Ipe 370 Midterm

Front 1

what is the health care principle that refers to the patient's right to self-determination concerning medical care?

Back 1

autonomy

Front 2

what is the health care principle that refers to the obligation of the health care professionals to act in the best interest of their patients and to seek and promote the well-being of the patient?

Back 2

beneficence

Front 3

what is the health care principle that prohibits the infliction of harm, injury, or death upon others? "First do no harm"

Back 3

nonmaleficence

Front 4

what health care principle that refers to the permission by the patient to the health care team to perform medical treatment?

Back 4

informed consent

Front 5

what term refers to the practice of overriding or ignoring preferences of patients to benefit them or enhance their welfare?

Back 5

paternalism

Front 6

what is the health care principle that requires that persons be given what they are due and also requires that equals ought to be treated equally?

Back 6

justice

Front 7

what is the health care principle that requires that the dignity of the person requires a community and is to be found in communal sharing?

Back 7

common good

Front 8

what is the health care principle that binds one to honesty truth-telling, and full disclosure?

Back 8

veracity

Front 9

what is the health care principle that state that a health care professional must be faithful, loyal, and fulfill one obligations?

Back 9

fidelity

Front 10

what is the health care principle that states that it is the professional duty to guard patient's secrets and protect patient's private information from disclosure?

Back 10

confidentiality

Front 11

what three health care principle factor into trust?

Back 11

veracity, confidentiality, and fidelity

Front 12

what are the four topics in the process of gathering relevant information?

Back 12

(1) clinical/medical indications
(2) patient preferences
(3) quality of life considerations
(4) contextual factors

Front 13

what are the four elements/requirements of informed consent?

Back 13

(1) professional disclosure
(2) patient comprehension
(3) patient voluntariness
(4) patient capacity

Front 14

what is the term for the systematic study of and reflection on morality?

Back 14

ethics

Front 15

what are the five fundamentals of a caring response?

Back 15

(1) elements of human nurturance
(2) the patient as the primary focus of loyalty
(3) limits guided by the patient's vulnerability because of the health-related concern
(4) recognition of it as the professional responsibility involving duty
(5) the condition that it be indiviualized

Front 16

what is it when a health care professional faces a challenge about how to maintain integrity or the integrity of the profession?

Back 16

ethical distress

Front 17

what is it when a health care professional faces a challenge about the morally right thing to do when two or more courses of action diverge?

Back 17

ethical dilemma

Front 18

what is it when a health care professional faces a challenge of deciding who should be the primary decision maker?

Back 18

locus of authority

Front 19

what are the three components of ethical problems?

Back 19

(1) moral agent
(2) course of action
(3) an outcome

Front 20

what is the integral well-being of the patient and the goal of the health care relationship

Back 20

caring response

Front 21

what situation tends to surround "organizational ethics" problems?

Back 21

ethical distress

Front 22

what are the three objectives of the science of medicine?

Back 22

(1) cure the ill
(2) preserve life
(3) ease pain

Front 23

what is the health care principle that occurs when one action simultaneously has both good effects and evil effects?

Back 23

principle of double effect

Front 24

what are the four conditions of the principle of double effect?

Back 24

(1) the action itself must be good or indifferent (morally neutral)
(2) the evil effect is not directly intended
(3) the good effect is not produced by means of the evil effect
(4) a proportionate reason supports causing or tolerating the evil effect

Front 25

what is the goal of professional ethics?

Back 25

a caring response

Front 26

what is an experience at the heart and core/center of the person that summons one to be at peace with oneself in his/her concrete decision?

Back 26

conscience

Front 27

what are the four things you need in gathering relevant information?

Back 27

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

Front 28

what are the three basic components of building trust?

Back 28

(1) informed consent
(2) truth telling (veracity)
(3) confidentiality

Front 29

Does one ethical principle weigh more than the other? what term do we use to describe this?

Back 29

-no, but sometimes nonmaleficence takes precedence over other principles
-prima facie

Front 30

what does prima facie binding mean?

Back 30

all things being equal on its face-> -equal obligation or binding to each principle
-some circumstances the moral obligations of one principle has to override the obligations of another

Front 31

the principle of confidentiality is based on what two ethical principles?

Back 31

autonomy and fidelity

Front 32

what are the two immediate aims of confidentiality?

Back 32

(1) facilitate the sharing of sensitive info with the goal of helping the patient
(2) exclude unauthorized people from such info

Front 33

60 yr. old man, heart attack, admitted to hospital, critically ill and asks you NOT to share his medical info with his wife because she will not be able to take it. Wife catches you in the hall and asks about husband's condition...would it be ethically appropriate for you to tell his wife?

Back 33

-no, because the patient still hold decision making capacity and authority and does not want his wife to know (his wishes=his autonomy)
-HP cannot breach confidentiality cause wife is not authorized to know

Front 34

in the 60 yr. old heart attack case, the patient/husband loses consciousness...now what? may you discuss with wife? why or why not?

Back 34

-yes, because he does not have decision making capacity and needs someone to step in and make decisions about his health care.
-would not be able to if he had previously mentioned who the power of attorney was and it was not wife

Front 35

decisions need to be made regarding unconscious patient/husband's treatment, what decision-making standards should we use? how do we know?

Back 35

-substitute judgment
-make decision on what patient wants vs. what you would want to see happen (proxy knows person well enough to make decision on what patient would want)
-if don’t know what patient would want, go to best interest for patient (still revert to substitute judgment- if he is Jehovah witnesses does not want blood products, needs blood transfusion or die, don’t give blood cause not what patient wanted)

Front 36

Rams OB suffered a concussion 3 weeks ago and he was in your care at the hospital. Your colleague at the hospital asks you how bad his injury is and when he will be cleared to play football again. This is a member of the HC team…what ethical principle is at stake?
what test may help you determine whether or not discuss Dane’s medical condition with your colleague?

Back 36

-confidentiality
-need to know test (reasoning tool)

Front 37

Me (OT) in hospital as patient where I work, nurse sees head of hospital looking in your medical records. Is this ok?

Back 37

No, confidentiality states that he does not need to know because he is not part of the health care team; you can go up to him and be like “oh I didn’t know you became part of the health care team”
-as nurse, be advocate for patient

Front 38

What is the Goal of professional ethics?

Back 38

a caring response

Front 39

When conflicts occur, primary loyalty belongs to whom or what?

Back 39

patient

Front 40

“FREEDOM” of conscience entail certain responsibilities! What are these?

Back 40

(1) well informed conscience-> needs to be educated, must be based on various sources or moral wisdom to inform one’s moral analysis
(2) morality= critical realism= morality based on reality-> we must test/question our conscience to make sure we are seeing reality correctly

Front 41

what are the sources of moral wisdom to inform one's moral analysis?

Back 41

-colleagues and trusted HPs, mentors, family/friends
-Professional code of ethics
-rights, duties, ethical principles
-the virtues

Front 42

Conscience clause protections allow HPs to refuse treatment to patients with HIV or AIDS if one disagrees with how the patient/client acquired the disease. T/F? explain….

Back 42

False
-conscience clause protections are usually used to protect those with strongly held religious beliefs (ex. Abortion)
-conscience clause does not protect from bigotry, discrimination, prejudice, etc.

Front 43

what is the ethical principle underpinning informed consent?

Back 43

autonomy

Front 44

what information is included in an informed consent document?

Back 44

only information material to a patient's decision: diagnosis, prognosis, treatment options, treatment consequences, and sometimes consequences of non-treatment

Front 45

informed consent is a what?

Back 45

process

Front 46

what types of skills are needed to honor informed consent?

Back 46

-communication
-listening
-interpretive

Front 47

what is the "patient-oriented" standard of disclosure? (reasonable patient standard)

Back 47

it requires that physicians disclose as much information as a patient would want or need to know.

Front 48

what is the disclosure rule?

Back 48

disclosure of relevant information is a HP's DUTY based on a patient's RIGHT to it. Therefore, if information is withheld, it must be on the basis of other moral considerations deemed more compelling in a given situation than the patient's right and your corresponding duty to disclose

Front 49

what are some obstacles to disclosure?

Back 49

-over half of all patients do not have the skills to read and understand the overage informed consent form
-fear and anxiety by the unknown or distrust of HC system may make some feel they are being taken advantage of

Front 50

what is the six step process?

Back 50

(1) gather relevant information
(2) identify the types of ethical problem
(3) use ethics theories or approaches to analyze the problems
(4) explore practical alternatives
(5) complete the action
(6) evaluate the process and outcome

Front 51

what are some topics covered in the clinical indications of gathering relevant info?

Back 51

-diagnosis and prognosis
-what is needed to provide comfort
-caregivers
-medical and social history

Front 52

what are some topics covered in the preference of the patient of gathering relevant information?

Back 52

-what does the patient want?
-what was patient actually told?
-is patient competent?
-does patient have living will, advanced directive, etc.?

Front 53

what are some topics covered in the quality of life of gathering relevant information?

Back 53

-what are the patient's values and beliefs?
-are biases influencing the quality of life considerations?
-is there hope for improvement in the patient's quality of life?

Front 54

what are some topics covered in the contextual factors in gathering relevent information?

Back 54

-what institutional policies may influence what can be done?
-what are the legal implications?
--how will services be paid for?

Front 55

what is the disclosure rule?

Back 55

if information is witheld, it must be on the basis of other moral considerations deemed more compelling in a given situation than the patient's right to information and the HP's corresponding duty to disclose.

Front 56

what can be a consequence for breaching confidentiality?

Back 56

it may discourage patients from revealing all information relevant and necessary to their care

Front 57

what is the practice of keeping harmful, shameful, or embarrassing patient information within proper bounds?

Back 57

confidentiality

Front 58

what are the legal exceptions to confidentiality?

Back 58

(1) an emergency in which keeping the confidence will harm the patient
(2) the patient is incompetent or incapacitated and a 3rd party needs to be informed to be a surrogate decision-maker for patient
(3) 3rd parties are at serious risk for harm (STDs)
(4) when there is a serious risk that many others may be harmed (terroist threat)
(5) unknown direct threat to individual specific identifiable persons or threat to public health

Front 59

what is the general rule of confidentiality?

Back 59

a HP must not share confidential info unless it is authorized by law of the patient personally

Front 60

informed consent becomes a vehicle for ______in the HC environment, and should foster____between the HP and the person receiving services

Back 60

-protecting a patient's dignity
-trust

Front 61

what is the ethical principle invoved with informed consent?

Back 61

autonomy

Front 62

situations where a medical treatment, surgery, or procedure was authorized but the consent was uninformed

Back 62

negligent disclosure

Front 63

the act of offensive touching done without the consent of the person being touched

Back 63

battery

Front 64

what are two challenges of obtaining informed consent?

Back 64

(1) the standard of disclosure and amount of disclosure
(2) the person's ability to grasp the situation

Front 65

what does it mean by voluntariness must be assured?

Back 65

the patient agrees to the procedure without being coerced or compelled to act against his/her own best interests or wishes

Front 66

HPs have a moral obligation to ascertain the level of a patient's ability to grasp the situation, what is this called?

Back 66

mental capacity or decision-making capacity

Front 67

what are the four levels of capacity?

Back 67

(1) understand relevant info on which the choice is based
(2) ability to appreciate the situation according to one's own values
(3) ability to weigh various values to arrive at a decision
(4) ability to communicate choices and the ability to maintain and communicate these choices consistently over time

Front 68

capacity of a patient is presumed unless there is strong reason to think other wise. true or false?

Back 68

true

Front 69

decision-making capacity is tied to what two ethical principles?

Back 69

informed consent and autonomy

Front 70

what are four barriers of informed consent?

Back 70

(1) problems with IC form itself
(2) patient's life experiences may cause anxiety
(3) patient may be afraid of what the medical tests may find
(4) patient simply may have difficulty comprehending (functionally illiterate, learning disability, mentally incompetent)

Front 71

what are the two types of incapacitated patients?

Back 71

(1) never competent patients (newborns, small children, severly mental disabled people)
(2) previously capacitated patients

Front 72

what allows a person, while capacitated, to make one's wished known regarding decisions that will be made at a time he/she is incapacitated?

Back 72

advanced directive (durable power of attourney, living wills, medical directives)

Front 73

A patient want antibiotics for a cold. The PA considers giving the patient a placebo b/c it will do little harm and may even be helpful psychologically. Which ethical principle is at stake?

Back 73

veracity

Front 74

what are some harmful consequences of placebo use?

Back 74

(1) loss of trust in the therapeutic relationship
(2) inadequate diagnosis
(3) lack of respect for the patient as a person

Front 75

Purtilo believes ________ allows us to use placebos in situations where a patient may be respectfully benefited and where the patient is likely to be unable to produce the desired effect without the symbol of the medication or other medical procedure.

Back 75

compassion

Front 76

Remembering the Dax case-Donald Cowart, what element of Informed Consent missing?

Back 76

voluntariness

Front 77

What term describes the actions of the doctors in the Dax case?

Back 77

paternalism

Front 78

which 2 ethical principles collided in the Dax case? How does the principle of autonomy fit in that case?

Back 78

-Autonomy and beneficence
-Autonomy-> did he have capacity?

Front 79

what are the three guidelines pertaining to information recorded in the medical record?

Back 79

(1) untrue info should not be recorded, and questionable info should be clearly labeled as questionable
(2) true info that is not relevant shout NOT be recorded
(3) all info should be handled among health professionals with regard for the privacy and dignity of patients

Front 80

keeping confidences, truthful disclosure, and informed consent are used to ________to______.

Back 80

-build trust into the relationship
-maintain patient's dignity

Front 81

_____ is a legal term. _______ is a clinical judgment made by a professional pertaining to the patient's ability to give informed consent.

Back 81

-competency
-decision making capacity

Front 82

Used in incapacitated patients to determine who can speak for the best interests of the person who has never been in a position to voice his/her opinion.

Back 82

best interests standard

Front 83

used in incapacitated patients to attempt to make decisions on the basis of what a person would have wanted when competent.

Back 83

substitute judgment standard

Front 84

what are the three components of trust-building?

Back 84

(1) confidentiality
(2) truth telling
(3) informed consent

Front 85

the main argument advanced against disclosure of "bad news" is that the HP role is to maintain the patient's hope, and hope may be shattered by bad news. true or false and what can this been seen as?

Back 85

true/paternalism

Front 86

When it comes to a caring response toward yourself, _____ is a resource that boosts _____.

Back 86

-self-esteem
-self-respect

Front 87

What is the term meaning 'owing it to yourself' and achieveing such leads toward self-fulfillment?

Back 87

aspiration

Front 88

What are the two responsibilities to yourself that will serve you throughout your professional career?

Back 88

(1) the responsibility to maintain personal integrity
(2) the responsibility to engage in self-improvement as an individual

Front 89

When it comes to maintaining your personal integrity, what is the most fundamental resource?

Back 89

personal values system

Front 90

What are two responsibilities to improve yourself?

Back 90

(1) charge to remain competent professionally
(2) the charge to improve yourself personally (outside of work)

Front 91

What term is helpful in guarding our personal integrity and is defined as alertness and watchfulness?

Back 91

vigilance

Front 92

When it comes to ethics, our moral choices can be categorized into three broad categories, they are?

Back 92

(1) character (who we ought to be or become)
(2) conduct (what actions we ought to do or refrain from doing)
(3) conditions that influence what we can do and who we can become

Front 93

Organizational HC ethics pays attention to the character traits, rights, values, and suties of the organization expressed in its...

Back 93

-mission statements
-policies and administrative practices
-business priorities

Front 94

What addresses the conditions under which a profit can be ethically realized and the amount of profit that is acceptable for the types of services?

Back 94

business ethics

Front 95

Who are the "voice" of the HC institutions?

Back 95

the business stakeholders

Front 96

What are mission statements?

Back 96

An institution's/organization's brief description of its ideals and aspirations; a public statement declaring the type of organization it is.

Front 97

What are statements designed to establish formal and informal guidelines for practice within an organization?

Back 97

policies

Front 98

What are the 3 realms of ethics that are always present?

Back 98

(1) individual
(2) institutional
(3) societal

Front 99

When it comes to policies of an organization, proceed with what obligation? What does this mean and what must you assess?

Back 99

-prima facie
-one moral obligation might trump another if ethically supportable

Front 100

Generally speaking, organizations have a _____ value system designed to provide the greatest good for the greatest number.

Back 100

utilitarian

Front 101

What is the term for the greatest quality of care possible provided at the lowest price?

Back 101

cost-effectiveness

Front 102

What allows HPs to use placebos in situations where a patient may be respectfully benefited and where the patient is likely to be unable to produce the desired effect without the symbol of the medication or other medical procedure?

Back 102

Compassion

Front 103

What is the ethical principle that underpins informed consent?

Back 103

autonomy

Front 104

What are the three aspects or challenges of living ethically as a member of the HC team?

Back 104

(1) providing and accepting support from each other
(2) peer review and evaluation issues
(3) whistle blowing

Front 105

What are the 5 aspects of how a truly cohesive team behaves?

Back 105

(1) trust and vulnerability
(2) unfiltered healthy conflict
(3) commitment and action
(4) hold accountable
(5) collective achievement

Front 106

Reasonable expectations of teammates in the work place is based on the ethical principle of what?

Back 106

fidelity

Front 107

How can HPs honor their multiple duties between patients and colleagues?

Back 107

- the professional-patient relationship as the proper relationship governing the decision
-principle of justice
-degree of clinical need is common element to which patients can be compared

Front 108

What is the aim of peer reviews?

Back 108

to uphold the high standards of professional disclosure

Front 109

What is the common denominator in chronic and long term care?

Back 109

symptoms persist over time

Front 110

True or False. The terms chronic care and long-term care do not denote that the person will die of the condition, although some fit into this category.

Back 110

true

Front 111

What are four typical problems in long-term and chronic care?

Back 111

(1) fluctuations in condition
(2) possibly uncertain prognosis, timeline, or predictions
(3) family may become "medicalized"
(4) grieving without finality

Front 112

What are the four generic considerations that apple to all individuals with chronic conditions?

Back 112

(1) goal is not to effect a cure
(2) quality of life
(3) caregiver is crucial, must take well-being into account
(4) difficulty harnessing appropriate care services

Front 113

What assumes every life has intrinsic value, regardless of condition, personal potential, or disabilities?

Back 113

sanctity of life

Front 114

What is the process of finding a caring response when the object of care is you?

Back 114

-Self respect
-self esteem
-personal integrity and vigilance

Front 115

What is team oriented care designed to do?

Back 115

-to enhance the effectiveness of caring for the patient and for the team members

Front 116

Describe the distinction between Ordinary/Extraordinary Means.

Back 116

-rests on the patient’s decision, not the health professional’s judgment
-extraordinary =when the patient judges that the burdens decisively outweigh the benefits

Front 117

Describe Passive euthanasia

Back 117

-“letting the patient die” by removing or withholding treatment

Front 118

Describe Medically Administered Suicide.

Back 118

-physician commits act by medical means
-physician is necessary and sufficient for act
-patient’s illness simply provides the context

Front 119

Describe Assisted Suicide.

Back 119

-physician provides medical means
-physician necessary but not sufficient for act
-patient does final act

Front 120

Describe Palliative Care.

Back 120

-means to relieve or lessen without curing
-not limited to patients with an incurable condition that leads to death
-HC professional must be as sensitive as possible to the time frame the patient and family are living with and professional must adjust approach accordingly

Front 121

Describe Quality of Life.

Back 121

-indicates there are moral limits to the use of life-prolonging medical interventions that only the patient can decide

Front 122

Describe the Burden Benefit Ratio –why do patients refuse treatments?

Back 122

-because they decide that treatments may be promising from a medical point of view and that may be routinely administered to others impose too great a burden on them to be worth it

Front 123

Describe “Abiding” with a patient.

Back 123

-to endure without yielding.
1. recognize own feelings of fear, disgust and repulsion
2.encourage sessions in work place to share feelings
3.make efforts to talk to patients so know better
4.don’t abandon patients

Front 124

-documents designed to enable a patient to specify who they want to make the treatment decisions when they can’t make them any more
-when the patient doesn’t want it to go to next of kin or has to decide between them

Back 124

durable power of attorney

Front 125

-designed to enable a patient to specify types of treatment she wants to have and not to have

Back 125

living will

Front 126

-developed to assure patients their end of life wishes would be honored as much as possible and it only becomes effective at the time the patient no longer is able to make her wishes known regarding care
-founded on autonomy

Back 126

advanced directive