Advance Directives
Decisional Capacity
Consent/Refusal
Ethical Theory & Consultation
Challenging Ethics Cases
100
• This religious group has created their own advance directives to ensure respect for their beliefs regarding the medical use of blood products.
Who are Jehovah Witnesses?
100
Mr. Smith is unresponsive. He has not created a Power of Attorney naming a person of his choice to be his medical decision maker. The medical team turns to this list or Act to determine who should speak on his behalf.
What is a Surrogate Act?
100
Before this age a patient may not provide legal consent for medical procedures.
What is age 18, or age of legal maturity?
100
Any member of the health care team, patient, their families & surrogates may ask for one of these when they need help clarifying patient values or to resolve a values conflict.
What is ethics consult?
100
Anguish in response to a situation in which the person is aware of a moral problem & makes a moral judgement about the correction action yet, as a result of constraints, cannot act on their sense of what is right.
What is moral distress?
200
Only a patient with this ability or level of functioning may complete a Power of Attorney for health care.
What is a patient with decisional capacity?
200
NMH Decisional Capacity Guidelines names this health care provider as the person responsible for determining if a patient has capacity to make their own medical decisions.
Who is the attending physician?
200
An 80 year old patient with decisional capacity refuses chemotherapy for her leukemia. This ethical principle upholds her right to refuse treatment.
What is Autonomy? Or what is bodily integrity? Or what is self-determination?
200
Use this easily remembered abbreviation to reach the ethics consultant.
What is pager 5-ETHX?
200
This condition which made headlines because of the Jahi McMath case is widely misunderstood by the public. Some persons refuse to accept its definition on religious grounds causing an ethical dilemma for health care providers.
What is Brain Death? Or what is death by neurologic criterion.
300
In Illinois you can only name one of these as your primary decision maker?
Who is your healthcare agent, or who is your POA?
300
This NMH guideline provides instructions for making sure a person is capable of making their own medical decisions.
What is NMH decisional capacity guideline?
300
The resident quickly explains the medical reasons an endoscopy is scheduled. When she discovers her patient is primarily Vietnamese speaking, she puts the procedure on hold in order to arrange for an interpreter out of respect for this core ethical value.
What is informed consent?
300
Paternalism of physicians has been nearly universally replaced or trumped by this ethical principle.
What is Autonomy?
300
Clinicians may insist that an elderly Chinese woman be made fully aware of her cancer diagnosis even when family says the news would make her "give up." What ethical value or principle upholds their insistence?
What is truth-telling? What is informed consent? What is autonomy?
400
No employee of Northwestern Medicine may witness one of these advance directives.
What is Power of Attorney for Finance, Estate or Will?
400
If a patient is actively suicidal or severely depressed, this clinician may be called upon to assess for decisional capacity.
What is psychiatry?
400
A patient with advanced dementia unable to eat by mouth is receiving nutrition via an NG tube. She pulls it out repeatedly, is frightened and violent when the team tries to reinsert it. This ethical principle or value upholds the decision NOT to force the patient to receive nutrition.
What is respect for person? What is body integrity? Or, what is do no harm, non-maleficence?
400
This ethical principle informs decision-making in contexts of allocation of scarce resources and public health issues.
What is justice?
400
An unresponsive patient arrives in the ED, is stabilized and sent to the ICU. The patient has no advance directives, no family or friends to make medical decisions on their behalf so this person is appointed to do so.
What is state guardian? What is public guardian? What is guardian ad litem?
500
Practitioner Orders for Life Sustaining Treatment (POLST) should only be implemented for this population of patients.
Who are patients with a life expectancy of less than 1 year?
500
- Grogginess due to sedation - Drug-induced psychosis - Feeling overwhelmed by new life-threatening diagnosis
What are temporary states that impact decisional capacity?
500
IL Law permits a doctor to disclose HIV status of a patient only to this person after unsuccessfully trying to persuade the the patient to do so themselves.
What is a legally married spouse?
500
The principle makes morally permissible the use of titrated dose of pain medication to relieve suffering for an actively dying patient even when it may slow or repress respiration.
What is the principle of double effect?
500
These two values are in conflict when a legal substitute decision maker demands that "everything be done" and the medical team believes continued aggressive care is not only inappropriate but causing suffering.
What are maleficence & autonomy (to do no harm)?
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