Principles
This principle is based on the obligation to respect patients as individuals and to honor their preference in accepting or not accepting medical care.
What is autonomy?
The famous 1973 U.S. Supreme Court case which stated that access to safe and legal abortion is a constitutional right.
What is Roe v. Wade?
The name of the unethical study conducted to record the course of Syphilis without obtaining informed consent from patients or offering treatment.
What is the Tuskegee Study?
A 16-year-old girl comes to the office to establish care. While taking social history, she expresses that she is thinking about quitting her high school softball team because "the other girls are mean, and I just don't enjoy playing anymore." When asked to describe how she feels, the patient hesitantly mentions that she gets depressed at times and frequently feels self-conscious and that no one likes her. She appears uncomfortable and nervously asks the physician, "You won't say anything about this to my parents, will you?" Which of the following is the most appropriate response to the patient?
Tell the patient your conversations are private except under very specific circumstances.
The term used to describe the administration of a lethal agent to a patient for the purpose of relieving the patient’s suffering.
What is euthanasia?
This principle is based on the idea of treating patients fairly and equitably.
What is justice?
The famous case that was the first to explicitly recognize the right to refuse unwanted medical treatment.
What is Cruzan v. Director (1990)?
The first state to legalize physician-assisted suicide for terminally ill patients.
What is Oregon?
A 15 year old girl presents to the emergency department after a motor vehicle accident. Her heart rate is 130.min, BP is 60/35 mmHg, respiratory rate is 30/min, and oxygen saturation is 94% on face mask. Ultrasonography of the chest indicates fluid in the thoracic cavity. The ED senior resident seeks consent for appropriate treatment from the child’s parents. The child’s parents refuse blood transfusions on the grounds that they are Jehovah’s Witnesses. What should you do?
Take the patient to surgery and give blood transfusions as needed.
A process that requires an understanding of pertinent information, ability to reason and make one’s own decisions, and freedom from coercion.
What is informed consent?
This principle states physicians have the duty to act in the patient’s best interest.
What is beneficence?
The woman involved in a famous euthanasia case in which her husband and parents fought over whether or not to remove her feeding tube after she was diagnosed with persistent vegetative state.
Who is Terry Shiavo?
The philosopher who is often associated with the ethical theory of deontology.
Who is Immanuel Kant?
You are the inpatient physician taking care of an elderly woman who will likely be diagnosed with metastatic cancer pending results of a biospy. Although the patient is alert and oriented, she is very sick and the family has concerns regarding lack of a cure. The family asks you to inform them first about the results of the biopsy. They do not want to depress the patient further, and appear very genuine about their concern. What should you tell them?
Tell them that you are obligated to inform the patient of the findings.
This is determined by any physician, is time and situation specific, and requires the patient to be informed about his or her condition.
What is decision-making capacity?
This principle states “Do no harm.”
What is nonmaleficence?
This case in 1972 resulted in the Supreme Court ruling that a doctor has a duty to disclose all reasonable information about a proposed treatment to his patients.
What is Canterbury v. Spence?
Virtue ethics is one of the three primary schools of ethics, this person is considered the founder of virtue ethics.
Who is Aristotle?
A 9 year-old girl is brought to the ER for a foot infection which looks serious. She needs IV antibiotics and debridement, or you know that her foot is in danger of amputation. The mother refuses consent for antibiotics and debridement. You discuss the need for immediate treatment and the risks in the presence of a witness, but the mother still refuses the treatment. What is your next step?
Order the antibiotic and debridement.
This document specifies healthcare interventions that a patient anticipates he or she would accept or reject during treatment for a critical illness.
What is an advance directive?
Describe a time when you used an ethical principle in clinical practice.
Examples:
Autonomy - religious barriers to treatment
Beneficence - ED patients who are incapacitated
Nonmaleficence - DNR/DNI principles
Justice - triage
This case ruled that physicians have a duty to warn third parties if they determine someone is in danger based on a patient’s words or actions.
What is Tarasoff v. Regents of the University of California?
The English author and physician who published a document describing requirements and expectations of medical professionals and whose work was used to write The Code of Ethics in 1847.
Who is Thomas Percival?
A 33 year-old man with AIDS is brought by ambulance to the hospital after collapsing on the street. Paramedics resuscitated and intubated the patient for ventilatory support and transported him to the hospital while in an incoherent, agitated state. Physical examination and laboratory studies confirm an extensive pneumonia involving the entire left lung. Shortly after, his designee demands that the patient be taken off the ventilator. The designee produces a copy of the patient’s living will indicating the patient wishes no life support and that his designee is to make all medical decisions if he becomes incapacitated. The patient’s previous hospital record contains a copy of the same living will. What is the best course of action?
Provide sedation and pain medication and extubate the patient.
Describe 2 exceptions to patient confidentiality.
SI/HI
Abuse (children, elderly, and/or prisoners)
Epileptic patients and other impaired automobile drivers
Reportable diseases (STIs, hepatitis, food poisoning)