Nursing Ethics Final Exam Pt 1

Front 1

rights-based approaches to health care:

Back 1

Rights related to virtue
Must fit with justice (equality, fairness, impartiality/ need & merit)
Rights: people can claim them as due to them
Free to not exercise rights
Others have duty to facilitate exercise of rights
Must be enforceable to have meaning
Compensation if violated or set aside
Duties follow rights 
Not wrong to exercise a right
Others are wrong to interfere with exercise of one’s rights

Front 2

Positive/ welfare / subsistence rights:

Back 2

more consensus here re children
society obligated to provide; e.g. the right to be cared for; imposes a moral obligation on others

Front 3

Negative/ Liberty rights:

Back 3

not to be interfered with/ society not to get in the way of exercising an absolute or non-absolute right

Front 4

______ rights overrule ______ rights when harm to self or others may result  

Back 4

positive, liberty

Front 5

Moral-correlativity approach:

Back 5

having rights depends on demonstrating the capacity to live up to corresponding responsibilities

Front 6

Rights in trust:

Back 6

rights children will have when they are mature enough to exercise them—are held in “safekeeping” by appropriate adults

Front 7

regarding moral standing, how do we figure out who has it? you ask:

Back 7

Who counts morally (i.e. who are we required to take into account in ethical decisions and actions?

Front 8

_______ decides who has moral standing

Back 8

community

Front 9

Moral standing: Based on being granted membership in the moral community. according to paternalism, who has moral standing?

Back 9

persons/only persons

Front 10

Moral standing: Based on being granted membership in the moral community. According to humanism, who has moral standing?

Back 10

humans/only humans

Front 11

Moral standing: Based on being granted membership in the moral community. according to vitalism, who has moral standing?

Back 11

all/only living entities

Front 12

Moral standing: Based on being granted membership in the moral community. According to racism, who has moral standing?

Back 12

all/only members of one race

Front 13

Moral standing: Based on being granted membership in the moral community. According to nationalism, who has moral standing?

Back 13

all/only members of a nation

Front 14

Moral standing: Based on being granted membership in the moral community. According to sexism, who has moral sanding?

Back 14

all/ only those of one gender

Front 15

Moral standing: Based on being granted membership in the moral community. According to universalism, who has moral standing?

Back 15

all/only sentient creatures

Front 16

what is valued i the Biographical (vs. biological definition of being human)? (4)

Back 16

-Implies being a bearer of rights and duties
Feinberg: criteria:
-Consciousness
-Self-concept
-Capacity to experience emotions, reason, acquire understanding, plan, feel pleasure & pain

Front 17

having moral status means that:

Back 17

persons consciously consider their interests and welfare as moral agents

Front 18

(according to the biological view) full moral status begins when:

Back 18

humans come into existence, or become sentient beings

Front 19

(according/created by Feinberg) full moral status is based on:

Back 19

the amount of accrued possession of interests. known as the time-relative interest account

Front 20

regarding personhood and Kant, what were 4 of his proposed universal human attributes?

Back 20

Rational being
Social being
A worker
Exercise freedom or autonomy

Front 21

regarding the Quorum principle for personhood, what is this?

Back 21

majority of features that constitute a human life

Front 22

the Quorum principle may conflict with:

Back 22

sanctity of life principle & with quality of life principle

Front 23

historically, children did not generally have full _____ ______

Back 23

moral standing

Front 24

per Ethics Committee of the American Fertility Society, a pre-embryo is:

Back 24

not a person, but must be treated with special respect as genetically unique, living human entity that might become a person

Front 25

regarding moral status and rights of embryos, what are some competing rights? 5

Back 25

woman, society, fetus, family, father, etc.

Front 26

what are 4 central dilemmas surrounding abortion?

Back 26

Actual vs.. potential personhood of an embryo
Various right-holders
Principles to consider, such as beneficence, non-malefecience, utilitarianism
Non-abandonment of patient

Front 27

regarding historical views on genetics, what did eugenics ask?

Back 27

can we have a "perfect" population?

Front 28

The term eugenics was introduced into public discourse in ____ by Sir Francis _____ as a "science of racial improvement through controlled breeding"

Back 28

1883, Galton

Front 29

what are the two conflicting approaches regarding eugenics?

Back 29

negative / repressive vs. positive eugenics.

Front 30

negative/repressive eugenics has included:

Back 30

Has included sterilization of the "physically and mentally unfit" (September 1919, p. 18), as well as social policy to abolish child labor, establish compulsory education, and prohibit educational subsidies--all in an effort to make child bearing prohibitively expensive for the poor

Front 31

positive eugenics included:

Back 31

includes encouraging "the healthy" to have larger families and support of these children through adolescence and into adulthood. Writers of the time such as Raymond B. Cattell (1937) contrasted these two foci of eugenics as the "Civilization Wreckers, Unlimited" of large immigrant families and the "National Suicide Club" of smaller affluent old stock families

Front 32

positive eugenics in the early 20th century:

Back 32

introduction of a "compound of morphine and scopolamine administered by physicians and nurses at elaborate birthing establishments" to cause "twilight sleep" or total amnesia regarding childbirth.
This practice was intended in encourage child bearing among the middle class and wealthy who, it was believed, were uniquely susceptible to pain

Front 33

according to social darwinism, biological laws govern ____ of nature;
population growth generates _______ for existence

Back 33

all, struggle

Front 34

according to social darwinism,advantages spread through ________

Back 34

inheritance

Front 35

according to social darwinism, selection and _______ lead to evolution and ________

Back 35

inheritance, extinction

Front 36

regarding social darwinism, all this applies to human ______, therefore consciousness, _______, psychology, politics and ethics evolved through _______ ________

Back 36

culture, religion, natural selection

Front 37

social darwinism applied:
Morality based on _____
Humans as part of the natural ______
Focus on gradations between ________
Survival of the fittest as a moral _______

Back 37

nature, spectrum, humans, imperative

Front 38

social darwinism applied:
Human value based on functional characteristics - not _______
Notion of life not worth living...?

Back 38

inherent

Front 39

in the early 20th century, Rich and poor (women in particular) were equally to blame for the anticipated "race suicide," the poor for their _____ more _______ than they could support (and their supposed lack of ______ self control), and the wealthy for choosing _____ ____ over motherhood.

Back 39

bearing, children, sexual, social life

Front 40

during the early 20th century when the rich and poor (women in particular) were blamed for the anticipated "race suicide," birth control could be defined as most appropriate for the _____, but a menace for society if freely distributed to the already _______ ______ ______

Back 40

poor, dwindling higher classes

Front 41

Types of Genetic tests:
-Carrier of genetic mutations
-______: fetus genes
_______: for treatable diseases
_______ (DNA of victims and suspects)

Back 41

prenatal, newborn, forensic

Front 42

Types of Genetic Tests:
-Diagnostic
________ or _______: supposedly offer customized recommendations for diet

Back 42

Nutrigenomic, nutrigenetic

Front 43

types of genetic tests:
_________: tailoring medications

Back 43

Pharmacogenetic

Front 44

7 kinds of genetic tests:

Back 44

-carrier of genetic mutations
-prenatal
newborn
forensic
diagnostic
nutrigenomic or nutrigenetic
Pharmacogenetic

Front 45

what are the 3 pros of self-administered genetic screening

Back 45

Can enhance ethical health care
Autonomy: choice to have information
Primary and secondary prevention

Front 46

4 ethical concerns of self-administered genetic screening:

Back 46

Usefulness of information
Obtaining information indirectly about relatives
Accuracy of tests (not regulated)
How calculate risk?

Front 47

11 new ethical consequences/ issues:

Back 47

Decisions demanded in new areas
Is technology morally neutral?
Technological advances outpace ethical consensus & resources
Clinical vs. political decisions
Extending human life
Living wills / patient choice about use of technology
Quantity vs. quality of life
A right to technology? Inequalities
Depersonalization
Technological imperative

Front 48

Regarding enhanced diagnostic capabilities, they are Usually embraced as a good thing, but questions & concerns exist. what are 2 good aspects?:

Back 48

Disease without clinical symptoms
Multiple present and future genetic tests on single sample

Front 49

regarding enhanced diagnostic capabilities, what are 3 concerns that exist?

Back 49

-Consent/ who gives consent? do people always want to know?
-Confidentiality
-Impact of diagnoses on insurability

Front 50

genetic screening enhancement allows earlier _______

Back 50

diagnosis

Front 51

What is unique about ethics of Mental Health Care? (3)

Back 51

-Implications of diagnosis
-Decisional capacity
-Relationship between clinicians and patients

Front 52

what are 4 aspects of the relationship between clinician and patient? (in mental health care)

Back 52

Boundaries
Privacy
Confidentiality
Privileged communication

Front 53

what is psychology's role in mental health and social control?

Back 53

Role of psychology in controlling social behavior and use of power

Front 54

who are 2 psychologists that were involved in mental health and social control?

Back 54

Michel Foucault
Paul Starr

Front 55

regarding mental health and social control, what is the dilemma?

Back 55

conflict between caring and control of aberrant behaviors
--Cultural variations

Front 56

what is an ethical implication regarding mental health and diagnosis? --Often no ______ tests that can be used to diagnose illness (________ in diagnoses of WNL & DSM / medicalization)

Back 56

difinitive, subjectivity,

Front 57

what is an ethical implication for mental health and diagnosis? --Often represent the boundaries of what is categorized as _____ versus ______ in society

Back 57

normal, abnormal

Front 58

ethical implications for mental health and diagnosis include: _____ relationships
______ & labeling
Examples in popular media:
“The Changeling”
“The Secret Scriptures”
“_______________"

Back 58

power, stigma, one flew over the coocoo's nest

Front 59

What are 3 types of stigma?

Back 59

-Body: visible or not
-Character: behavior or condition interpreted to reflect negatively on character
-Tribal / Identity
(religion
race or ethnicity
nationality)

Front 60

inborn/ascribed stigmas: (4)

Back 60

congenital
racial identity
person may be protected until faces outside world
socialized into the role while also socialized re roles of “normals”

Front 61

acquired stigmas:

Back 61

accident/injury
illness
aging
character blemishes
behavior
often internalized negative attitudes
turning point
new social identity
loss of prior identity

Front 62

what are 3 discredited stigmas?

Back 62

-differences already known
-differences readily evident
-person can be more prepared for others’ reactions

Front 63

what are 2 discreditable stigmas?

Back 63

-stigma not known about in the present e.g. diagnostic or behavioral history
-not readily perceivable by others

Front 64

what are 3 impacts of mental health on decisional capacity?

Back 64

Informed consent
Competence
Statutory authority to treat

Front 65

regarding mental health and decisional capacity, ______ is assessed by health care professionals and _______ is determined within the court system

Back 65

capacity, competence

Front 66

regarding mental health and decisional capacity, Both capacity and competence are related to questions of whether patients have a right to ______ to and ______ ________

Back 66

consent, refuse, treatment

Front 67

regarding decisional capacity, ______ _______, as required by legal authorities, is ________ in situations involving incompetent patients

Back 67

informed consent, impossible

Front 68

regarding decisional capacity and statutory authority to treat, involuntary hospitalization decisions can be made only after:

Back 68

less restrictive options have failed or have carefully been determined not to be a viable option

Front 69

what are 3 components of clinical care and for mental health patients?

Back 69

psychotherapeutic clinician-patient relationship (words)
psychopharmacology (drugs)
milieu management (environment)

Front 70

what is decisional privacy?

Back 70

With regard to personal choices

Front 71

what is proprietary privacy?

Back 71

Property interests, including interests with regard to bodily tissues, one’s name, etc.

Front 72

in the mental health field, Confidentiality, or nondisclosure of information, involves limits on the communication of “:

Back 72

any information a clinician obtains about a patient in the context of the clinician-patient relationship”

Front 73

regarding privileged communication in the mental health field, Privilege provides relief from having to:

Back 73

disclose information in court proceedings

Front 74

regarding privileged communication in the mental health field, Patients have a legal right to believe that their communication with clinicians will be kept ________

Back 74

confiedential

Front 75

In some cases, clinicians may have a ____ __ _____, which involves “a duty to disclose confidential information to protect an identifiable victim”

Back 75

duty to warn

Front 76

Ethical Mandates for vulnerable groups (e.g. mental health issues) (8):

Back 76

-Respect for human dignity
-Do good, do not harm
-Truth-telling
-Protect from illegal or unethical Rx of others
-Therapeutic use of self
Caring, compassionate
-Promote autonomy
-Advocacy

Front 77

Special issues for Children and Adolescents -- Reasons for treating children differently:

Back 77

Developmental appropriateness
Decision-making capability and informed consent
Level of involvement of and impact on others (usually family)
Permission of 1 or both parents required
Assent of child usually required
Not all children capable of assent
Waiving or overruling parental permission and/or child assent

Front 78

rights-based approaches to health care: (10)

Back 78

Rights related to virtue
Must fit with justice (equality, fairness, impartiality/ need & merit)
Rights: people can claim them as due to them
Free to not exercise rights
Others have duty to facilitate exercise of rights
Must be enforceable to have meaning
Compensation if violated or set aside
Duties follow rights 
Not wrong to exercise a right
Others are wrong to interfere with exercise of one’s rights

Front 79

types of rights (4):

Back 79

-Positive rights 
-Negative/ Liberty rights:
-Moral-correlativity approach
-Rights in trust

Front 80

rights in trust:

Back 80

rights children will have when they are mature enough to exercise them—are held in “safekeeping” by appropriate adults

Front 81

1959 UN Declaration of rights of the child:
Non-discriminatory entitlement to rights to:
At birth (5):

Back 81

name, nationality, adequate food, shelter, recreation, health care

Front 82

1959 UN Declaration of rights of the child:
Handicapped child has rights to(3):

Back 82

special care, treatment & education

Front 83

1959 UN Declaration of rights of the child:
_____ support for families or other caretakers of children

Back 83

state

Front 84

1959 UN Declaration of rights of the child:
__________

Back 84

education

Front 85

1959 UN Declaration of rights of the child:
Protection from:

Back 85

cruelty, neglect, exploitation & discriminatory practices

Front 86

1959 UN Declaration of rights of the child:
Summary:

Back 86

Enhance personhood & protect basic needs as grows to adulthood

Front 87

1959 UN Declaration of rights of the child:
Some note absence of rights to (4):

Back 87

Autonomy, love, being wanted, personal space & self-expression, to reach potential

Front 88

regarding best interests, Competent person with decision making capacity makes a decision regarding what he or she thinks is:

Back 88

in the best interest of the child or adolescent

Front 89

regarding best interests, what are some components of substituted judgement(6)?

Back 89

History (self & others)
Existing preferences
Beliefs, values, culture
Self-assessed quality of life
Ability to make decisions
Advance directives (IF lacks decision-making capacity)

Front 90

define rational paternalism:

Back 90

Adult must act on basis of wisdom or rational thought

Front 91

competency, a _____ term, refers to:

Back 91

global capacity to manage legal, one’s affairs
Adults are presumed to be competent unless a court has declared otherwise

Front 92

decision making capacity, a ______ term, requires (4):

Back 92

clinical,
-Ability to understand information presented
-Understand the consequences of the options available
-Ability to express a preference
-Evidence of reasoning

Front 93

5 requirements for giving informed consent in research:

Back 93

-Legal and mental capacity
-Sufficient opportunity to consider participating
-Minimal coercion or undue influence
-Language is understandable
-Not asked to waive any legal rights`

Front 94

stages of kohlberg's moral development:

Back 94

Pre-conventional
Conventional
Post-conventional

Front 95

gilligan's moral development (4):

Back 95

Individual survival
Care and conformity
Independence of self and others
Care & responsibility

Front 96

particular issues regarding children: Best-______ standard

Back 96

interest

Front 97

particular issues regarding children: Rights of children or their parents to _____ health care treatments

Back 97

refuse

Front 98

Baby Doe rules:

Back 98

Child abuse amendments of 1984 re withholding and withdrawing supportive care of infants

Front 99

regarding research, Parents permission overrides child’s refusal to give assent when (2):

Back 99

Too young to give assent
Health of child at stake

Front 100

regarding children and trends influencing ethics of care... MT/FD:

Back 100

(medically fragile, technology-dependent) children surviving longer

Front 101

regarding children and trends influencing ethics of care, there is More _____ care for children

Back 101

home

Front 102

regarding children and trends influencing ethics of care, there is increased _____-____ care

Back 102

long term

Front 103

regarding children and trends influencing ethics of care, there are _____ for public _____ to support families

Back 103

needs, policy

Front 104

regarding children and trends influencing ethics of care, ______ care is an influence.

Back 104

critical

Front 105

regarding children and trends influencing ethics of care, there was the 1st pediatric intensive care unit (PICU) in _____: Children’s Hospital __________

Back 105

1960s, philedalphia

Front 106

regarding children and trends influencing ethics of care, there are increased survival and recovery rates for ______ and ______

Back 106

surgery, anesthesia

Front 107

adolescents can be legally _________

Back 107

emancipated

Front 108

regarding adolescents, Early (10-14) is when _____ of ______

Back 108

onset, puberty

Front 109

regarding adolescents, Middle (15-17), primary characteristics include (3):

Back 109

peer pressure
Oriented to peers
Conformity

Front 110

for adolescents, when is the transition into adulthood

Back 110

18-20

Front 111

regarding core ethical issues for adolescents, the Right of freedom to consent to or refuse treatment raises what ethical question?

Back 111

Capacity for understanding?

Front 112

what is the origin of most adolescent risk-taking behaviors?

Back 112

social usually

Front 113

regarding adolescents and risk-taking behaviors, 6 critical health behaviors connected to leading causes of death & disability among U. S. adolescents include:

Back 113

Violence
Alcohol & other drugs
Risky sexual behavior
Tobacco
Poor diet
Lack / inappropriate physical activity

Front 114

particular areas of possible exceptions when it comes to adolescent rights to autonomy(3):

Back 114

-Sexual abuse
-Areas related to sexual behavior
-? Rights to refuse treatment

Front 115

areas related to sexual behavior that limit adolescent rights to autonomy include:

Back 115

contraception
Testing & treatment for STD’s
Pregnancy-related issues

Front 116

__ million over age 65 (20% of population) in US by year ____

Back 116

69, 2050

Front 117

By 2050 number over __ will be > number under __

Back 117

60, 14

Front 118

it is anticipated that in the future, of the aging, Most will need some care with Activities of _____ ______

Back 118

daily living

Front 119

it is anticipated that ___% of elders will need skilled nursing for some time. (by 2050?)

Back 119

43%

Front 120

define the frail elderly:

Back 120

65 & older, with significant physical and/or mental disabilities

Front 121

regarding the frail elderly, Over 65% over of people 65 have significant:

Back 121

physical or mental frailty

Front 122

what are 2 sets of conflicting principles and values with the frail elderly?

Back 122

-independence vs. safety
-Autonomy vs. best interest / paternalism

Front 123

regarding ethical concerns with the fail elderly, a question asked is: With aging, does _____ take on more importance vs. autonomy?

Back 123

dignity

Front 124

regarding ethical concerns with the frail elderly, one question asks: Who decides on _____ of life?

Back 124

quality

Front 125

regarding ethical concerns with the frail elderly, there are Various ways to look at ______ and distribution of scarce resources (_________ _______)

Back 125

justice, distributive justice

Front 126

regarding ethical concerns with the frail elderly, one question asks On whom do ______ fall? (another justice issue)

Back 126

burdens

Front 127

what are 6 trends and issues with the frail elderly?

Back 127

-Technology
-Defining death
-Living longer with chronic illnesses
-Technology gets in the way of family and others being present: patient fears of dying alone
-Hospitals increasingly site of death, but home preferred
-Elderly at risk for abuse

Front 128

historically, how was death defined?

Back 128

unconscious, no pulse, no breath sounds, fixed/dilated pupils

Front 129

mid 19th-mid 20th century, how was death defined?

Back 129

heart stopping

Front 130

beginning in 1981 how was brain death defined?

Back 130

need criteria: done at state levels

Front 131

how is whole brain death defined?

Back 131

need mechanical ventilator

Front 132

how is higher-brain death defined?

Back 132

indefinite vegetative state but don’t need ventilator (no criteria)

Front 133

4 types of elder abuse:

Back 133

-Physical: inflicting harm/injury, sexual abuse or misconduct
-Psychological: threats, insults or humiliation
-Financial: controlling elder’s resources through misrepresentation, coercion or theft
-Neglect:

Front 134

which elders are more vulnerable to abuse (7)?

Back 134

Mentally ill
Cognitively impaired
History of family violence
Dependency
Poor health
Isolated
Lack financial resources

Front 135

6 risk factors for abusers of elders:

Back 135

-Mental illness
-Shared living arrangement
-History of family violence
-Stressful events
-Substance abuse
-Lack financial resources
-Family members, caregivers or “friends”

Front 136

relevant ANA position statements for elders (6):

Back 136

Palliative care
Pain management
Patient restraint
Foregoing Nutrition and hydration
Active Euthanasia
Assisted Suicide

Front 137

relevant AMA position statements for elders (6):

Back 137

End of life care
Euthanasia
Futile care
Physician-assisted suicide
DNR
Withholding or withdrawing life-sustaining medical treatment

Front 138

when does medical futility occur?

Back 138

Occurs when it has been determined that interventions will have little or no chance of a positive effect on the health of a patient

Front 139

medical futility occurs when you wont _______ patient's goal.

Back 139

achieve

Front 140

medical futility: Serves no legitimate _____ of health care

Back 140

goal

Front 141

medical futility: Ineffective at least ___% of the time

Back 141

95

Front 142

medical futility: Doesn’t conform to ______ ________ standards

Back 142

accepted, community

Front 143

ethical questions regarding medical futility (4):

Back 143

Consideration of cost?
Consideration of age of patient?
Consideration of ability to pay?
What percentage chance is too low

Front 144

regarding passive euthanasia, voluntary passive is when competent adult:

Back 144

asks caregivers to withhold or withdraw life-sustaining treatment eg. As for a DNR order

Front 145

regarding passive euthanasia, voluntary passive is when incompetent patient:

Back 145

has previously expressed wishes for withholding or withdrawing life-sustaining treatment

Front 146

regarding passive euthanasia, non-voluntary passive involves what standard?

Back 146

Use best interest standard

Front 147

regarding passive euthanasia, non-voluntary passive happens when formerly competent patient:

Back 147

whose wishes are not known

Front 148

regarding passive euthanasia, non-voluntary passive never happens with:

Back 148

competent patient

Front 149

regarding passive euthanasia, involuntary passive occurs with:

Back 149

medical futility

Front 150

what is an issue with involuntary passive?

Back 150

Should patients or their families demand medically futile care? Rights?

Front 151

regarding active euthanasia, voluntary active occurs with:

Back 151

competent adult’s request

Front 152

voluntary active euthanasia:
Not _____ in ____ except in Oregon
-Terminal ________
Law of _____ ______ is NOT ________

Back 152

legal, US, sedation, double effect, euthanasia

Front 153

regarding active euthanasia,non-voluntary active occurs when:

Back 153

Incompetent patient believed to be in unrelievable pain or suffering

Front 154

an example of when non-voluntary active euthanasia occurs:

Back 154

infant

Front 155

regarding active euthanasia, involuntary active occurs when:

Back 155

Decision to terminate the life of someone who does not wish to die
ex: nazi T4 program

Front 156

regarding Importance of individual assessment: values history...dont assume:

Back 156

an individual fits exactly with values of his/her culture