Ethics for Medical Students

1
ETHICS

• IMEC INC.

2
AUTONOMY

• Obligation of respect for patients individual
  rights in preference to their personal wishes
• Note this goes medical care

3
INFORMED CONSENT

• Legally requires
• Discussion of pertinent information
• Obtaining agreement for plan of care
• Freedom from coercion
• PT MUST UNDERSTAND RISKS, BENEFITS, AND
  ALTERNATIVES, WHICH INCLUDE NO INTERVENTION BY
  MEDICAL STAFF

4
EXCEPTIONS TO INFORMED CONSENT

• Patient lacks decision making capacity
• Implied consent in an emergency
• Therapeutic privilege- when a disclosure would
  severely harm the patient
• Waiver-when a patient waives the right

5
DECISION-MAKING CAPICITY

• Patient makes and communicates a choice
• Patient is informed
• Decision remains stable over time
• Decision is consistent with patients values
• Decision is not a result of delusion

6
WRITTEN ADVANCED DIRECTIVES

• Adults (ages 18 or older) who are mentally
  competent have the right to make healthcare
  decisions in advance. Advance directives state
  your choices for medical treatment, especially in
  regard to life-sustaining procedures. You can
  also use advance directives to name a healthcare
  agent, who is any person you choose, to make your
  healthcare decisions if you are unable to do so.
  Advance Directives only apply if you are unable
  to make personal medical decisions, unless you
  indicate you want your healthcare agent's
  authority to begin when the document is signed.
  You cannot be refused medical care because you do
  not have advance directives.

7
ORAL ADVANCED DIRECTIVES

• Adults often make healthcare decisions during
  discussions with their physicians. The physician
  describes the options and explains the pros and
  cons of each, but you make the final decision.
• The same process can be used to decide about the
  possible use of life-sustaining treatment and the
  type of medical intervention you want, given
  particular situations that might occur.
• For example, you might decide in this way about
  the use of CPR (cardiopulmonary resuscitation).
  An oral advance directive is legally effective
  and is to be honored by your healthcare
  providers.

8
NONMALEFICENCE

• DO NO HARM
• Goes beyond this to the point of physician not
  gaining anything from patient
• Legally
• If a second party does not effect the wishes of
  the first party
• Very touchy ethical situation, under constant
  scrutiny

9
BENEFICENCE

• Physician have a special ethical responsibility
  (physician is fiduciary)
• Patients autonomy may conflict with benficience
• The patient has the right to decide
• As long as the physician does not gain benefit
  without the patient gaining an equal benefit
  there is no discrepancy

10
CONFIDENTIALITY

• Disclosure to friends and relatives shouls be
  guided to patients expectations
• Privacy and autonomy

11
EXCEPTIONS TO CONFIDENTIALITY

• Potential harm to other or self
• No alternatives
• Physician can make attempts to
• Infectious disease (STATE)
• The Tarosoff Decision (PROTECTION)
• Child/elder abuse
• Impaired drivers
• Suicide/homicide

12
MALIPRACTICE

• Negligence
• Physician breach of duty
• Patient suffers harm as a result of breach
• Breach causes harm

13
20 Rules
14
Rule 1

• Competent Patients have the right to refuse
  medical treatment

15
Rule 2

• Assume that the patient is competent unless clear
  behavioral evidence indicates otherwise!

16
Rule 3

• Avoid going to court. Clinical decision making
  should occur in the clinical setting whenever
  possible.

17
Rule 4

• When surrogate must make decisions, use
• Substituted judgment
• Who best to represents the patient!
• Subjective standard
• What did the patient say in the past

18
Rule 5

• If the patient is incompetent the physician may
  rely upon advanced directives, or living wills

19
Rule 6

• Feeding tube is a medical treatment that can be
  removed at the patients request
• CRUZAN 1990

20
Rule 7

• Do nothing to actively assist the patient to die
• Passiveallowing to dieOK
• Active---ordering something that would killnot OK

21
Rule 8

• The physician decides when the patient is dead!!
• No treatment options can help
• Situation is futile

22
Rule 9

• Never abandon the patient
• Lack of financial resources is not a reason to
  stop treatment
• An annoying patient is still your patient

23
Rule 10

• Full, informed consent requires that the patient
  understands
• Nature of the procedure
• The purpose or rationale
• Benefits
• Risks
• And available alternatives

24
Rule 11

• Special rules apply to children!
• If 13 YO and living by self, treat as an adult
• Marriage and the Military emancipates the child
  as an adult

25
(No Transcript)
26
Rule 13

• Good Samaritan laws limit liability of a
  competent physicians in a non-medical setting

27
(No Transcript)
28
Rule 15

• Patients should be given the chance to state DNR
  (Do Not Resuscitate) in their chart

29
(No Transcript)
30
Rule 17

• Detain patients to protect themselves or others.
• Tarasoff Decision

31
(No Transcript)