What are the four core ethical principles of medicine?
Autonomy, beneficence, nonmaleficence, and justice
What ethics term is defined as an obligation to respect patients as individuals and to honor their preferences in medical care?
Autonomy
What ethics term refers to a physician’s ethical responsibility to act in the patient’s best interest?
Beneficence (the physician has a fiduciary duty to the patient)
True or False? Patient autonomy may conflict with beneficence.
TRUE
If a patient has decision-making capacity, will patient autonomy or beneficence prevail when there is a conflict?
Autonomy
What ethics term can be described by the principle of do no harm?
Nonmaleficence
True or False? If the benefits of an intervention outweigh the risks, a patient may make an informed decision to proceed, thus overriding the ethical principle of nonmaleficence.
TRUE
When a patient makes an informed decision to proceed with a medical treatment when the benefits of the intervention outweigh its risks, then that patient is exercising which one of his or her rights?
Autonomy
Which core ethical principle of medicine dictates that all patients must be treated fairly?
Justice
What must be explained by a doctor to obtain informed consent?
The risks and benefits of the proposed intervention and risks and benefits of the alternatives (including doing nothing)
What are the four exceptions to informed consent?
If the patient lacks decision-making capacity; if the situation is emergent; if disclosure of information would harm the patient; and if the patient waives the right of informed consent
When may a minor patient (rather than the parents) provide informed consent?
Parental consent is not required if the minor is married, self-supporting, in the military, or has children
What are four conditions in which a minor may be considered emancipated?
If the minor is married, self-supporting, has children, or is in the military
What are the five requirements that must be met in order to determine that a patient has full decision-making capacity?
The patient must make and communicate a choice; the patient must be informed; the decision must remain stable over time; the decision must be consistent with the patient’s values and goals; and the decision can not be a result of delusions or hallucinations
True or False? A patient’s family can require that a doctor withhold information from the patient.
False; a patient’s family cannot require the physician to withhold information from the patient
What term refers to an incapacitated patient’s prior oral statements, which are commonly used to guide medical decisions?
Oral advance directive
What problem can arise when carrying out a patient’s oral advance directive?
Variance in interpretation
What four factors give a patient’s oral advance directive more validity?
The patient was informed, the directive is specific, the patient made a choice, and the decision was repeated over time
What is the term for the legal document that describes treatments the patient wishes to receive or not receive if he/she becomes incapacitated and cannot communicate about treatment decisions?
Living will (ie, written advance directive)
A living will commonly dictates care that will be given in what situations?
Situations in which life-sustaining treatment is required because the patient develops a terminal disease or enters a persistent vegetative state
What legal term refers to a patient’s designated surrogate that may make medical decisions in the event that the patient loses decision-making capacity?
Durable power of attorney
True or False? When authorizing a power of attorney, the patient may specify decisions that are to be made in certain clinical situations.
TRUE
True or False? A patient’s agent authorized with power of attorney retains that power unless it is revoked by the patient.
TRUE
Which type of advanced directive provides more flexibility, a living will or a durable power of attorney?
A durable power of attorney
Which ethics term refers to respecting a patient’s privacy and autonomy?
Confidentiality
What standard should be used to determine the amount of medical information to disclose to a patient’s family?
Disclosing information to family and friends should be guided by what the patient would want
True or False? A patient may waive the right to confidentiality.
TRUE
List four exceptions to confidentiality.
If the potential harm to others is serious; if the likelihood of harm to self is great; if there is no alternative means to protect those at risk, and if physicians can take steps to prevent harm
In the case of serious infectious diseases, a physician may have a duty to break patient confidentiality to warn what groups of people?
Public officials and identifiable people who may be at risk
What legal precedent requires physicians to directly inform and protect a potential victim from harm, even if it involves a breach of confidentiality?
The Tarasoff decision
A child presents to the emergency department with multiple fractures and bruises of different ages. The patient’s mother requests that authorities not be involved. Must the physician respect her request for confidentiality?
No, a physician may break confidentiality to report the abuse of a child or an elder
A young woman confides to her physicians that she has thought about ending her life by ingesting a bottle of her prescription pills, but that she does not want anyone to know of her plan. Must the physician respect her request for nondisclosure?
No, a physician may break confidentiality to report a suicidal or homicidal patient
A patient states he is so mad he is going to kill his brother. What option does the physician have to protect the other party?
A physician may hold a suicidal or homicidal patient involuntarily for a period of time
A patient discloses (in confidence) that he frequently drives after consuming 4-5 drinks at the bar. In the office, the patient clearly has been drinking alcohol and has arrived on his own. Is the physician obligated to uphold confidentiality?
No, a physician can break confidentiality to report an impaired driver
In medical malpractice, what are four requirements (or four D’s) for a civil suit under negligence?
The “4 D’s”: the physician has a duty to the patient (Duty); the physician breached that duty (Dereliction); the patient suffered harm (Damage); and the breach of the duty was what caused the harm (Direct harm)
True or False? In a medical malpractice suit, the burden of proof is beyond a reasonable doubt.
False; unlike a criminal suit, in a medical malpractice suit, the burden of proof is more likely than not
What is the most common factor that leads to litigation in medical malpractice?
Poor communication between the physician and the patient
What is the Good Samaritan law?
A law that relieves healthcare workers from liability when providing care in emergency situations
What is an appropriate response to a patient who is upset with the way that he or she was treated by another doctor?
Suggest that the patient speak directly to that physician about his or her concerns; if the problem is with a member of the office staff, tell the patient that you will speak to that individual
What is an appropriate response to a child who wishes to know more about his or her illness?
Ask the parents what they have told the child about his or her illness; the parents decide what information should be relayed to the child about the illness
Under what special circumstances is parental notification not required when treating teens?
Parental consent is not required for emergency situations, the treatment of sexually transmitted diseases, medical care during pregnancy, prescriptions for contraceptives, or the management of drug addiction
What is an appropriate response to a patient who is noncompliant?
Working to improve the physician-patient relationship
What is an appropriate response to a patient who has difficulty taking medications?
Provide written instructions; attempt to simplify treatment regimens
What is an appropriate response to family members asking for information about a patient’s prognosis?
Avoid discussing issues with relatives without the permission of the patient
What is an appropriate response to a 17-year-old girl who is pregnant and requests an abortion?
Many states require parental notification or consent for minors for an abortion; however, parental consent is not required for emergency situations, the treatment of sexually transmitted diseases, medical care during pregnancy, prescriptions for contraceptives, or the management of drug addiction
What is an appropriate response to a terminally ill patient who requests physician assistance with ending his or her life?
In the overwhelming majority of states, physicians should refuse to be involved in any form of physician-assisted suicide; however, the physician may prescribe medically appropriate analgesics that coincidentally shorten the patient’s life
What is an appropriate response to a patient who states that he or she finds you attractive?
Ask direct, closed-ended questions, and use a chaperone, if necessary; romantic relationships with patients are never appropriate
What is an appropriate response to a patient who refuses a necessary procedure or desires an unnecessary one?
Attempt to understand why the patient wants or does not want the procedure; address the underlying concerns, and avoid performing unnecessary procedures
What is an appropriate response to a patient who is angry about the amount of time that he or she spent in the waiting room?
Apologize to the patient for any inconvenience, but stay away from efforts to explain the delay
What is an appropriate response to a patient who continues to smoke, believing that cigarettes are good for him or her?
Ask how the patient feels about smoking; offer advice about cessation if the patient seems willing to make an effort to quit
