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19 Cards in this Set
- Front
- Back
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True or false: adult patients of sound mind are allowed to refuse life-saving treatments? |
True- e.g., you should not force blood products, antibiotics, or any other treatments on a patient who does not want them |
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What should you do if a child has a life-threatening condition and his parents refuse a simple, curative treatment (e.g., antibiotics for meningitis)? |
- First try to persuade them to change their mind - If this fails, get a court order to give treatment - Do not treat until you have talked to the courts unless it is an emergency - Even with Jehovah's witnesses who do not want their children to receive a blood transfusion, you should seek court assistance in getting the transfusion if it is the only tx option available |
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True or false: people with terminal illness can choose to die? |
True - This is the rationale behind hospice care - Let competent people die if they want to do so - Do not commit active euthanasia but respect the patient's wishes for passive euthanasia |
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What is the difference between active and passive euthanasia? |
Active euthanasia is the intentional hastening of death, whereas passive euthanasia is withholding treatments and "letting nature take its course" |
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With whom can you discuss your patient's condition? |
Only with people who need to know because they are directly involved in the patient's care and with people authorized by the patient (e.g., family members) Do not tell a medical colleague who is uninvolved with their care how they are doing even if they are a friend of yours or the patient |
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In what situations are you allowed to breach patient confidentiality? |
- Patient asks you to do so - Child abuse is suspected - Courts mandate you to do so - You must fulfill the duty to warn or protect (if they say they are going to kill someone or themselves, you have to tell someone, the authorities, or both) - Patient has a reportable disease - Patient is a danger to others (e.g., if they are blind or have seizures, let authorities know so they can revoke their license to drive; if they are a pilot and are paranoid, hallucinate, or suffer from schizophrenia, authorities need to know) |
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What are the components of informed consent? |
Give pt information on: - Diagnosis (their condition and what it means) - Prognosis (natural course without tx) - Proposed tx (description of procedure and what the pt will experience) - Risks / benefits of tx - Alternative tx |
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What should you do if a patient is incompetent to make decisions? |
Get family and/or courts to appoint a guardian (surrogate decision maker or health care power of attorney) |
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True or false: a living will should not be respected if the next of kin asks you not to follow it? |
False - Such situations are tricky, but technically living wills or patient-mandated "DNR" orders should be respected and followed if properly documented |
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What should you do if a patient is in critical condition or in a coma and has made no advance directive or living will? |
- The wishes of the family, next of kin, or health care power of attorney should be followed - In cases of disagreement among family members, suspicion of ulterior motives, or uncertainty, involve the hospital's ethics committee - As a last resort, go to the courts for help |
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What should you do about patients with depression in the context of end-of-life decisions? |
Depression always should be evaluated as a reason for "incompetence" Patients who are suicidal may refuse all treatment, but their refusal should not be respected until the depression is treated |
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True or false: in some circumstances patients can be hospitalized against their will? |
True - Psych pts frequently are hospitalized against their will if they are deemed to be a danger to themselves or others - Pts can be held only for limited time (1-3 days) before they must have a hearing before a court official to determine whether to remain in custody - These decisions are made on principle of beneficence (principle of doing good for pt and avoiding harm) |
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True or false: restraints can be used on patients against their will? |
True - Restraints can be used on an incompetent or violent (delirious / psychotic) pt if needed, but their use should be brief and reevaluated often (at least q24 hours) - Be aware use of restraints in delirious or demented pts rarely helps prevent falls and may cause injury |
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When do patients <18 years of age not require parental consent for a medical decision? |
- Emancipated (married, living on their own, financially independent, raising children, or serving in armed forces) - Have an STD - Want contraception - Pregnant - Want illicit drug treatment or counseling - Have psychiatric illness |
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What should you do if a child has a medical emergency and the parents are unavailable for decision making? |
Treat the child as you see fit; that is, act in the child's best interest |
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True or false: it is acceptable to hide a diagnosis from a patient if the family asks you to do so? |
False - Do not hide a diagnosis from a patient (including a child) if the pt wants to know (even if family asks you to do so) - Do not lie to any patient because family asks you to do so - Conversely, you should not force pts to receive information against their will; if they do not want to know the diagnosis, do not tell them |
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What should you do if a patient requires emergency care but the pt cannot communicate and no family members are available? |
Treat the pt as you see fit unless you know the pt wishes otherwise |
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True or false: withdrawing care and withholding care are the same in the eyes of the law? |
True - It is important to communicate this principle to family members who feel guilty - Simple fact that a pt is on a respirator does not mean you can't turn the respirator off |
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True or false: in terminally ill, nondurable pts, one of the primary goals is to relieve pain? |
True - Opioids are commonly used, even though they may cause respiratory distress - It is more important to make them comfortable and pain-free than to worry about respiratory depression in this setting |
