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36 Cards in this Set
- Front
- Back
What is the term for the obligation to respect patients as individuals (truth-telling, confidentiality), to create conditions necessary for autonomous choice (informed consent), and to honor their preference in accepting or denying medical care |
Patient Autonomy
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What is the term for the special ethical (fiduciary) duty of physicians to act in the patient's best interest?
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Beneficence
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How do Patient Autonomy and Beneficence relate?
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- Patient Autonomy: patient's right to decide their medical care
- Beneficence: physician's ethical duty to act in the patient's best interest * They may conflict, but if the patient can make an informed decision, ultimately, the patient has the right to decide |
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What is the term for "do no harm"?
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Non-Maleficence
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How do Beneficence and Non-Maleficence relate?
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- Beneficence: physician's ethical duty to act in the patient's best interest
- Non-Maleficence: do no harm * If the benefits of an intervention outweigh the risks, a patient may make an informed decision to proceed (most surgeries and medications fall into this category) |
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What is the term for treating persons fairly?
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Justice
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What does informed consent legally require?
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1. Disclosure: discussion of pertinent information
2. Understanding: ability to comprehend (assess) 3. Mental capacity: unless incompetent (legal determination) 4. Voluntariness: freedom from coercion and manipulation |
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What are the exceptions to informed consent?
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- Patient lacks decision-making capacity or is legally incompetent
- Implied consent in an emergency - Therapeutic privilege: withholding information when disclosure would severely harm the patient or undermine informed decision-making capacity - Waiver: patient waives the right to informed consent |
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What is necessary for a patient to have informed consent?
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- Patient must have an intelligent understanding of the risks, benefits, and alternatives, which include no intervention
- Written consent can be revoked by the patient at any time, even orally |
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What are the informed consent requirements for minors (<18 years)?
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Consent must be obtained by parents/guardians unless the minor is emancipated (eg, married, self-supporting, has children, or is in the military)
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Under which conditions is parental consent not necessary for a minor (<18 years)?
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SEX: contraception, STDs, pregnancy
DRUGS: addiction ROCK and roll: emergency / trauma) - Emancipation: married, self-supporting, has children, or in the military - Emergency situations - Prescribing contraceptives - Treating STDs - Medical care of pregnancy - Treatment of drug addiction |
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What are the components of decision-making capacity?
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- Patient is >18 years old or otherwise legally emancipated
- Patient makes and communicates a choice - Patient is informed (demonstrates knowledge and understanding) - Decision remains stable over time - Decision is consistent with patient's values and goals, not clouded by a mood disorder - Decision is not a result of delusions or hallucinations |
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What is an advanced directive?
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Instructions given by a patient in anticipation of the need for a medical decision; details vary per state law
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What are the types of advanced directives?
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- Oral advance directive
- Living will (written advanced directive) - Medical power of attorney |
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What information is gained from an "Oral Advanced Directive"? Pros / Cons?
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- Incapacitated patient's prior oral statements used as guide
- Pros: If patient was informed, directive was specific, patient made a choice, and decision was repeated over time to multiple people, oral directive is more valid - Cons: Problems arise from variance in interpretation |
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What information is gained from a "Living Will" (written advanced directive)?
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- Describes treatments the patient wishes to receive or not receive if he/she loses decision-making capacity
- Usually patient directs physician to withhold or withdraw life-sustaining treatment if they develop a terminal disease or enter a persistent vegetative state |
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What information is gained from a "Medical Power of Attorney"?
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- Patient designates an agent to make medical decisions in the event that he/she loses decision-making capacity
- Patient may also specify decisions in clinical situations - Patient can revoke anytime patient wishes (regardless of competence) - More flexible than a living will |
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What happens if a patient has not prepared an advance directive and becomes incompetent / unable to make decisions?
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- Individuals (surrogates) who know the patient must determine what the patient would have done if he/she were competent
- Priority of surrogates: spouse, adult children, parents, adult siblings, other relatives |
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What are the general principles for exceptions to confidentiality?
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- Potential harm to others is serious
- Likelihood of harm to self is great - No alternative means exists to warn or to protect those at risk - Physicians can take steps to prevent harm |
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What are some examples of exceptions to confidentiality?
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- Reportable diseases (STDs, TB, hepatitis, food poisoning) - may have a duty to warn public officials who will then notify people at risk
- Tarasoff decisions - requirement to directly inform and protect potential victim from harm - Child and/or elder abuse - Impaired automobile drivers - Suicidal / homicidal patients |
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What is the appropriate response to a patient who is not adherent?
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- Attempt to identify patient's reason for non-adherence and determine their willingness to change
- Do not attempt to coerce the patient into adhering or refer the patient to another physician |
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What is the appropriate response to a patient who desires an unnecessary procedure?
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- Attempt to understand why the patient wants the procedure and address underlying concerns
- Do not refuse the patient or refer him/her to another physician - Avoid performing unnecessary procedures |
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What is the appropriate response to a patient who has difficulty taking medications?
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- Provide written instructions
- Attempt to simplify treatment regimens - Use teach-back method (ask patient to repeat medication regiment back to physician) to ensure patient comprehension |
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What is the appropriate response to a patient's family members who ask for information about the patient's prognosis?
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Avoid discussing issues with relatives without the permission of the patient
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What is the appropriate response to a child's wishes to know more about his/her illness?
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- Ask what the parents have told the child about his/her illness
- Parents of a child decide what information can be relayed about the illness |
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What is the appropriate response to a 17-year old girl who is pregnant and requests an abortion?
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- Many states require parental notification or consent for minors for an abortion
- Unless she is at medical risk, do not advise a patient to have an abortion regardless of her age or condition of the fetus |
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What is the appropriate response to a 15-year old girl who is pregnant and wants to keep the child, but who's parents want you to tell her to give the child up for adoption?
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- The patient retains the right to make decisions regarding her child, even if her parents disagree
- Provide information to the teenager about the practical issues of caring for a baby - Discuss the options, if requested - Encourage discussion between the teenager and her parents to reach the best decision |
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What is the appropriate response to a terminally ill patient whom requests physician assistance in ending their own life?
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- Refuse involvement in any forms of physician assisted suicide
- You may prescribe medically appropriate analgesics that coincidentally shorten the patient's life |
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What is the appropriate response to a patient who is suicidal?
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Assess the seriousness of the threat
- If it is serious, suggest that they remain in the hospital voluntarily - Patient can be hospitalized involuntarily if he/she refuses |
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What is the appropriate response to a patient that states that he/she finds you attractive?
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- Ask direct, closed-ended questions and use a chaperone if necessary
- Romantic relationships with patients are never appropriate - Never say "there can be no relationship while you are a patient" because this implies that a relationship may be possible if the individual is no longer a patient |
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What is the appropriate response to a woman who had a mastectomy and says she feels ugly when she undresses?
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- Find out why the patient feels this way
- Do not offer falsely reassuring statements (eg, "you still look good") |
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What is the appropriate response to a patient who is angry about the amount of time he/she spent in the waiting room?
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- Find out why the patient feels this way, but do not take a patient's anger personally
- Apologize for any inconvenience - Stay away from efforts to explain the delay |
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What is the appropriate response to a patient who is upset with the way he/she was treated by another doctor?
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- Suggest that the patient speak directly to that physician regarding the concerns
- If the problem is with another member of the office staff, tell the patient you will speak to that individual |
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What is the appropriate response to a drug company offering a "referral fee" for every patient a physician enrolls in a study?
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- Eligible patients who may benefit from the study may be enrolled, but is never acceptable to receive compensation from a drug company
- Patients must be told about the existence of a referral fee |
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What is the appropriate response to a physician ordering an invasive test for the wrong patient?
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No matter how serious or trivial a medical error, a physician is ethically obligated to inform a patient that a mistake has been made
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What is the appropriate response to a patient that requires a treatment not covered by his/her insurance?
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- Never limit or deny care because of the expense in time or money
- Discuss all treatment options with patients, even if some are not covered by their insurance |