Ethics

Front 1

Five elements of informed consent

Back 1

1. Adequate disclosure of information
2. Decisional capacity of the patient
3. Patient's comprehension of the information
4. Voluntariness (freedom from coercion)
5. Consent of the patient.

Front 2

Four circumstances for which full informed consent is not necessary

Back 2

1. Emergency privilege
2. Therapeutic privilege
3. Patient does not have decisional capacity
4. Waiver of rights

Front 3

Two standards of disclosure most frequently applied by courts

Back 3

1. Professional community standard
2. Reasonable patient standard

Front 4

Three elements of decision making capacity

Back 4

1. Ability to understand
2. Ability to evaluate
3. Ability to communicate

Front 5

Emergency privilege entails:

Back 5

- patient must be unconscious, without capacity to make a decision, w/o legally authorized person to act as agent
- Time of the essence, inaction risks bodily injury/death
- a reasonable person would consent

Front 6

Therapeutic privilege entails:

Back 6

- physician takes into account circumstances of patient
- physician believes full disclosure of information would adversely impact patient (rarely used)

Front 7

Ability to understand entails:

Back 7

- ability to comprehend information about diagnosis and treatment and identify issue at hand
- ability to appreciate the impact of disease and consequences

Front 8

Ability to evaluate entails:

Back 8

- ability to deliberate in accordance w/ one's own values
- ability to manipulate information rationally and compare risks and benefits
- ability to make choices that are not irrational and to give the reasons
- ability to maintain a consistent choice over time

Front 9

Substituted judgment standard

Back 9

- guideline used by surrogate if patient has expressed a preference before becoming incapacitated
- if surrogate knows patient's wishes, what patient would choose if able

Front 10

Legal exceptions to confidentiality

Back 10

- Testifying in court
- reporting communicable disease
- reporting child abuse, spose abuse, elder abuse
- Reporting gunshot or suspicious wounds resulting from suspected crime
- reporting for workers' compensation cases

Front 11

types of advance directives

Back 11

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

Front 12

Authority for withdrawal of treatment in order of importance

Back 12

1. Request of a decisional patient
2. Dictates of an advance directive
3. Judgment of guardian or healthcare agent appointed in an AD
4. Approval of relatives (spouse, adult children, parents, adult siblings -- in that order)
5. Approval of close friends who know patient's preferences

Front 13

President's Commission 1982 opinion on distinction between withdrawing and withholding therapy

Back 13

- no moral importance in distinction
- justification adequate for not commencing treatment sufficient for ceasing ineffective treatment
- a higher requirement for cessation might discourage potentially successful trials.

Front 14

AMA policy on euthanasia

Back 14

- incompatible with physician's role as healer
- difficult or impossible to control
- pose serious societal risks
- patients should not be abandoned
- may be practiced on vulnerable populations

Front 15

Goals of medicine

Back 15

1. Prevention of disease and untimely death
2. Cure of disease, when possible
3. Improvement or maintenance of functional status when cure is not possible
4. Palliation, pursuit of a peaceful death, comfort care in all situations
5. patient education and counseling

Front 16

Case Method

Back 16

Serious Decisions Make Good Proxies Nervous

- Stakeholder
- Decisional Authority
- Medical Indications
- Goals and Preferences
- Plan and Alternatives
- Norms

Front 17

Terminal Sedation

Back 17

- Deep sedation for terminally ill patients experiencing severe symptoms
- Dyspnea, Pain, Agitation, Vomiting

Front 18

Futility

Back 18

1. There is a goal
2. There is an action aimed at achieving the goal
3. There is virtual certainty that the action will fail

Front 19

Medical Indications for writing a DNR

Back 19

- 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 20

Grounds for refusal of an unreasonable request

Back 20

1. outside the scope of good medicine/lack of objective evidence
2. requires doctor to act illegally
3. requires doctor to violate personal and professional standards of responsible medical practice
4. treatment cannot be anticipated to produce any beneficial result

Front 21

Brain death

Back 21

1. Profound coma -- eyes-closed unconsciousness
2. No eye movement; no pupillary response
3. No corneal reflexes
4. No cough or gag reflex; no motor response to pain
5. No spontaneous respiratory attempts off the ventilator

Front 22

persistent vegetative state

Back 22

1. Sleep-like coma -- days to weeks, then eyes open; sleep-wake cycles begin
2. Eyes-open unconsciousness, random eye movements, no focus or follow
3. Unintelligible grunts, screams; grimacing and chewing w/o purpose; uncoordinated swallowing
4. many reflexes present (corneal, cough, gag, startle)
5. gross involuntary reflexive movement w/o purpose.

- after 3 months, recovery virtually nil.