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60 Cards in this Set
- Front
- Back
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Ethics
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science of morals in human conduct. seeks to define and understand morality
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Bioethics
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application of ethics to medicine and life sciences
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technical error
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leaving a sponge in a patient during surgery
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moral error
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not admitting responsibility for a technical error
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Philosophy
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use of reason and argument in seeking truth and knowledge of reality
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Morality
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has to do w/ conforming to accepted rules and standards guiding human behavior
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Law
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customary rule in community that is recognized as enjoining or prohibiting certain actions
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Informatics
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is the science of processing data for storage and retrieval
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Medical informatics
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developing sciencetific field that deals w/ resources, devices, and formalized methods for optimizing the storage, retrieval, and management of biomedical info for problem solving and decision making
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Explode
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search query - expands on subject heading/all refs indexed to that term
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Major Concept (search query)
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returns only articles where subject heading is major point
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Boolean Logic
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And/or/Not
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Wildcard/Truncation
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wildcard: ne?t finds citations like next,neat,nest
truncation: hemat* finds words like hematocrit or hematoma |
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Professionalism
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involves standards, attitudes, knowledge & character
-Altruism -Honor and Integrity -Caring and Compassion -Respect -Accountability |
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Professional Competencies
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(MIRC) involves use of specific skills to benefit the individual and community being served:
-Moral -Integrative -Relational -Cognitive |
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Moral Competency
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*deals with the self-awareness necessary to respond effectively to patients & society
-to better own prof. competency: -Attentiveness -Critical curiousity -Awareness of thought and emotion -Recognition/response to cognitive and emotional biases -Willingness to acknowledge and correct errors |
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Integrative Competency
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*has to do with seeing the whole as well as the parts, managing ambiguity, and making decisions with limited information
-Incorporation of scientific, clinical, and ethical judgement -Appropriate use of reasoning strategy -Linking of interdisciplinary and clinical knowledge -Managing uncertainty -Examining and refining one's own reasoning strategies |
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Relational Competency
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*involves communication and the image one projects of oneself
-Communication skills (written, verbal, listening, style, appearance, actions) -Handling conflict -Teamwork -Teaching others |
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Cognitive Competency
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*knowledge/factual info and recall/application of info to real life situations
-Knowledge -Information management -Application of info to real life situation -Use of tacit knowledge and personal experience -Self directed acquisition of new knowledge -Ability to generate useful questions -Awareness of, and ability to make adjustments for, ones own biases |
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Principles of Bioethics
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"RUN BJ"
-codes of conduct, not laws -Respect for persons -Utility -Nonmaleficence -Beneficence -Justice |
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Respect for Persons
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-requires one to respect the privacy and confidentiality of others
-facilitates patient's trust of the profession and individual doctors Sub-components: -Autonomy (self-rule) -Veracity (truthfulness) -Fidelity (loyalty) -Avoidance of killing EXAMPLE: -distribution of free condoms/ information on how to use them to women in developing countries -cancer patients are seen as victims of disease, whereas people w/ AIDS, obesity, or addictive disorders are perceived as being responsible for own condition |
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Reproductive Liberty
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-every individual or couple has the right to decide responsibly on the number/spacing of their children, and to have the info and means to do so
-laws prohibiting abortion VIOLATE principle of beneficence, women's reproductive liberty (respect for persons), and principle of justice |
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Mexico City policy
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bush policy prohibits family planning clinics outside the US that receive US funds to counsel women about abortion
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Harm Principle
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limitation of respect for person
-says that violations of respect for persons are justified when these prevent harm to others Ex. Alzheimer's |
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Paternalism
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limitation of resepect for person
-used when a patient's preference might cause harm to patient -allows docs to override patient's wishes, thus neglecting respect for persons |
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Utility
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combines beneficence and nonmaleficence
-produce good while minimizing harm Utility = Benefits - Harm -Patient utility: benefits/harms dealing with patient -Social utility: benefits/harms to all that are affected, similar to justice in that it seeks to maximize the net good, but it does not take into consideration how it is distributed |
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Nonmaleficence
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"first and foremost, do no harm"
ex. when asked to recruit patients for a clinical study, the principle of nonmaleficence (do no harm) requires docs to weigh the possible harms to each patient before recruiting them |
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Beneficence
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-Acting in the patient's best interest
-aim to prevent injury, illness, provide comfort and cure when possibile Ex. beneficence obligates doctors to provide treatment to women who present w/ complications of pregnancy or abortion |
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Justice
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-deals w/ fair distribution of benefits and harms. It is CONCERNED WITH the criteria for how good is distributed
Ex. distribution of morphine: standard of pain relief recomm. by the WHO Ex. principle of just helped determine which patients received care, and in what order when the renal dialysis was first invented |
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Telehealth
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-refers to greater emphasis on roles of non-physicians in providing healthcare services
-importance of care as compared to cure |
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Telecare
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-refers to that subset of telemedicine concerned w/ home healthcare and monitoring
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Cybermedicine
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internet-based medicine can be included as part of telemedicine
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Distance medicine
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-provision of healthcare services, clinical info, and education over distance and time using information communication technology
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Telemedicine
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useful b/c:
-facilitate patient interaction w/ doctors when patients are geographically distant, disabled, or unable to leave home -Allow easy access to med info and patient records -improve continuity of patient care -improve patient compliance and health outcomes ethical issues: -could reduce patients to data sets or objects -some websites have unreliable info can harm patients -online support groups/med info could weaken patient trust in physician authority |
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Informed consent / elements of informed consent
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-derives from respect of persons
-means of protecting respect for patients and persons "UV got ADD" -Understanding -Voluntariness -Authorization -Disclosure -Decision making capacity |
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The Reasonable Person Standard
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-patient should be informed of any info that a reasonable person would want to know
-patient ought to understand the risks, benefits, or other options available to them |
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Understanding (Elements of Informed Consent)
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-indicates each patient's understanding of the varied impacts of treatment options on themselves and their prognosis
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Voluntariness (Elements of Informed Consent)
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-requires the absence of coercive influence
Ex. compromised by "white coat syndrome" where patients give consent because the doctor is seen as an authority to obey" |
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Authorization
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-means that the patient has given verbal and/or written permission to a specific procedure or treatment
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Disclosure
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-provision of whatever information a reasonable person wold want to know about their options and prognosis should meet the reasonable person standard
-protects patients/families against false and unrealistic hopes, abandonment by their doctors, and unwarranted despair |
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Decision making capacity
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-a medico-legal determination based on age, psychiatric, and other considerations
EX. Alzheimers EX. parents of young children are not legally or competent to make healthcare related decisions, but are able to express preferences |
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Deontological Theory (duty-based)
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-holds that the value of human life centers on dignity, and that dignity stems from rationality and autonomy
-it is based on obligations, duties, and rights -Guides us to obey laws, follow rules, be truthful, and keep promises -respect the intrinsic value of human life, follow rules, keep promises, and actions ought to fulfill our obligations EX. should HIV tests be mandatory for all pregnant women? No- deontological view is that one has a duty to obtain informed consent |
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Consequential Theory (consequence-based)
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-One ought to act to provide the most benefit to the most people
-Actions should always be guided by consequences -The consequential view is that one should choose to act in ways that will have the best consequences for all people affected Ex. Should HIV tests be mandatory for all pregnant women? Yes- consequential view is that mandatory testing is needed because it will do more help to people |
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Virtue Theory (character-based)
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-deals with intentions and character that give rise to one's choices and actions
-An action can be right w/o being virtuous, but an action can only be virtuous if it is performed for the right motivation and state of mind *requires self-knowledge Ex. setting a broken bone is virtuous if it is done to heal the patient, even if pain or other harms result |
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A man has HIV, should you as his physician violate his confidentiality and inform his wife?
-explain deontological/ consequential arguments |
-Deontological argument: A doctor's primary duty is to the patient and so NO, however, in a jurisdiction where it is the law to report HIV as a communicable disease and/or warn contacts, you must tell his wife and so YES
-Consequential argument: It violates his confidentiality to tell his wife but if it does the most good by telling his wife than YES - you need to weigh out the utility - the balance b/w benefit and harm |
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Physician Assisted Suicide (PAS)
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-is when a doctor uses medical means to help a patient take their own life, and to do so at the patient's request
-legal in some jurisdictions when performed in accordance w/ specific criteria i.e.: independent assessment of patient over several months by different doctors |
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Arguments supporting PAS
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-principle of beneficence requires doctors to relieve unbearable suffering
-respect for persons requires honoring patient's autonomous and informed suffering |
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Arguments opposing PAS
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-PAS violates the sanctity of life and/or respect for persons
-Legalization may lead to societal acceptance of euthanasia Ex. Kevorkian |
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Euthanasia
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-when a doctor kills a patient through lethal injection or other means, sometimes out of pity or other motivations, but only sometimes upon the patient's request
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Life support
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withholding/withdrawing- certainty that there will be no improvement to patient from life supporting measures. No benefit to the patient in continuing, it is ethical and legal to withdraw life support
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Terminal Sedation
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administering of large doses of sedatives to relieve suffering - done with the knowledge that it may hasten death
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Physician Assisted Death (PAD)
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"inclusive" describes all of the terms:
-Euthanasia -Terminal sedation *withdrawal or withholding of life support methods is legal in the US and does not constitute PAS, euthanasia, terminal sedation, or PAD |
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Goal of Medical Research
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improve care for future patients and populations
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Goal of Clinical practice
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help the patient
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Therapeutic misconception
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the belief that a drug or treatment is efficacious when it has not been conclusively proven to be so
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Therapeutic misrepresentation
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implying to someone that a drug or treatment is efficacious knowing that it has not conclusively been proven to be so
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Describe 4 phases of clinical trials
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-Phase I: small group 20-80 people; evaluate overall safety and determine safe dosage range, toxicity & side effects
-Phase II: larger group 100-300; evaluate EFFICACY and further evaluate safety -Phase III: 1000-3000; tests the drug or treatment on large groups of people; confirm effectiveness, monitor side effects; seek FDA approval -Phase IV: post marketing studies; data is sought from clinicians about adverse events, risks, benefits, and optimal use among their patients |
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Declaration of Helsinki
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-well-being of the human subject should take precedence over the interests of science and society; produced by the World Medical Association (WMA)
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Nuremburg Code
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-voluntary consent of the human subject is absolutely essential
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Belmont Report
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-commissioned and adopted in the U.S. in the 1970s after the Tuskegee Study
-Outlines ethical principles presented in this course as they apply to research |
