Health Care Ethics

Front 1

1. List and briefly describe the five elements of informed consent

Back 1

informed consent: patients have the right to make major life challenging decisions for themselves. the five elements are adequate disclosure of information; decisional capacity of the patient; patient's comprehension of the information; voluntariness (freedom from coercion); consent of the patient

Front 2

adequate disclosure of information

Back 2

Includes following information about proposed intervention: Purpose, Nature, Burdens, Risks, Alternatives

Front 3

decisional capacity of the patient

Back 3

Patient comprehends the disclosed information and is able to integrate this medical information with his/her stable values in order to arrive at a decision

Front 4

patient's comprehension of the information

Back 4

the ability to comprehend the given information about diagnosis and treatment and to identify the issue at hand (to test: ask the patient to paraphrase the discussion); the ability to appreciate the impact of the disease and its consequences (to test this, ask the patient to state the major otions and the most likely outcome for each option)

Front 5

voluntariness (freedom from coercion)

Front 6

consent of the patient

Back 6

consent is the patient's voluntary, autonomous authorization to proceed with the proposed intervention

Front 7

What are 4 circumstances in which it is not necessary to obtain full informed consent from patients

Back 7

emergency privilege; therapeutic privilege; patient does not have decisional capacity; waiver of rights

Front 8

What are the two standards of disclosure that are most frequently applied by courts?

Back 8

professional community standard; reasonable patient standard

Front 9

professional community standard

Back 9

what a capable and reasonable medical practitioner in the same field would reveal to a patient under he same or similar circumstances (some states use this standard)

Front 10

reasonable patient standard

Back 10

because of the recognition of patient's autonomy, another standard has been developed, which asks for the information that a reasonable patient would consider material to the decision of whether to consent to the procedure offered (the majority of states use this standard)

Front 11

list and briefly explain the three elements of decision-making capacity

Back 11

to e considered as having DMC a patient has to have the ability to understand; ability to evaluate; ability to communicate

Front 12

understand

Back 12

the ability to comprehend the given information about diagnosis and treatment and to identify the issue at hand (to test: ask the patient to paraphrase the discussion); the ability to appreciate the impact of the disease and its consequences (to test this, ask the patient to state the major otions and the most likely outcome for each option)

Front 13

ability to evaluate

Back 13

the ability to deliberate in accordance with one's own values, to manipulate information rationally and to compare risks and benefits of the options, to make choices that are not irrational and to give the reasons for them

Front 14

ability to communicate

Back 14

the ability to communicate choices (to test: ask the patient to state his or her choice of treatment)

Front 15

substituted judgement standard

Back 15

guideline the surrogate uses if the patient is incapacitated and has expressed a preference before becoming incapacitated, or if th surrogate knows the patient well enough to determine what the patient would choose if he or she were still decisional

Front 16

list 4 of the 5 exceptions to the requirement for confidentiality where divulgence is legally necessary

Back 16

testifying in court, reporting communicable disease; reporting child abuse, spouse abuse or elder abuse; reporting gunshot or suspicious wounds if there is a reasonable cause to believe that they are the result of a crime; reporting for workers' compensation cases

Front 17

list and briefly describe the three types of advance directives

Back 17

living will statuatory form; power of attorney for healthcare (PAHC) statutory form; nonstatutory forms

Front 18

living will statutory form

Back 18

most statutory forms are documents stating the desire to die a natural death and not to be kept alive by medical treatment and machines. in some states the principal may also stipulate that fluid and nutrition are to be discontinued if in PVS state; living wills are usually activated by determination of "terminal illness", "imminent" death, or a diagnosis of PVS made by two doctors in same places

Front 19

power of attorney for heathcare

Back 19

most forms provide a way for the principal to appoint a person to act as healthcare agent (a proxy or surrogate) to make healthcare decisions in the event that the principal loses the capacity to make decisions, to add specific directions, and often the agent may be given authority to have feeding tubes withheld or withdrawn; the PAHC becomes effective when two physicians or one physician and one psychologist, determine that the principal is no longer decisional

Front 20

nonstatutory forms

Back 20

anything that anyone says or writes while possessing DMC that you should do that isn't on a technically legal form (e.g. comments recorded in chart, comments recollected by family or others)

Front 21

list 5 sources of authority (other than obvious medical resasons) for the decision to withdraw treatment, in order of importance.

Back 21

request of a decisional patient, dictates of an advance directive; judgment of guardian or healthcare agent appointed in an advance directive, approval of relatives, approval of close friends who know the patient's treatment preferences or are able to make decisions that promote the patient's best interest

Front 22

what is the opinion of the president's commision (1982) on the distinction between withdrawing and withholding therapy?

Back 22

withholding is failing to initiate therapy and withdrawing is discontinuing therapy. the commission said that that the distinction was not of moral importance. it believed that a justification adequate for not commencing a treatment was sufficient for ceasing a treatment that proved ineffective and notes that erecting a higher requirement for cession might discourage trials of treatment that might sometimes be successful

Front 23

what are 4 common mistakes in using narcotics for pain management

Back 23

1. drug selection is poor 2 dose may be inadeuate or the dosing interval too long 3 physcians may fear causing addiction in patients who experience chronic pain or terminal illness and have to take large doses for long periods of time 4. physicians may prescribe inadequate doses of narcotics to patients who are terminally ill, for fear of inducing respiratory depression

Front 24

what is the AMA policy on euthanasia

Back 24

the intentional termination of the life of one human being by another is contrary to public policy, medical tradition, and the most fundamental measures of human value and worth

Front 25

what are the 5 general goals of medicine

Back 25

prevention of disease and untimely death, cure of disease, when possible, improvement or maintenance of functional status when cure is not possible, palliation, pursuit of a peacful death, and comfort care in all situations, patient education and counseling

Front 26

what are the four medical indications for writing a DNR order?

Back 26

CPR is Physiologically Futile (The patient can’t be resuscitated); QOL before CPR is unacceptably poor before treatment; QOL after CPR is anticipated to be unacceptably poor; CPR is overly burdensome to patient

Front 27

what are the 3 conditions for futility? why do people disagree about ho to interpret this concept?

Back 27

futility exists when three formal conditions apply: there is a goal. there is an action aimed at achieving the goal, there is virtual certainty that the action will fail

Front 28

what are the 3 conditions for futility? why do people disagree about ho to interpret this concept?

Back 28

people disagree because there is...Controversy about Appropriate Goals; Controversy about what should count as “virtual certainty” that an action will fail; (Certainty is never epistemically absolute (though perhaps it may be psychologically absolute) –it is always “a level of certainty sufficient to the purposes at hand” –significance testing, fallibilism) Controversy about who has the authority to settle these questions (about Goals and “virtual certainty”) in specific cases

Front 29

according to junkerman and schiedermayer, what are 4 grounds by which physicians may refuse unreasonable requests from patients

Back 29

1. a request for something outside the scope of good medical care. this judgment is based on lack of objective evidence for the effectiveness of the requested intervention. 2 request requires the doctor to act illegally. 3. request requires the doctor to violate a personal and professional standard of responsible medical practice. 4. requested treatment cannot be anticipated to produce any beneficial results for this patient

Front 30

what is the difference between brain death and persistent vegetative state

Back 30

whole brain death occurs when the entire brain including the cerebral cortex and the brain stem has died. it can be diagnosed after there is a neurologic event adequate to produce brain death and reliable examination shows absence of brain stem function

Front 31

PVS Definition

Back 31

PVS is the total loss of cerebral cortical function with a functioning brain stem; you are not sentient

Front 32

what is non-heart-beating cadaver donation and why is it controversial?

Back 32

in brain-dead patients for whom life-sustaining medical treatment withdrawal is ethically appropriate and who have opted to be organ doners, the ventilator is discontinued in the operating room or in close proximity with the expectation of imminent death. the patient is then proclaimed dead using the heart-lung death criteria. organ procurement is begun after a specified period (e.g. 5 minutes) after the declaration f death to assure the continued progression of heart-lung death.it is controversial because of the practitioners' comfort with the irreversibility of brain death, and the knowledge that the cardiopulmonary arrest under some circumstances may be reversible

Front 33

what is the medical covenant of trust endorsed by the american college of physicians and the american board of internal medicine?

Back 33

it is a covenant that states that medicine is a moral enterprise grounded in a covenant of trust between physician and patient which obliges the physician to use his competence in his patient's best interest. physicians are intellectually and morally obligated to act as advocates for the sick wherever their welfare is significantly threatened and for their health at all times.