Ethics- Exam #1

medical, environmental, research, public health

Specific components of bioethics

health, healthcare, research, biotech

questions bioethics research involves

missing other information that isn’t medically related such as personal values and goals and there could be other outside factors such as state laws and policies

Why does knowing all medical facts not tell us what should be done?

religious beliefs, public reaction to either the patient or healthcare workers, legal rights and laws which are all things the healthcare provider can’t control

What are things that could come into contact in an ethical problem?

It involves respecting moral principles of others beliefs but also trying to prevent harm. It is right to give the child treatment to save their life but also wrong to go against their parent’s religious beliefs.

What is the ethical issue of parent’s refusing a sick child treatment that could possible save their life due to religious beliefs?

Autonomy can conflict with beneficence where a patient may chose not to get a treatment, but the treatment can give them the greatest benefit and it is the doctor’s job to do what is medically best for the patient but they also have to respect the patient’s decision.

How can ethical principles conflict? Give an example.

If there is no consideration of all principles, all possible evidence would be not be collected and other principles could better fit the situation. Others could be harmed in other ways that wasn’t thought out.

Why is it important to consider every ethical principle?

They have to follow one moral rule, but break the other and make the ethical choice of which is more important

What problem could arise if a person has two duties that conflict?

Moral virtues of loyalty and honestly because they build trust between the patient and healthcare provider which helps providers get more accurate information from the patient since they will feel more comfortable and safe to share it.

What are two virtues that are important to healthcare providers?

It doesn't follow abstract or universal rules where the goal is to preserve the network of the relationship and always consider personal circumstances

How does considering relationships change an ethical analysis?

having more social authority and specialized knowledge such as a doctor can cause an imbalance power where the doctor undermines patient control and their input on what is best. Discrimination or poverty can also be a factor that doctors blame on patients for poor health outcomes.

How are power and social context ethically relevant in healthcare decisions?

It’s purpose is to protect people from harm while they are nonautonomous, or to restore them to full autonomy while strong paternalism directly overrides the patient;’s decision while they are fully autonomous.

Why is weak paternalism more easier to justify?

It can cause moral distress and emotional strain since providers have the ethical drive to save people’s lives and help them heal

why is treatment refusal challenging for healthcare professionals?

Medical Futility

the alleged pointlessness or ineffectiveness of particular treatments

Not allowing patient’s to opt out and physically preventing patients from walking alone (individual patients should be evaluated instead)

What is the most paternalistic part of requiring bed alarms for high risk patients to prevent them from falling when getting up?

It helps patients to understand their options, remove manipulation, and enables true consent

How does the truth help patients make decisions?

It provides patients with relevant information such as risk and benefits to make an informed decision

How does disclosure help patients make a decision?

it protects patient dignity, builds trust, and prevents personal or social harm

why is confidently important in healthcare?

Autonomy allows the patient to retain control over personal info, nonmaleficnce requires healthcare workers from disclosing info that can expose the patient to real harm

what ethical principles are important in confidentiality?

Nonmaleficence because disclosure can be justified if a patient is at risk to harming themselves or others. This ethical duty is to avoid harm and preserve life which overrides maintaining privacy.

what ethical principle cam confidentiality conflict with?

Nonmaleficence protects harm to the patient or others, beneficence promotes the overall well being pf society or the patient’s treatment, utilitarianism gives collective good and safety of the community compared to just the individual

How can certain ethical principles and theories justify breaching confidentiality?

how likely is the harm, what is the harm, are there other options that can avoid disclosure, is there a specific target, if the patient understands their actions and consequences, if the patient is actually capable of causing harm, how serious is the patient

A patient tells a healthcare professional something that, if disclosed, could potentially prevent harm to another person. What information would you need before deciding whether confidentiality should be breached?

nonmalefiecence because the goal is to protect the child from harm

what ethical principle is a child abuse case?

infant within six weeks has been affected by a substance, within 4 years a child has a birth defect due to alcohol, parent protects and abuser

what three specific cases would result in an automatics CPS report?

physicians are obligated to tell patients about possible medical interventions and respect their choices

why is informed consent an ethical ideal?

It requires healthcare workers to disclose info about interventions to patients and obtain their permission before proceeding

why is informed consent a legal requirement?

competence (capacity)

the ability to render decisions about medical interventions, legal determination (how patient makes decision)

A surrogate could step in and be the person to make decisions or if the patient didn’t name anyone in the document, the doctor would pick a close family member

what happens if a patient lacks capacity?

how much risk a physician must disclose to a patient before procedure (in the case paralysis wasn’t disclosed even though it was rare to occur but it could have influenced the patient’s decision to not get the surgery)

Canterbury v. Spence. What issue concerning the disclosure of risk does the case raise?

if the patient actually understood and comprehended all the relevant information such as risks, benefits, alternatives and details of the procedures and made the decision from their own free will

A patient signs a consent form. Based on what you read, what would you still need to know before concluding that genuine informed consent occurred

1) identify- what is the problem

2) know- what info is missing

3) consider- who is impacted

4) recognize- ethical concerns

5) analyze- conflicts

6) explore- options

7) challenge- strongest argument against your perspective

8)recommend- justification of why you are making that choice

Ethical analysis framework

autonomy

a patient’s right to make their own decision

beneficence

provide the best benefit

nonmaleficence

avoid causing harm or burdens (doesn’t mean never cause harm)

justice

fairness, ensures benefits and burdens are distributed fairly without discrimination

principles help identify and reason what matters while theories help think why it matters and how we should reason about it

difference between principles and theories

Utilitarianism

outcomes based on the greatest good for the greatest number of people has act and rule)

Consequentialism

outcomes

Deontology

rules, duties, obligations, laws

care ethics

relationships

virtue ethics

how to be a good person

feminist ethics

who’s voice isn’t being heard, power imbalance

Hippocratic oath, code of ethics, patient rights

what are the three autonomy principles?

paternalism

healthcare provider makes the decision for the patient

weak paternalism

acceptable for mist people; want to protect people from harm while nonautonmous or restore them to full autonomy or determine if they are nonautomnous

strong paternalism

override someone’s request (delaying discharge, forcing patient to stay)

seriousness of potential harm, probability of harm, reversibility of harm, patient’s ability to understand decision, voluntariness, availability of less restrictive alternatives, effects on other people

Justifiable paternalism

healthcare depends on info, info depends on trust, trust depends partly on confidentiality (more patient can feel comfortable and safe more accurate and relevant info they can share for effective treatment)

Why do patients need to trust healthcare providers?

Privacy

the patient’s interest/right in controlling access to themselves and their info

Confidentiality

the healthcare professional’s obligation to protect info entrusted to them

autonomy- control over personal info

beneficence- patients disclose info clinicians need

nonmaleficence- disclosure can cause harm

trust- patients must be willing to speak honestly

why is confidentiality an ethical obligation?

autonomy and paternalism- patients should retain control over personal info

trust- patients should withhold important info if they can’t trust clinicians to protect it

beneficence and nonmaleficence- confidentiality supports effective care; disclosure can expose patients to real harm

why does confidentiality matter?

child abuse, elder abuse, matter of the greater good, domestic violence

when must you report and break confidentiality?

Tarasoff v Regents

led to healthcare providers having a duty to warn; confidentiality can be overridden when a patient poses a serious danger of violence to others

intimidated threats (threaten to harm others)

when does one have the duty to warn

informed consent

autonomous and informed person agrees to a medical treatment or to participate in a research study (patient has capacity)

capacity (patient makes own decisions), disclosure (patient receives relevant info), understanding (patient comprehends relevant info), voluntaries (free will)

Informed consent requires…

Decision-making capacity

clinical assessment, made by healthcare provider

prior expressed wishes, substitute judgement, best interest

what should guide surrogates decision if a patient lacks capacity?

what did they actually document; ex: patient doesn’t want dialysis

patient knows wishes

what would the patient chose (beliefs, values) ex: independence is more important to them than longevity

substitute judgement

what option best protects that patient’s overall interest, what would the patient have wanted

best interest

Disclosure

relevant info provided by the healthcare worker to the patient

Understanding

patient comprehending relevant info sufficiently to use it in making a decision

nature of procedure/intervention, relevant risks, alternatives including no treatment, expected benefits

what must be disclosed?

definition of informed consent was expanded due to this case, Canterbury’s consent was not informed, paralysis risk should have been disclosed by the physician no matter how unlikely the risk. The risk could influence the patient’s decision to not get the surgery.

Canterbury v Spence (1972)

waiver

patient chooses not to receive info

therapeutic privilege

clinician determines that info shouldn’t be disclosed

beneficence, nonmaleficence, prevent serious harm, timing/context

reasons to withhold…

autonomy, truth telling, ability to make informed decisions, patient lives with consequences

reasons to disclose…

what does it depend on and why does the fact matter ethically

questions an ethical analysis would ask

is it ever acceptable to lie to a patient

question deontology would ask

what would an honest and compassionate healthcare provider do in the situation

question virtue ethics would ask

what could we miss if we focus only on the individuals rights and choices

question ethics of care would ask

who has the power, who’s perspective might be overlooked, how might inequality shape the options available to a patient

feminists ethic questions

veracity

quality of being true, accurate, or truthful

nonmaleficence because a person could be in danger of harming themselves or others

what ethical obligation could outweigh confidentiality

what harm, how serious, how likely, who is at risk, is disclosure necessary, is there a less intrusive option

what questions should you ask before overriding confidentiality

protects patient autonomy, builds trust, ensures understanding, provides legal and ethical protection

why do we need informed consent

receive relevant info, consider alternatives, make decisions according to one’s own values, accept or reject recommendations

what does a meaningful choice require

info, deliberation, decision

process of informed consent

understanding, appreciation, reasoning, communication

what does a clinical assessment test for

yes because it prevents informed choice by the patient not knowing all relevant info to accurately weigh the risks and benefits. It also could enable manipulation by steering someone towards a choice the would have made otherwise knowing the potential risk

does withholding info undermine autonomy?

who should decide, what does the patient need in order to decide, how do we respect the patient’s values while still fulfilling our professional obligations

what does informed consent require to ask