Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
60 Cards in this Set
- Front
- Back
|
what is the difference between obligatory, permissible & prohibited?
|
- obligatory: ethically required
- permissible: ok, but not required - prohibited: ethically wrong |
|
|
what is beneficence?
|
- doing good for a patient
- taking actions to improve a patient's health, prevent disease or otherwise enhance a patient's welfare |
|
|
what is respect for autonomy?
|
- respecting a patient's decision making authority
- person has right to make decisions about his or her own life & body |
|
|
what is non-maleficence?
|
- refraining from harming the patient
|
|
|
what is justice?
|
- protecting one's patient from discrimination & exploitation
- balancing the interests of other parties affected by a decision - focus on everybody else affected by your actions |
|
|
what is the primary tool to protect autonomy?
|
- informed consent
- information about diagnosis & treatment options should be disclosed - competency is required & understanding should be evaluated |
|
|
when is there a specification to informed consent?
|
- ex. in an emergency setting informed consent is waived
|
|
|
what is deontology?
|
- some actions are morally wrong independent of the consequences they have
- don't break rules no matter what, once you decide something is a lie you move on & don't consider it |
|
|
what is consequentialism (utilitarianism)?
|
- actions are morally right or wrong solely b/c of the consequences they have
- figure out if something is right or wrong based on consequences |
|
|
what is Kan's good will?
|
- deontology
- act is moral ONLY if it is done for the right reasons |
|
|
what did John Mill believe? what did he believe about withholding vs. withdrawing treatment?
|
- actions are right if they promote happiness, wrong if they produce the reverse of happiness
- Utilitarianism (consequentialism) - he believed withholding > withdrawing |
|
|
what is not egoism?
|
- please & pain of all people
- 1 vs 10 people have to go with 10 because all people |
|
|
what is not hedonism?
|
- short-term & long-term pleasures count
|
|
|
what is not depravity?
|
- higher pleasures better than lower pleasures
- higher activities = higher pleasures, going to shakespeare, being educated, etc. |
|
|
what did aristotle believe?
|
- moral excellence leads to a good life
- when you do what is good for others you do what is good for yourself |
|
|
what is medical futility?
|
- effort to provide benefit to patient when probability of success is low, based on research evidence & clinical experience --> too low to justify the attempt
|
|
|
what is physiological vs probabilistic futility?
|
- physiological: probability = 0
- probabilistic: probability = low > 0 |
|
|
CPR is a standing order. When can it be countermanded?
|
- physiologic futility: patient is currently or imminently will be dead
- probabilistic futility: patient keeps deteriorating despite maximal therapy for terminal condition - or pt has DNR |
|
|
can physicians order DNR w/out permission of patient or patient's surrogate?
|
- No
- but they can unilaterally choose not to do CPR b/c CPR might be maleficent act |
|
|
what is the criteria for brain death?
|
- nonreceptivity & nonresponsivity
- apnea test (w/ hypercapnia) - no reflexes (spinal reflexes ok) - pupils dilated & fixed at midposition - no changes for > 24 hrs - no hypothermia or CNS depressants, EEG not necessary |
|
|
what is the Uniform determination of death act?
|
1) irreversible cessation of circulatory & respiratory functions
OR 2) irreversible cessation of all function of the entire brain including brainstem |
|
|
what is PVS?
|
- not self aware, intact sleep-wake cycles
- no purposeful movements - normal respiration - traumatic has better prognosis than non-TBI |
|
|
what is extraordinary vs. ordinary care?
|
- extraordinary: used to be mechanical ventilation & dialysis
- ordinary: water & nourishment (always ethically wrong to deny people food & water) |
|
|
what is passive vs. active euthanasia?
|
- passive: withhold therapy & illness takes its course
- active: take them out of their suffering |
|
|
what is veracity vs. therapeutic privilege?
|
- veracity: obligation to tell the truth
- therapeutic privilege is ability to not tell the truth when you think it will be better (if telling the truth will harm patient then don't do it) |
|
|
what is capacity vs. competence?
|
- capacity: medical determination by psychiatrist
- competence: judicial determination by judge |
|
|
what are the 4 requirements to determine capacity?
|
- ability to communicate choices
- ability to understand relevant information (teach back method) - ability to rationally manipulate information (why did you choose treatment?) - ability to appreciate situation & consequences |
|
|
for information, what is the: community standard? reasonable person standard? subjective standard?
|
- community: what other physicians in community would do
- reasonable person: what info would average person want? - subjective: what does my patient think is relevant? |
|
|
if the patient lacks capacity what do you do?
|
- substituted judgment: determine what patient would have wanted were they able to understand relevant info & make a choice
- POA --> family --> living will --> MR --> other providers (PCP) - living partner > family, spouse --> adult child --> parent --> brother or sister --> grandchild, etc. - if not available then move to best interest standard |
|
|
what is substituted judgement is not available?
|
- move to best interest standard
- POA --> court appointed guardian --> family member as surrogate --> others who know the patient |
|
|
what is the best interest standard?
|
- POA --> court appointed guardian --> family member as surrogate --> others who know the patient
|
|
|
what is substituted judgement?
|
- substituted judgment: determine what patient would have wanted were they able to understand relevant info & make a choice
- POA --> family --> living will --> MR --> other providers (PCP) - living partner > family, spouse --> adult child --> parent --> brother or sister --> grandchild, etc. - if not available then move to best interest standard |
|
|
what are advanced directives?
|
- write down what you want & put it in MR
- directive part & POA are important |
|
|
what is the new maine advanced directive form?
|
1) I have illness that will not get better, cannot be cured, will result in my death soon (terminal condition)
OR 2) I am no longer aware (unconscious) & very likely I will never be conscious again (PVS) |
|
|
what are the problems with advance directives?
|
- have not been effective
- terminal & irreversible are vague concepts |
|
|
what are physician orders for life sustaining treatment (POLST)?
|
- for people with <1 yr of life
- better than advance directives - different parts: A = DNR, B = where you die, C = antibiotic treatment, etc. |
|
|
what is the respecting choices program?
|
- very good program, trying to duplicate it
- 99% had this form in their MR - where people were dying was where they wanted to die |
|
|
why do you want to start palliative care earlier?
|
- helps people live well with disease rather than just live & end up in hospice last year of life
- transition into hospice nicely |
|
|
what disease is high functioning then you die? more steady w/ drops in functioning? low functioning w/ low QOL?
|
- cancer
- CHF & COPD - dementia |
|
|
if you have a moral conflict with one of your patients what should you do?
|
- refer them to someone who is willing to help them
|
|
|
what is the principle of proportionate treatment?
|
- medical treatment mandatory if benefits > burden
|
|
|
what is the principle of double effect?
|
- clinical situation with two outcome (one bad & one good) - two are linked
- must intend the good effects, not the bad ones, even though both are foreseen - it is the intention that matters |
|
|
what is the difference between palliative sedation & terminal sedation in terms of the principle of double effect?
|
- palliative sedation is ok under principle of double effect b/c you're trying to treat the pain even if it increases the risk of death from excessive sedation
- terminal sedation does not apply under principle of double effect because purpose of doing this is to lead to patients death |
|
|
what are the 3 requirements for the death with dignity act?
|
1) patient has capacity
2) they have incurable irreversible disease that will cause death w/in 6 months 3) voluntarily express the wish to die |
|
|
what is a COI?
|
- exists when individual or organization has financial relationship with entity that might influence one's actions w/ respect to professional responsibilities
|
|
|
why are physicians & pharmaceuticals goals inconsistent?
|
- physician: act in best interest of patients
- pharmaceuticals: maximize economic return, priority is to have drug prescribed |
|
|
what is illegal promotion?
|
- physicians can prescribe drug for off label uses, but pharmaceuticals cannot promote off label
|
|
|
what are incentives?
|
- kickbacks from formularies to purchase drugs
- formulary: approved to be prescribed under particular insurance policy, illegal to pay kickbacks to get on formulary list |
|
|
what is the Bayh-Dole Act?
|
- promote commercialization of funded research
- designed to promote use & development of technology invented by federal funding - bring inventions to the market |
|
|
what is the Mass flip/flop?
|
- Mass flip: physicians could not accept free meal during pharma event - unless held in hospital & accompanied by presentation
- Mass flop: physicians can accept free meal if meal is modest & accompanied by educational presentation |
|
|
what is ghost writing?
|
- industry prepares written material & materials attributed to non-industry author
|
|
|
what is the dead donor rule?
|
- can't take an organ unless someone is dead
- problem is short supply, waiting list |
|
|
what happens with living donors?
|
- kidney, liver lobe, bone marrow, lung lobes
- should allocation be directed by donor - alturistic donation is legal (matchingdonors.com) |
|
|
what are the 4 match criteria under UNOS policy?
|
1) ABO typing
2) geography 3) urgency 4) wait time |
|
|
is there an age where you can't get a transplant anymore?
|
- no, no UNOS define counter indication for transplant
|
|
|
what is dual agency?
|
- responsible for patient & for parties other than patient
- ex. sports medicine - responsible for best interest athlete & of team |
|
|
when can you breach confidentiality?
|
- information necessary to care for patients (colleagues)
- reimbursement purposes (insurance billing) - protect identifiable person from harm - necessary to protect public from harm |
|
|
when can you place restrictions on personal liberties?
|
- harm: must be clear/measurable harm to others should disease go unchecked (quarantine needs to be person to person)
- proportionality: least-restrictive means necessary - reciprocity: assist individuals (aka feed, house, psychiatric support, no discrimination) - transparency: need to understand why & have ability to appeal |
|
|
do states require abuse reporting? IPV?
|
- all 50 states require reporting of child, elderly & disabled abuse
- no states require reporting of IPV |
|
|
what is quarantine vs isolation?
|
- quarantine: for health people during infectious disease
- isolation: for sick people |
