Ps-Quiz 2-9/9/11

Front 1

AMA ethical definition

Back 1

refers to matters involving moral principles, practices, social policy in the practice of medicine

Front 2

relationship between law and ethics

Back 2

ethical values and legal principles are usually closely related, but ethical obligations tend to overreach legal duties; in some cases the law may mandate unethical conduct; physicians should work to change unjust laws

Front 3

T/F physicians are free to deny services to anyone who seeks them out regardless of the individual who recommended the consultation

Back 3

T

Front 4

AMA principles of medical ethics

Back 4

1. competent medical care; compassion and dignity for human rights 2. uphold professionalism and report physicians who do not 3. respect law but seek changes to unjust ones 4. respect other's rights and keep confidences w/in constraints of law 5. study and disseminate knowledge, use colleagues' knowledge
6. maintain freedom to choose who to serve (except in emergencies) 7. improve community and public health 8. patient is paramount 9. support medical care for all

Front 5

acceptable breaches to patient confidentiality

Back 5

when the patient threatens to inflict serious harm on another person or him/herself; when disclosure is required by law, the minimal possible should be disclosed

Front 6

situations when it is ethically acceptable to refuse to care for a patient

Back 6

1. treatment request is beyond the physician's competence 2. request for treatment has no medical indication 3. specific treatment is incompatible with physician's personal, moral, or religious beliefs 4. physicians must recognize an obligation to serve all regardless of payment (w/in reason)

Front 7

4 medical ethical principles

Back 7

beneficence, nonmaleficence, respect for autonomy, justice

Front 8

CEJA

Back 8

Council on Ethical and Judicial Affairs-steward of the AMA's code of medical ethics

Front 9

utilitarianism

Back 9

19th century philiosphy proposed by Bentham and Mill that emphasizes the ends rather than the means, we should maximize the number of happy persons; modern: promote knowledge, beauty, love, etc.

Front 10

major objection to utilitarianism

Back 10

emphasis on the ends rather than the means; lack of criteria for "justice"

Front 11

Kantian Ethics

Back 11

mid-1800s; consequences of an action are irrelevant rather what matters is the "categorical imperative" or "always act to treat humanity as an end and never only as a means"; personal autonomy is honored, addressed the need for a standard of justice omitted by utilitarianism

Front 12

criticism of Kant's ethical principles

Back 12

ppl question whether there are absolute "categorical imperatives" i.e. whether or not lying is appropriate depends on the situation--what if lying saves a life; with regards to autonomy, what about mentally ill or mentally retarded persons

Front 13

Ross' Ethics

Back 13

19th century English philosopher who tried to integrate utilitarian and Kantian philosophy; believed in two fundamental moral properties: rightness and goodness; conscience is a good guide but not an absolute; approached conflicts of duty by distinguishing "prima facie" or figuring out which duties were major ones (such as fidelity, gratitude, justice, beneficence, nonmaleficence); the end does not justify the means but there are no absolute imperatives either

Front 14

criticism of Ross' Ethics

Back 14

since judgement is left to the individual, moral relativism comes into play which some people find objectionable

Front 15

Natural Law and Roman Catholicism

Back 15

reason is inherent in nature; opposite of moral relativism; goals and purposes of human nature are ordained by God; scriptures taken to be a major source of Divine revelation

Front 16

2 major contributions of Roman Catholic church to medical ethics

Back 16

1. principle of double effect: if an action has both a good and bad effect, the bad effect must be unintended or indirect consequence of the good, e.g. performing a hysterectomy on a newly pregnant woman who has uterine cancer is justified 2. principle of totality: individual can dispose of or destroy his/her organs only if the well-being of the whole body demands it; this rules out vasectomies, cosmetic surgery, and sterilization of the mentally retarded

Front 17

crticism of Natural Laws and Catholic theology`

Back 17

criticized basic of basic assumption that nature and life have a purpose, some question the existence of a divine force and say that what appears to be purpose can be explained by other scientific facts, such as evolution

Front 18

nonmaleficence

Back 18

do no needles harm or maximize benefit; we must treat to the standard of care

Front 19

noncomparative justice

Back 19

rights of people to receive that to which they are entitled; e.g. a patient is entitled to receive treatment from a doctor who is licensed and meets the standards of care for his/her area of medicine

Front 20

comparative justice

Back 20

concerns the distribution of burdens and benefits; e.g. does the patient have a "right" to a liver transplant

Front 21

Munson's ethics

Back 21

4 substantive principles that address how societal resources may be distributed: 1.equality 2.need 3. contribution 4. effort

Front 22

Feinberg

Back 22

in an affluent society, basic needs should be met for all first

Front 23

autonomy

Back 23

rational individuals have the right to self-determination; goes along w/ Kant's idea that individuals have worth in and of themselves, we should be free to make bad choices; requires informed consent

Front 24

three ethical questions to ask about research

Back 24

is it true? is it fair? is it wise?

Front 25

recent lessons on "truth" in research ethics

Back 25

autism and childhood vaccine false linkage, cloning of human cells falsification

Front 26

fairness history lessons

Back 26

Nazi medical experiments, Willowbrook hepatitis study, Tuskegee syphilis study

Front 27

Willowbrook hepatitis study

Back 27

1963-66; a school for "mentally defective persons" that deliberately infected children with Hep A, when crowding occurred, parents must agree to allow their child to participate in this experiment to be admitted

Front 28

Tuskegee syphilis study

Back 28

1932-1972: research done on rural black men, men were not informed that they had syphilis nor given the available standard of treatment (penicillin) despite its availability

Front 29

Nuremberg code

Back 29

1949: voluntary consent is essential

Front 30

Declaration of Helsinki

Back 30

1964: duty to protect the life, health, privacy, and dignity of the human subject

Front 31

Belmont Report

Back 31

1979: 3 basic principles: autonomy, beneficence, and justice

Front 32

Refined Belmont conception

Back 32

goal was to make sure that vulnerable populations are not understudied b/c people are afraid to study them

Front 33

increasing prevalence of vulnerability in the US

Back 33

minority population is nearly equal the size of the non-Hispanic white population; # of individuals in poverty is steadily rising; all of this increases demand on capacity and resources of medical and social services

Front 34

upstream factors

Back 34

aka social forces (economic, social, and political) that can create vulnerability (or address vulnerability); think population health and broad health care policies to address these vulnerabilities

Front 35

vulnerability is linked with national resources

Back 35

poor health not only impacts families but detracts from national productivity and economic prosperity

Front 36

vulnerability and equity cannot

Back 36

coexist

Front 37

downstream factors

Back 37

are individual factors

Front 38

vulnerability for poor health is determined by the convergence of

Back 38

predisposing factors, enabling factors, and need factors

Front 39

predisposing factors-individual

Back 39

ability of individuals to use services demographics (age, gender); belief systems (attitudes, culture); social position, status, and access to resources (race, ethnicity)

Front 40

enabling factors-individual

Back 40

services that are available for individuals to use, SES (income), health insurance

Front 41

need factors-individual

Back 41

specific illness or health needs, these are the principle driving forces for utilization of healthcare, self-perceived physical and mental health status, daily activity performance

Front 42

predisposing factors-ecological

Back 42

geographic location, neighborhood composition, physical environment (pollution?), political, legal, and economic system, culture and social norms

Front 43

enabling factors-ecological

Back 43

median household income, social inequality, occupational safety, family structure, availability/accessibility of healthcare

Front 44

health need factors-ecological

Back 44

population health behaviors (smoking), population health status trends (trends in mortality), population mental health trends

Front 45

vulnerability model and the victim

Back 45

does not blame the victim rather is seen as the result of interactions of many risks that the individual has no control of, this is in contrast with the reductionist view that thinks only about an individual's abilities

Front 46

three most commonly cited risk factors

Back 46

race/ethnicity, SES, health insurance status

Front 47

percentage that health care influences health status

Back 47

10%, lifestyle (51%) biology (20%), environment (19%)

Front 48

acculturation and medical training

Back 48

physician training is an acculturation process, physicians develop similar beliefs about disease causation, efficacy of treatment modalities, and ethical issues

Front 49

Kleinman's Explanatory Model

Back 49

beliefs about causation and healing of an underlying illness, often times the patient and physician will have different models

Front 50

4 psychosocial meanings of illness

Back 50

threat, loss, no significance, gain

Front 51

where do people under 65 get their healthcare insurance

Back 51

15%: Medicaid, 18%: uninsured 30%: employee-provided

Front 52

sickest 1% of people account for

Back 52

24% of total healthcare spending

Front 53

sickest 5% of people account for

Back 53

50% of healthcare spending

Front 54

top 50% of sick people account for

Back 54

97% of healthcare spending

Front 55

adverse selection

Back 55

i.e. healthy people will opt out of coverage

Front 56

medical underwriting

Back 56

insurance companies' response to adverse selection, insurance companies will refuse to sell to certain people such as ppl with diabetes

Front 57

risk-based rating

Back 57

charging premiums based on someone's likely healthcare needs

Front 58

community rating

Back 58

each person pays the same amount based on the average expected needs of everyone in the community

Front 59

benefit design

Back 59

designing specific policies that don't cover types of care such as OB/GYN to try and attract specific people

Front 60

indemnity

Back 60

this is what used to exist, ppl got reimbursed for medical services no matter what

Front 61

managed care

Back 61

PPO, HMO, POS, only get reimbursed full amount if you are in network

Front 62

consumer-directed health arrangements

Back 62

newest, high-cost sharing, fundamental shift in which the consumer is responsible for more of the purchasing

Front 63

how many Americans a month lose healthcare insurance

Back 63

2 million

Front 64

conditions that are always denied

Back 64

cancer, HIV/AIDS, diabetes, stroke, pregnancy, stroke

Front 65

Engel

Back 65

in the 1970s he popularized the biopsychosocial model which takes into account psychosocial as well as physical causes of illness

Front 66

systems hierarchy

Back 66

a biopsychosocial model that considers a person as part of a systems hierarchy i.e. the person subdivides intoa a nervous sytem, organs, etc. and is part of a larger system such as the two-person system, family, community, etc.

Front 67

SOAP

Back 67

subjective, objective, assessment, plan

Front 68

phenomonology

Back 68

gathering of signs, symptoms, and description of what is occurring

Front 69

etiology

Back 69

underlying cause of illness, "nail in the foot"

Front 70

pathogenesis

Back 70

development of an illness after the primary cause

Front 71

stress

Back 71

demand for adaptation from the environment

Front 72

internal stress

Back 72

hormone changes at puberty

Front 73

stress-diathesis

Back 73

interaction of stress and underlying vulnerabitlity

Front 74

strain

Back 74

results from a person's attempts to deal with stress, strain is subjective

Front 75

diathesis

Back 75

aka vulnerability is determined by interaction between heredity and environment, e.g. a patient with a history of depression may become more depressed over time if exposed to multiple truamas during development

Front 76

psychogenic

Back 76

when the root cause of an illness is mental or emotional

Front 77

reactions to death and dying

Back 77

denial, bargaining, anger, depression, dependency, acceptance

Front 78

common defense mechanisms

Back 78

denial, avoidance, repression, aggression, humor

Front 79

Weiss and Bertanlanffy

Back 79

created biopsychosocial model