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24 Cards in this Set
- Front
- Back
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Ethics ? |
Discipline that critically assesses values & human experience while mediating differences in values Examines right & wrong human acts |
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Autonomy ? |
Patient centered care Values & preferences of patient Informed consent - full disclosure of truth & patient agreement |
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Beneficence ? |
Know the patient & their life Conversations Determining whats best for patient |
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Non-maleficience ? |
"Above all, do no harm" Overly aggressive use of unreliable therapies (due to good intentions) can actually cause harm for the patient. |
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Justice ? |
Treat all patients with fairness Ensure patient's concerns are weighed equally in relation to family, staff & other patients. |
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Confidentiality ? |
Duty of the HCP to protect & maintain control over info gained in the relationship between the HCP & patient |
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2 categories of confidentiality issues? |
ABSOLUTE: *never* break confidentiality because the patient will not visit the HCP / will not tell them everything CONDITIONAL: confidentiality depends on the law, interest of others & in the interest of the client (eg. diminished capacity) |
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When can confidentiality be broken ?
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(1) Infectious Diseases - communicable disease = TB, typhoid - venereal disease = gonnherea, syphillis - HIV, AIDS (2) Suspected child abuse / neglect - child, family & community services - ministry of child & family development (3) Suspect that danger to oneself / others (4) Adult Abuse / Neglect - not required to report abuse / neglect - court will order protection only if the person is unable to understand the abuse / cannot protect him/herself > certain agencies will investigate - Adult Guardianship Act of BC |
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If one must break confidentiality, proper way to do so ? |
DISCLOSURE > limited as possible to protect patient eg. Patient is at risk of HIV infection. |
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Privacy? |
Fundamental right of every individual to control the flow of personal info, including collection, use & disclosure. |
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What are the 4 stages of ethical processing? |
(1) Medical Indictors - diagnosis, treatments, options, progression, severity, urgency, efficacy, risks (2) Patient Perspective / Preferences - consider patient's wishes / values (3) Quality of Life - consider patient's own evaluation of the condition (eg. decrease mobility, cognitive fx...) (4) Contextual Factors - consider cultural, religious & social values - competent patient may wish to designate a family member as the decision maker eg. refuse vaccines / blood products |
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Who makes the decision? (flowchart) |
Capable Client > client is decision maker Incapable Client (a) Substitute decision maker (b) Advance Directive ~ legal documents that allow you to spell out your decisions about end-of-life care ahead of time |
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Contrast the 2 types of decisions that can be made by a substitute decision maker. |
Substitute Decision: decision the person would have made Best Interest Decision: what a reasonable person in the patient's circumstances would do |
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Explain the 2 laws that are linked to health decisions for adults. |
(1) REPRESENTATION AGREEMENT ACT S7 Standard: can make major/minor decisions but cannot refuse life sustaining treatment S9 Enhanced: have the authority of a capable patient, limited only by restrictions placed on by patient Adult appoints the substitute decision maker via Advance Directive (2) HEALTH CARE & CARE FACILITIES ACT - Temporary substitute decision maker can refuse life-sustaining treatment - Capability is presumed: adult demonstrates that he/she understands info from HCP & apply info appropriately (risks / benefits) (3) Patients Property Act Supreme Court of BC appoints a committee & defines the authority of the committee. |
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Explain the hierarchy of temporary decision makers |
Spouse Adult Children Parent Sibling Grandparent Grandchild Others related by birth / adoption (not in-laws or stepchildren) Close Friend Immediately linked by marriage > in-laws, stepchildren Public Guardians & Trustee of BC |
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Explain process that temporary decision makers should use when making decisions |
Consult with adult as much as possible Comply with any instructions / wishes provided by the adult while he/she was capable ^ If wishes/instructions not known, act in the adult's best interests |
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Which act pertains to health decisions for children? Explain what it's about. (If child is capable vs not) |
INFANTS ACT (19 y/o) Infant can consent to health care if - capable of understanding the nature, consequences, risks, benefits, etc - health care provider has concluded that it is in patient's best interests Child is not capable > child, family & community services act |
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Define: Child Protection Concern |
Physical, emotional, sexual abuse, & neglect of a child (includes domestic violence) |
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Mental Health Act |
- Applies to adult & children - Nothing to do with capability - Only correlated with psychiatric conditions - Treatment authorized by the 'Director' is deemed consent of the patient To apply, all 3 must be met in the affirmative (A) Is there a disorder of the mind that requires treatment & seriously impairs an individual's ability to react appropriately to the environment / associate with others? (B) Does the individual require treatment from a facility? (C) Does the individual need to be in a facility to prevent the patient's substantial mental / physical deterioration or for the protection of the patient & others? |
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Explain: Child, Family & Community Services Act (8 principals) |
Fundamental Principle: safety & well-being of children is paramount! 1) Children should be protected from abuse, neglect, harm or threat of harm 2) Preferred environment for children = family 3) Parent's responsibility to protect children 4) If a family can provide a safe environment for the children with the assistance of social services, they should be made available 5) Child's view should be taken into account for decisions pertaining to the child 6) Preserve child's ties to extended family 7) Preserve the cultural identity of Aboriginal children 8) Decisions should be made & implemented in a timely manner |
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Explain patient/family centered vs patient/family directed care |
Patient Centered Care: - active listening: patient & family - honour their choices / decisions - incorporation of values, beliefs, cultural norms = / = do whatever the patient / family wants |
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BC Human Rights Act |
A person cannot without reasonable justification: - deny person of accommodation / service / facility otherwise available to the public via discrimination based on race, color, ancestry, place of origin, religion, marital status, family status, mental / physical disability, sex, age & sexual orientation |
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What limits a patient's autonomy? |
Cannot limit the self-determined choices of others (rights & freedoms) |
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How to determine if accommodation should be made? (assume family / patient request) |
Understand the reason of the request / Empathize Consider the outcome of accepting the request on: patient, family, other patients, health care team, organization, healthcare system |
