1- Ethics

Question 1

4 principles of declaration of geneva

Answer 1

1. Beneficence: provide benefits, promote good, prevent harm (generally)
2. Non-maleficence: avoid inflicting harm (personally)
3. Respect of patient autonomy: respect the decision making of autonomous individuals
4. justice: fairness in distributing risks and benefits

Question 2

Criteria for overriding confidentiality

Answer 2

• potential harm to third parties is serious
• likelihood of harm is high
• no alternative for warning/protecting those at risk exists
• breaching confidentiality will prevent harm
• harm to patient is minimized and acceptable

Question 3

HIPAA

Answer 3

Health insurance portability and accountability act: requires healthcare professionals receive patient permission before disclosing information except for cases of paying for and treating services

Question 4

AHA Patients bill of rights

Answer 4

1973: first document to sort of address “truth telling” and encourage patient to receive information that is relevant and understandable about their health/care

Question 5

Clinical standards for decision making capability (5)

Answer 5

1. Choice: patient makes and communicates a choice
2. Information: patient appreciates medical situation and prognosis, nature of recommended care, alt courses of care, risks/benefits/consequences of alts
3. Consistency: decisions are consistent with patients goals and values
4. State of mind: decisions do not result from delusions
5. reason: the patient uses reasoning to make a choice

Question 6

decision making capability vs. competency

Answer 6

Physicians: determine decision making capability
Courts: designate a patient incompetent to make medical decisions

Question 7

Key case for informed decision making

Answer 7

Martin Salgo: suffered permanent paralysis, a known possibility, from a translumbar artography- case ruled that doctors have a duty to inform a patient “any facts which are necessary to form the basis on an intelligent consent by the patient to the proposed treatment”

Question 8

information needed to relay to establish informed consent

Answer 8

In order to consent, patients must know: (Mnemonic: DRAN)
Diagnosis and prognosis
The nature of the medical condition
Recommended treatment
Risks, benefits, and consequences of intervention
Alternative treatments
Risks, benefits, and consequences of alternatives
No treatment
Consequences of not treating the condition
Risks and benefits

Question 9

Tarasoff case

Answer 9

duty to warn, breaching confidentiality

Question 10

Exceptions to informed consent

Answer 10

Exceptions to informed consent (Mnemonic: WELT)
Waiver
Patients can waive the right to informed consent
Emergencies
Lack of decision-making capability
Therapeutic privilege
If disclosure would severely harm the patient or undermine informed decision-making of the patient
i.e. suicidal patient

Question 11

how to respond to competent, informed patients who refuse treatment

Answer 11

Promote shared decision-making
Encourage the patient to play an active role in decisions
Elicit the patient’s perspective about the illness
Build a partnership with the patient
Ensure that patients are informed
Provide comprehensible information
Try to frame issues without bias
Interpret the alternatives in light of the patient’s goals
Check that the patients have understood information
Protect the patient’s best interest
Help the patient deliberate
Make a recommendation
Try to persuade patients

Question 12

Deception
Misrepresentation
Nondisclosure

Answer 12

DECEPTION:
broader than lying; includes all statements that are intended to mislead the patient whether or not they are literally true
MISREPRESENTATION:
Even broader category; includes intentional AND unintentional statements
NONDISCLOSURE:
Physician does not provide information about diagnosis