for professional commitment to
confidentiality:

Back 25

(1) affirms and protects the more fundamental value of privacy
(2) affirms and protects the social status of the client
(3) is economically advantageous to the client
(4) promotes openness of communication between professional and client
(5) encourages clients to seek professional help when it is needed
(6) promotes trust between the client and professional
(7)allows persons autonomous control over private/personal info about self

Front 26

according to Higgs, three principle arguments for not telling the truth to patients - one response/objection of Higgs to each

Back 26

(1) it is enormously difficult to put across a technical subject to those with little
technical knowledge and understanding, in a situation where so little is
predictable – just because a patient does not know everything does not mean
that they are not entitled to the truth
(2) no patient likes hearing depressing or frightening news – after being upset
patients are glad they were knew, or wish they were told
(3) truthfulness can actually do harm (what you don’t know can’t hurt you) –
outcomes are better if the news is broken in a careful manner while providing
support

Front 27

describe Freedman’s “offering truth” approach to uninformed patients

Back 27

when offering the truth to a patient attempt to repeatedly ascertain from the patient how much he/she wants to know (if the family want the patient to remain uniformed it is important to stress this approach)

Front 28

three responsibilities/roles proposed by Quill and Townsend for hcp in “delivering the bad news”

Back 28

(1) initial assessment of the patient’s readiness to hear the news
(2) use clear and easily comprehensible language
(3) do not deliver too much information all at once

Front 29

Cullen and Klein say deception-to-benefit-patients does not show “respect for persons.” What ability do we have that they say makes us special? How
does DBP interfere with it?

Back 29

humans are rational beings. We have the capacity to guide our actions on the basis of deliberation, rather than being moved only by instinct or psychological conditioning. Humans have the ability to reason.
If we are special because of our ability to make choices, then others should not destroy this ability or interfere with our exercise of it. DBP denies us the ability to choose for ourselves.

Front 30

Complete the phrase used by Cullen and Klein “ When knowledge is power…”

Back 30

Ignorance is slavery

Front 31

What does this mean in the context of the principle of truthtelling?

Back 31

by failing to tell the truth the physician is restricting the patients freedom to make meaningful choices. It also discounts the patients ability to reasonand make decisions, and treats the patient with disrespect

Front 32

What considerations do they think may override a patient’s explicit
wish not to be told the truth?

Back 32

(1) if the patient has HIV/contagious disease - this is to protect others
(2) “vertical transmission” of genetic disease – to protect family

Front 33

What do they say to the point that hcp’s are “unable” to tell patients
the truth?

Back 33

if the hcp is not fully aware of the situation themselves must do the best they can to convey what they do know even thought that may mean they cannot tell the whole truth

Front 34

What principle do the allow that may give a hcp a “duty” to lie to patients?

Back 34

if a sick person wishes to regain health and the desire can most likely be attained by the hcp deceiving him the physician is justified in the deception. This is because the deception assists the patient in securing their goal

Front 35

Define “therapeutic privilege”

Back 35

Physician withholds medical information from patients when they believe full disclosure to be medically contraindicated, to avoid potential harm to the patient’s physical or psychological well-being

Front 36

according to Bostick et. al., two conflicting hcp ethical obligations

Back 36

(1) when it is not feasible to disclose information to a patient such as in an
emergency
(2) disclosure issues that arise from medical errors

Front 37

What three elements of the AMA recommendations about therapeutic
privilege do you see as important?

Back 37

(1) physicians should encourage patients to specify their preferences regarding
communication of their medical information, preferably before the information
becomes available
(2) physicians should honor requests not to be informed of certain medical
information or to convey the information to a designated proxy, provided
these request appear to genuinely represent the patient’s own wishes
(3) physicians should assess the amount of information s patient is capable of
receiving at a given time, delaying the remainder to a later, more suitable time

Front 38

According to Sirotin and Lo, two reasons for disclosing information and
two for withholding information

Back 38

disclosing information:
(1) most patients want to know
(2) patients’ need for information for decision making
(3) deception requires more deception
(4) might be impossible to keep the information from the patient
withholding information:
(1) prevent harm
(2) not culturally appropriate
(3) patient does not want to be told

Front 39

According to Sirotin and Lo, four areas/questions to consider regarding
disclosure of information; one key guideline in each

Back 39

(1) who should disclose? – patient’s careprovider or physician with a long-
standing relationship
(2) when to disclose? – consider patients readiness to absorb information
in addition to what is happening around the patient at time of disclosure
(3) where to disclose? – private, sensitive, calm, confidential environment
(4) what to say to the patient? – warn that bad news is coming, assess for
readiness to hear bad news

Front 40

two central values underlying informed consent according to the Presidential Commission

Back 40

(1) the promotion of a patient’s well-being
(2) respect for a patient’s self determination

Front 41

what does Brody mean by “transparency” in relation to informed consent?

Back 41

The transparency standard is a means to operationalize the best features of the conversation model in medical practice. Adequate informed consent is obtained when a reasonably informed patient is allowed to participate in the medical decision to the extent of the patient wishes. This consists of two features: (1) the physician discloses the basis on which the proposed treatment, or alternative possible treatments, have been chosen; and (2) the patient is allowed to ask questions suggested by the disclosure of the physician’s reasoning, and those questions are answered to the patient’s satisfaction.