Ethics in Stack o' Flaction

  1. respect for autonomy
    • truth-telling, confidentiality, informed consent
    • honor preferences in accepting or not accepting medical care
  2. beneficence
    do what is best for the patient
  3. nonmaleficence
    only do things when the benefits outweigh the risks
  4. justice
    treat everyone fair and equitably but not necessarily equally (triage)
  5. capacity
    (doctor determined) ability to reason and make decisions
  6. competence
    (legal determined) ability to reason and make decisions
  7. requirement for informed consent
    • disclosure (discussion of pertinent information)
    • understanding (ability to comprehend)
    • capacity (MD determined ability to reason/make decisions)
    • voluntariness (freedom from coercion and manipulation)
  8. exceptions for informed consent
    • patient lacks decision-making capacity (MD determined) or is incompetent (JD determined)
    • implied consent (emergency)
    • therapeutic privilege (witholding harmful information because it would undermine the informed decision making capacity)
    • waiver (patient doesn't wanna hear it)
  9. consent for minors
    • varies by state
    • generally get parental consent unless not required (separate flash card), necessary but counter to parental beliefs, or emancipated (married, self-supporting, military)
  10. situations where minor doesn't need parental consent
    • contraception, STIs, prenatal care (except abortion), substance abuse, emergency
    • sex, drugs, rock and roll
  11. components of decision making capacity
    • 18 yo or emancipated
    • makes a choice and communicates it
    • patient is informed
    • decision is stable over time
    • decision is consistent with values, goals, not clouded by mood disorder
    • decision is not result of altered mental status (delirium, psychosis, intoxication)
  12. advance directives
    umbrella term for oral advance directive, living will (written advance directive), and medical power of attorney
  13. oral advance directive validity
    most valid when patient was informed, directive was specific, patient made a choice, and repeated over time to multiple people
  14. medical power of attorney revocation
    if decision making capacity is reestablished then they can go against a medical power of attorney
  15. surrogate decision maker
    • decision maker for a patient lacking advance directives
    • typical order is spouse, adult children, parents, adult siblings, other relatives, friends, appointed
  16. principles of breaking confidentiality
    • 1a. potential physical harm to others is serious and imminent
    • 1b. high likelihood of self harm
    • 2. no alternative means to warn or protect others at risk
    • 3. physician can take steps to prevent harm
  17. exceptions to confidentiality
    • you can tell family that their loved one is stable
    • state report of STI
    • state report of TB
    • state report of hepatitis
    • state report of food poisoning
    • child abuse
    • elder abuse
    • impaired drivers (epileptics, other neuro diseases)
    • suicidal
    • homicidal
Card Set
Ethics in Stack o' Flaction
master these flash cards and learn to be ethical!