Health Care Ethics Unit 1 Review Set

Review Flashcard Set for Unit 1 Exam for Health Care Ethics

What is Medical Ethics?

A set of moral rules and values that guide doctors, nurses, and other healthcare workers when making choices about patient care

What are the three distinct branches of Medical Ethics?

Public policy, applied medical ethics, clincial ethics

What is a key element of Medical Ethics?

Making difficult choices

What is a key element of the Importance of Ethical Frameworks in the healthcare system?

fostering trust and integrity in the healthcare system

What is Graber’s 3 Kinds of Medical Judgements?

• Evaluative judgement

• Judgements of duty or moral obligations

• Judgements of character or moral evaluation

What is the Utilitarian Theory?

An ethical theory that judges whether an action is right or wrong based on its outcomes, aiming for "making the best outcome decision" of people

Utilitarian decision: is a choice that aims to produce the greatest good for the greatest number of people

What is the main challenge with the Utilitarian Theory?

It fails to address the fact that one cannot predict the outcome of actions in advance

What is moral reasoning?

the deliberative process of careful reflection on what one “ought to do”

What is the Deontological Theory?

Analyzes issues in terms of duties and rights, and underlines the importance of one’s moral duties, rules, and obligations.

• Deontological decision: is a choice made based on rules, duties, or obligations, rather than the final outcome or consequences of the action

What is the main challenge with the Deontological Theory?

Refusal to consider consequences

What is the Virtue Theory?

Focuses on who you are as a person rather than following strict rules or calculating the results of your actions

Virtue Decision: A choice guided by your moral character and good habits (like honesty, courage, or kindness) rather than just following strict rules or worrying about the final result

What is the main challenge with the Virtue Theory?

lack of clear action-guidance

What is the Common morality?

the set of shared, unwritten moral beliefs and rules that most people in a society generally accept and follow in daily life

What are The Four Principles?

1. Autonomy (deontological practices)

2. Beneficence (utilitarian)

3. Non-maleficence (utilitarian)

4. Justice (deontological practices)

What is Autonomy?

A patient has the right to make their own decisions about their medical care

• Liberty (independence)

• Informed consent

• The right to refuse

• Confidentiality: A patient's medical information belongs to them and cannot be shared without permission

What is Justice?

fairness in healthcare

What is Beneficence?

acting in the absolute best interest of the patient

What is non-maleficence?

do no harm

What is Paternalism?

Someone else makes decisions in your best interest because they know better

What are the Four Models of the Patient-Physician Relationship?

• Paternalistic

• Informative

• Interpretive

• Deliberative

What is the Paternalistic Model?

The doctor makes all the decisions about a patient's care without giving the patient a choice

What is the Informative Model?

A doctor-patient relationship where the physician acts strictly as an objective provider of facts, and the patient makes the final medical decision

What is the Interpretive Model?

An approach where a doctor acts as a counselor or advisor to help a patient understand their own values and choose the best medical treatment

What is the Deliberative Model?

An approach to medicine where the doctor acts as a teacher or counselor to help the patient choose the best possible care based on the patient's own values

What is Internal Morality of Medicine?

the idea that medicine has its own built-in ethical goals and values that are distinct from society's laws or personal beliefs

What is clinical medicine?

Using medical knowledge for healing and helping of sick person in the present moment

What is the first principle in the philosophy of medicine?

the good of the patient

What is conscience?

A healthcare worker's moral beliefs and values, which guide their judgment on what is right or wrong in patient care

What is Cultural Competency?

The ability of healthcare providers to deliver care that respects and responds to a patient’s diverse values, beliefs, and behaviors

What are issues with the Cultural Competency Approach?

• Racial and ethnic biases

• Stereotypes are reinforced

• Conflates systemic forces (poverty, violence, and concepts of racism)

What are 5 Big Takeaways for Health Care?

1. Culture matters in health and health care.

2. Being culturally competent does not mean you can solve all health disparities

3. Culture, race, and ethnicity are distinct concepts

4. Culture is mutable and multiple

5. Context is critical

What is Intersectionality?

The understanding that a patient’s health outcomes are shaped by multiple, overlapping identity factors rather than just one single issue

• Serves to supplement cultural competence and humility

What are the 2 Themes that Emerge from Applying Intersectionality?

• The clinician to confront their own biases

• Complicates the picture, challenges assumptions, and potentially clarifies issues

What is Plato’s philosopher king?

Someone of great virtue with a love for learning is best to lead the city

What is an ERF?

An ERF is a good/value, right, or any other factor to which you ought to be sensitive in determining that ethically right way to respond to the situation

What is the So Far No Objections Framework (SNFO)?

Allows for a systemic approach to identify sources of uncertainty in ethical decisions

What are the three major sources of uncertainty or disagreement with SNFO?

Competing Stakeholders, Uncertainty/Disagreement about Facts, Clashing Ethical Norms

What are The 4 Elements of SNFO?

Stakeholders: Who has a stake in the decision? Who will be significantly affected?

Facts: What factual issues might generate disagreement? What facts are relevant to a solution?

Norms: What ethical principles, norms, or values are at stake? Which might appear to conflict or generate disagreement?

Options: What actions or policies deserve serious consideration? If the ethical ideal is not possible, what compromise solutions are most attractive?

What is Care Competencies of Clinical Ethics?

The specific knowledge, skills, and values healthcare workers need to identify, analyze, and resolve moral or ethical problems in patient care

What do Care Competencies of Clinical Ethics do?

• Establishes clear professional standards

• Clarifies expectations for those doing ethics work

• Supports consistent, credible decision-making

• Equips ethics professionals to assess and strengthen practice

• Balances rigor with practicality

• Scales across context

What is Informed Consent?

Patients should agree to the proposed plan

For major interventions like surgery, what form should the informed consent be in?

In writing (this is standard)

What are some problems with Informed Consent?

• Patients do not understand medical information

• Physicians do not provide key information

• Some patients do not want to make decisions

• Patients may want families make decisions

• Patients cannot anticipate their future reactions

What are some exceptions with Informed Consent?

• Lack of decision-making

• Capacity

• Emergencies (including doctrine of implied consent)

• Therapeutic Privilege

• Waiver

What is Emotional overwhelm?

A patient may be emotionally overwhelmed by the illness experience and by the implications and complexity of decisions she is now faced with

What are the 10 Myths of DMC (Decision-Making Capacity)?

1. DMC and competency are the same

2. Lack of DMC can be presumed when patients go

   against medical advice

3. No need to assess DMC unless patients go

   against medical advice

4. DMC is ’all or nothing’ phenomenon

5. Cognitive impairment equals lack of DMC

6. Lack of DMC is a permanent condition

7. Patients who have not been given relevant and

   consistent information about their treatment lack DMC

8. All patients with certain psychiatric disorders lack DMC

9. Patients who are involuntarily committed lack DMC

10. Only mental health experts can assess DMC

What are the Four Standard of DMC (Decision Making Capacity)?

1. Ability to Communicate a Choice

2. Ability to Understand Relevant Information

3. Ability to Reason with Relevant Information

4. Ability to Appreciate the Consequences of the Choice

What is Persuasion?

The process where a healthcare provider uses communication, empathy, and evidence to guide a patient toward making a healthy medical decision

What is Manipulation?

When a healthcare provider or family member intentionally influences a patient to make a specific choice by distorting the truth

What is Coercion?

When a healthcare provider, family member, or caregiver uses threats, force, or severe pressure to make a patient accept or refuse a medical treatment

What is Burden-based DMC (Decision Making Capacity)?

The strictness of the capacity assessment increases as the risks or burdens of the patient's choice increase

What is Goals-based DMC (Decision Making Capacity)?

A patient can connect a medical choice to their own personal values, life goals, and what matters most to them

What are Comparative Refusals?

When a patient refuses a specific, recommended treatment but agrees to an alternative treatment instead

What are Goals-Based Refusals?

When a patient declines a medical treatment because it clashes with their deeply held life goals or values

What is Competence?

The ability of an individual to participate in legal proceedings

What is a surrogate?

Anyone who makes decisions for a patient who lacks decision-making capacity?

What is Advance Directive?

Legal document that states a person’s wishes about receiving medical care if that person is no longer able to make medical decisions because of serious illness or injury

• ADVANCE DIRECTIVE= LIVING WILL + DPoA

What is Living Will?

A legal document that tells doctors what medical treatment you want or do not what if you become unable to speak or make decisions for yourself

What is Durable Power of Attorney for Health Care?

Document that allows people to name another person to make decisions about their medical care if they are unable to make these decisions for themselves

What two questions must physicians address?

1. Who should act as a surrogate?

2. What standards should be used when patients can’t give informed consent or refusal?

What do states differ with regard to surrogates?

• Priority of Default Surrogate DM (Decision Making)

• Limitations of surrogate’s powers

• Disagreement Process

What is the hierarchy (priority) in Missouri for surrogates?

1. The spouse of the patient

2. An adult child of the patient

3. A parent of the patient

4. An adult sibling of the patient

5. A grandparent or adult grandchild

6. The next nearest adult relative

7. A religious person who is a member of the patient's community

8. A person unanimously agrees upon by those in the priority list

What are the main two types of advance directives?

1. Oral statements to physicians

2. Written documents

What is a POLST?

A binding, portable medical order that tells doctors and emergency responders what kind of medical care you want during a life-threatening crisis

What is Preferred option in reference to Surrogate decision-making standards?

Patient’s known wishes

• What the patient expressed they wanted done

• Advance directives, living wills, portable medical orders (POLST) etc

What is Next best option in reference to Surrogate decision-making standards?

Substituted judgement

• What the patient would’ve picked if they could’ve

What is Last choice in reference to Surrogate decision-making standards?

Best interests

• What is in the patient’s best interests

What are some conditions that disqualify a surrogate?

• Abuse

• Neglect

• Serious conflict of interest

• Incapacity

What are the 4 standards for surrogate decisions making in pediatrics?

1. The Best Interest Standard

2. Diekema’s Harm Principle

3. Ross’s Constrained Parental Authority

4. Shared Family Centered Decision-Making

What is Diekema’s Harm Principle?

The state or medical professionals should only step in and overrule a parent's decision for their child if that decision is likely to cause serious, preventable harm

What is Shared Family Centered Decision Making?

A collaborative healthcare approach where doctors, the patient, and family members or caregivers work together as a team to choose a medical treatment or care plan

What is Emergency Exception?

Allows treatment without parental consent during immediate crises

What is Public Health Exception?

Permits consent for contraception, STD treatment, and mental

health/substance abuse services

What is Emancipated-Minor Exception?

Applies to minors who are married, in the armed forces,

parents, or living independently

What is Mature-Minor Exception?

Highly variable across the U.S. Only 14 states have some version; only two (Louisiana and Nevada) broadly base it on demonstrated capacity