Ethics Exam 2 (New content and cases)

This type of justice distributes resources to prioritize the worst off

pritorian justice

This type of justice distributes resources very efficiently in order to help as many as possible

utilitarian justice

Assessing the relative need of each patient and then prioritizing the most in-need patients (ED triage) is an example of

pritorian justice

Assessing the relative effectiveness of using a resource and then prioritizing its use where it will help the largest number of people live the longest (disaster triage) is an example of

utilitarian justice

autonomy, beneficence, and non-maleficence are in regards to __________, while justice is about caring for ________________

your patient, all patients

What is the main issue underlying the principle of justice?

There are always more potential patients than resources available

What is an example of ineffective treatment?

antibiotics for a viral infection

What is an example of inconsequential treatment?

antibiotics will not change the outcome of an actively dying person on comfort care

What is disproportionately harmful treatment?

CPR and intubation for 100 y/o grandmother with metastatic bone cancer

What are reasons for refusing to provide futile care?

won't benefit the patient, causes disproportionate harm, wastes scarce medical resources

What are problems with advance care directives?

- too specific or unreasonable

- codes and code options differ

- misunderstandings of DNR, DNI, CPR

- legal document is not always binding

true or false: CPR is often successful

false - 18% hospital success rate, 13% with favorable neurological outcomes

Dr. Kevorkian

Dr. Death -- felt doctors had the right to end a person's life if the patient chooses to. Guilty of 2nd degree homicide only when he administered the med himself

Physician-assisted death violates which principle?

beneficence

Voluntary active euthanasia violates which principle?

non-maleficence

Define physician assisted suicide

a physician's provision of means by which the PATIENT commits suicide - legal in 14 states, only 1 requires psych eval (others capacity assessment)

Define active euthanasia

either voluntary or involuntary causing the death of another person - first or second degree felony

Define withdrawal of treatment

removal of life-sustaining treatments to allow a natural death for an otherwise terminally ill patient; equivalent to withholding/not providing LST

Define double effect

the administration of drugs at high levels that will have the effect of both alleviating suffering while likely hastening the patient's death

An ethics consultation is called by oncology bc pain management is unwilling to increase opioid infusion for a pt with terminal cancer who is tolerant to the med. Patient is requesting more meds to treat pain; pain management feels that increasing infusion rate could lead to patient's death. What supports the decision to increase the analgesic regimen?

the good effect (relieving pain) outweighs the bad effect (hastening death) in this patient, as the intent, purpose, and desired outcome is solely pain relief and not hastening death.

What is the intention of palliative sedation and how does it differ from euthanasia and PAS?

intention: relieve refractory symptoms in dying patients, whereas the intention of PAS/euthanasia is to end the patient's life

What is the desired outcome of palliative sedation and how does it differ from euthanasia and PAS?

desired outcome: to achieve a level of sedation in patients that controls symptoms, whereas the desired outcome in E/PAS is the death of the patient

What are some requirements for PAS in Vermont?

- must be terminally ill (<6 mos)

- doesn't require residency

- 2 unrelated drs. involved in patient's direct care must sign off on prescription

- capacity assessment

- witnesses without conflict of interest, not named in will

Who is Smilin' Steve?

the only pharmacy in VT willing to produce drugs for PAS

MaiD

medical aid in dying - Canadian term referring to both PAS and euthanasia used to describe most US state laws allowing PAS

pEAS

a designation used to indicate EAS when pursued for primarily psychiatric reasons (psychiatric euthanasia and physician assisted suicide)

How is "terminal illness" certified?

2 physicians agree life expectancy < 6 months

examples of advance directive

living will, wishes, DNR, DNI, durable power of attorney for health care, proxy, "agent" in Ohio

Define advance directive

written instructions recognized under state law that are related to the provisions of healthcare when the individual is incapacitated

Ohio surrogates must be related by

blood or marriage

When is HCPOA used?

This document identifies a person who is going to make healthcare decisions when the patient is incapacitated.

When is a living will used?

Only when 2 physicians agree that a patient is terminally ill and unable to make own healthcare decisions or that pt is in a permanently unconscious state

Who has to witness withholding/withdrawing LST in OH?

patient physician, surrogate

What are requirements for withholding/withdrawing LST in OH?

2 physicians determine that the patient is in terminal condition is has been permanently unconscious for past 12 months AND patient is no longer able to make informed decisions and there is no reasonable possibility that the patient will regain capacity AND the patient has no acceptable living will that addresses the situation

Advancement in fetal therapies raises ethical questions about

maternal autonomy and decision making

What is owed to the fetus, ethically?

beneficence-based motivation

Who are the individuals involved with the ethical dilemma in case 5?

Mr. Garcia, his daughter Maria, Maria's brothers, Gillian, and the care team at the hospital

Who are the individuals involved with the ethical dilemma in case 6?

Mr. Lee, his daughter Maria Johnson, Dr. Brown (PCP), Dr. Smith (hospitalist)

Who are the individuals involved with the ethical dilemma in case 7?

Dr. Jenkins (obstetrician), Ms. Harper and her fetus, the cardiology team, and the neonatology team

What is the ethical dilemma associated with case 5?

Mr Garcia's family requests aggressive treatment despite progressing sepsis and multiple comorbid conditions, initiation of dialysis, and removal of his requested DNR

What is the ethical dilemma associated with case 6?

Mr. Lee's advance directive specifies no artificial nutrition or hydration if he is terminally ill, but his condition may improve. His daughter is advocating for a feeding tube.

What is the ethical dilemma associated with case 7?

Ms. Harper refuses treatment of her fetus's arrhythmia because she does not want it to survive, and requests only comfort care after it is born.