Medical Ethics Test 1

Someone with either severe mental retardation, serious mental illness, or alcoholism would not be able to give informed consent since they would not be deemed [condition].

competent

Bioethics

concerned with the ethical issues that arise in the fields of biology and medicine. These issues may pertain to animal welfare, the environment, emerging technologies, and of course medicine

Merely filling out consent forms doesn't meet the criteria for voluntary informed consent because it lacks the element of [condition].

consent

metaethics

considering higher order questions, such as what it means for an action to be right or wrong

Informed voluntary consent requires that medical practitioners [condition] relevant information, such as risks and benefits, to the patient.

disclose

In "Why Doctors Should Intervene," Ackerman is concerned that common understandings of the principle of respect for autonomy (select all that apply):

do not account for the transforming effects of illness., are too narrowly focused on the idea of non-interference.

medical ethics gained a strong foothold in

early 1980s

Applied ethics

employing moral norms and concepts to resolve the moral questions that confront people everyday

normative ethics

establishing and evaluating proper guides for our actions and judgements by way of principles, rules, and theories

A young mother delivers her baby at the hospital. The delivery doesn't go well and she begins to suffer major internal bleeding. She goes unconscious. The only way to save her life is to give her a blood transfusion. The woman is a Jehovah's Witness and, prior to the delivery, signed a form saying that under no conditions does she want a blood transfusion--even if it means death. She cites religious reasons. True or false: The hospital should give her a transfusion while she is unconscious to save her life.

false

According to The Declaration of Helsinki, it is permissible to engage in clinical research without the consent of a subject so long as the likely benefit to the scientific community significantly outweighs the possible risks.

false

Dworkin's main argument denies that paternalism is ever justified, given that paternalism infringes on the rights of individuals to act in ways that they determine to be in their own best interest.

false

In cases of medical futility, doctors are obliged to provide whatever treatment the patient or their family asks for.

false

A prima facie obligation to respect confidentiality mean that the obligation

has exemptions, could be violated if the patient has a serious contagious disease.

The idea that everyone should be treated the same unless there is a morally relevant difference between persons refers to

impartiality

A duty to warn

implies that confidentiality is prima facie., implies that confidentiality is prima facie.

Descriptive ethics

investing the actual beliefs, behaviors, and practices that constitute peoples moral experience

Durable power of attorney (DPOA)

make meaningful decisions such as choosing the individual they would like to assist them in making complex medical decisions

What follows from Mill's non-contingent argument against paternalism?

paternalism might be justified if it preserves or enhances individual liberty (especially for future choices).

What follows from Mill's contingent argument?

paternalistic actions and policies are permissible whenever they yield greater benefits than the evil they cause.

A very basic clinical trial can raise a number of ethical concerns, and clinical trials involving vulnerable populations raise many more ethical issues. But what types of individuals qualify as members of a vulnerable population? Select all that apply.

prisoners, children, mentally impaired or disabled

Proponents of full disclosure argue that full disclosure

requires that physicians explain the relevant information in language that is accessible to patients., doesn't mean explaining every technical detail.

The principle of justice in medical ethics has to do with

the idea that non-moral feature such as race, gender, sex, and class are not relevant to how medical resources and care are distributed.

autonomous authorization

the patient assumes responsibility for the act, meaning the patient understands the action and intents that it be performed

effective consent

the patient has gone through the institutional procedures for obtaining informed consent, meaning all the necessary protocol

The patient has a right to information:

the patient is entitled to access their medical records, to have their questions answered, and be advised of potential conflicts

The patient has the right to make decisions regarding their care:

the patient may accept or refuse any recommended treatment

According to the Nuremberg Code, during an experiment the subject should be at liberty to bring the experiment to an end if that subject feels the continuation of the experiment would be impossible.

true

Ackerman argues that it is the job of the physician to help patients restore control over their lives by assessing a patient's needs and psychological & social profiles, as well as by influencing the beliefs or attitudes of the patient or family members.

true

An action that is legally right or wrong can also be judged morally right or wrong, and these two kinds of judgments will not necessarily agree. This means it is possible for an action to be legally right but morally wrong, or legally wrong but morally right.

true

An autonomous patient's right to refuse care includes a right to refuse even life-sustaining or life-saving treatment.

true

In "On Telling Patients the Truth," Lipkin argues that telling the whole truth is impossible, and that the intent of the deception is what matters - namely, whether the deception is intended to benefit the patient of the physician.

true

In the Dworkin article, is this the contingent argument against paternalism? So long as the evils of paternalism outweigh the benefits, it isn't justified.

true

One argument against the withholding of information is that doing so can be detrimental insofar as it robs patients of the opportunity to make informed life decisions based on their prognoses.

true

Sometimes it may be permissible to cause harm to a patient if doing so results in a greater benefit, on balance.

true

Dworkin's example of Odysseus is used to illustrate that:

under certain circumstances it is rational for an individual to agree that others may force her to act in ways which, at that time, she may not see as desirable.

Which are arguments against people who say that sometimes it's OK to mislead patients? People who argue for the permissibility of misleading patients...

underestimate the beneficial effects of truthfulness.,exaggerate the harm done to patients by full disclosure.,fail to recognize that lying to patients can also do damage.

If patients can't assess the provided information and make inferences about the consequences of their medical decisions then they can't give informed consent because they lack the criteria of [condition].

understanding

If a patient is subject to coercion or manipulation they can't give informed voluntary consent because their decision will not be considered [condition].

voluntary

beneficence

we should actively promote the well-being of others

autonomy

we should allow persons to exercise their capacities of self-determination

non-maleficence

we should avoid causing unnecessary injury or harm to others

justice

we should treat equals equally by giving people what is fair or what is due

Suppose an otherwise competent patient is delirious from a fever. The patient refuses treatment but the medical staff give the patient a course of antibiotics via the IV when the patient passes out. This is an example of

weak paternalism

Medical ethics first emerged in

1940s

The concept of informed consent isn't monolithic, but rather contains several different but important components. Below are a number of those components, as discussed in the reading. Select all that apply:

All relevant information has been adequately disclosed to the patient., The patient understands the information that has been presented., The patient is competent to make decisions., The patient makes a voluntary decision and provides consent.

In the Dworkin reading, why does Mill think that it's usually wrong to act paternalistically? (Hint: 2nd column, p. 97)

Because most of people have a greater knowledge and interest in advancing their own well-being than do others.

In the Dworkin article, what is Mill's non-contingent argument against paternalism?

Being able to choose (even unwisely) how we live our lives is a good independent of the outcomes of our choices.

What does it mean for moral norms to have universality?

If an action is wrong for you to perform in a particular circumstance, then that action would be wrong for anyone in a relevantly similar circumstance to perform.

In the case "Bouvia v. Superior Court," Elizabeth Bouvia's attorney argues that an autonomous patient's right to refuse care (select all that apply):

Is a constitutionally guaranteed right., Is a basic and fundamental right, requiring no one's approval, and is not subject to begin overridden by medical opinion.

In "The Refutation of Medical Paternalism," Goldman claims that the notion of harm (select all that apply):

Is a moral concept insofar as it takes account of a range of value orderings and the independent value of an individual's integrity., Is relative insofar as it depends on subjective value orderings and comparative states of affairs., Is empirical insofar as certain conduct creates states of affairs that the vast majority of people would wish to avoid.

Which of the following is true.

It's possible to obtain consent in sense 1 but not in sense 2 and it's possible to obtain consent in sense 2 but not in sense 1.

According to the text, what are some of the positive reasons for why ethicists think doctors should be truthful with patients?

Patients aren't robbed of being able to make informed life decisions., informed patients are more likely to follow their treatment protocol., trust in medical professionals is preserved and improved.

Goldman's moral argument against medical paternalism:

Rests on the idea that the promotion of health may not be the highest value for all people.

Which are two conditions that may undermine a patient's capacity for decision-making but still require that physicians seek informed consent?

Schizophrenia and depression

examples of issues dealt with medical ethics

childhood vaccinations, abortion, euthanasia, informed consent, emerging medical technologies, mental health, human research and experimentation, genetic enhancements, etc.

If Theodora's physician determines that she lacks decision-making capacity, this means that:

She may be unable to make specific medical decisions, but it cannot be assumed that she lacks a global ability to make decisions about healthcare.

In "Telling the Truth to Patients," Thomasma argues that truth-telling isn't always essential in healthcare relationships because (select all that apply):

Sometimes the truth may be withheld for compassionate reasons, such as trying to promote the patient's long-term values., Telling the truth may sometimes impair the restoration of autonomy., Withholding information can sometimes be a means of helping the patient through an illness, which may include some non-medical factors.

According to Faden and Beauchamp, satisfying either sense-1 or sense-2 of informed consent does not guarantee that the other has been satisfied. What is the main point that the authors are trying to express by highlighting this distinction?

That the moral ideal of informed consent isn't always captured by the practice of obtaining informed consent.

The patient has a right to continuity of health care:

The physician must cooperate in the coordination of medically indicated care with other health care providers and may not

Which of the following studies involved infecting children with hepatitis in order to study the course of the disease?

The study at willow-brook state hospital

What is the main argument for occasionally misleading patients?

The truth can sometimes cause harm, panic, hopelessness, fear and depression which in turn that undermine the patient's ability to recover.

bioethical principlism

To help guide you in your moral decision making (both within and outside of this course), we will employ a basic framework for addressing the issues that arise in medical practice

Which are consequentialist arguments for confidentiality?

Unless patients are able to rely on a physician to keep their secrets, they would be reluctant to reveal truthful information about themselves.

The patient has a right to confidentiality:

Unless to protect patients welfare, or public interests, physicians should never reveal confidential communication or information

Paternalism is generally defined as a person's actions or decisions being overridden for their own sake. Though most people find paternalism morally troubling, they draw a distinction between weak paternalism and strong paternalism. What is the basis of this distinction?

Weak paternalism overrides the wishes of persons with diminished autonomy, while strong paternalism overrides the wishes of the fully autonomous.

bioethics

a branch of applied ethics focused on health care, medical science, and medical technologies

randomization

a mean of ensuring that researchers are not biased when placing subjects into test groups

blinding

a means of ensuring that assessments of interventions are not biased by the exceptions of subject or researchers

clinical trial

a scientific study designed to test a medical intervention in humans

In the article The Concept of Informed Consent, Sense 1 of informed consent refers to consent that is

active engaged authorization of the treatment plan by the patient.

placebo

an in-active or sham treatment given to subject in the control group

A patient has a cancer that is still in early stages and treatable with surgery. Without treatment the cancer will advance and the cancer will no longer be treatable. The patient, however, is afraid to have surgery--so much so that it's impeding the patients ability to reasonably weight risks. The doctor knows this and so, in order to get the patient to have the surgery, they do not disclose possible the risks of the surgery. The patient consents, the surgery goes well, and the patient recovers. In this scenario, which two bioethical principles were in conflict?

autonomy and beneficence

The notion of informed consent is often justified by the bioethical principles of ________ and ______

autonomy and beneficence

The paternalism occurs whenever the bioethical principle of _________ conflicts with the principle of ___________ and the latter is given more weight. (Be sure to put them in the correct order!)

autonomy, beneficence

What are the four bioethical principles?

autonomy, beneficence, non-maleficence, justice

Make your first answer the principle that is given priority above the other: __________ is given priority over the principle of ___________.

autonomy, beneficene

Historically, physicians justified the withholding of important information in order to delicately manage what patients knew about their own cases. Which bioethical principle did they appeal to in order to justify this?

beneficence (non-maleficence)

Medical Terminology is a subset of

bioethics

The principle of autonomy only applies when individuals are

capable of making autonomous decisions

Diminished ability to make decisions

children, dementia or severe mental illness, cognitive impairments