HCM 415 EXIT EXAM
Discuss why advance directive are important
AMD inform the providers of their wishes regarding treatment
Ordinary Care
all medicine, treatments, and operations which offer reasonable hope of benefit and which can be obtained and used without excessive expense, pain or other inconvenience.
Kantian Ethics
all people have value and deserve benefits of health care
What are Living Wills?
allows individuals unable to communicate with caregivers to express their wishes about treatment. Without legislation or case law the living has no legal support.
Autonomy
allows other to govern themselves, (viewed as a freedom right)
What is Autonomy?
allows others to govern themselves (viewed as a freedom right)
Examples of ethical dilemmas and expectations to confidentiality
an abused child, certain diseases, gunshot wounds
Virtue Ethics
an internal disposition habitually to seek moral perfection, to live one's life in accord with a moral law, and to attain a balance between noble intention and just action
Discuss why the concept Justice is important in resource allocation
because the concept is expressed in health services delivery by expending greater resources on individuals who are sicker and thus in need of more services
The principle that may defined as acting with charity and kindness is called:
beneficence
Utilitarian Logic
benefits of procedures balanced against the harm
When is "Consent" actually "Consent"?
when a physician discloses the known and existing dangers associated with a course of treatment to a patient, and the patient has approved the treatment without coercion
If there is no consent and treatment takes place anyway, what are the liabilities of the physician and the hospital?
physicians and hospitals are liable if no consent is given; the exceptions are emergency rooms where it is presumed that patients want treatment, or when the state allows treatment for a minor of mentally incompetent persons when those who speak for them refuse to give consent
Fidelity
promise keeping, doing one's duty
What is Fidelity?
promise keeping, doing one's duty
Discuss whether or not healthcare organizations should admit their mistakes
Organizations should admit their mistakes because it establishes a greater trust amongst the facility and its patient and prospective patients
Discus the rights of a parent to refuse treatment for a minor child
Parents have the right to refuse treatment for the minor child. In June 1986 the Supreme Court agreed that DHHA did not have the right to force hospitals to treat infants over parental objections. If patient is a minor or incompetent, parent or legal guardian must consent for treatment. Refusal for treatment in case of minor/incompetent person, the organization must request the state to intervene.
What two principles are conflicting with the consent to treat?
Paternalism and autonomy
Discuss why autonomy and paternalism conflict with each other
Paternalism is the concept that one person knows what is best for another. The two terms are conflicting because physicians act in what they believe to be the patients best interest; however autonomy does not eliminate paternalism, but paternalism should be limited to certain situations
Distributive Justice
that virtue, whose object is to distribute rewards and punishments to every one according to his merits or demerits
Reasonable Person Standard
the "reasonable person" is a composite of a relevant community's judgment as to how a typical member if said community should behave in situations that might pose a threat of harm (through action or interaction) to the public. The standard also holds that each person owes a duty to behave as a reasonable person would under the...?
Non-maleficence in the presence of infectious disease
"do no harm" except where some degree of harm is necessary to prevent greater degree of harm. The organization has a duty to protect patients, staff, and the community in the presence of infectious disease
Euthanasia
"good death" is care that makes death less painful
An advance directive is a good example of which ethical principle/ theory?
Autonomy
What are the 4 elements of Respect for Persons?
Autonomy, Truth Telling, Confidentiality, and Fidelity
Discuss the rights of the patient to refuse treatment
Competent patients have the right to refuse treatment. In the event of refusal or an advance directive, do not treat.
What elements must be present for consent to take place?
Consent must be voluntary, competent and informed.
Non-maleficence
DO NO HARM! Refraining from actions that aggravate a problem or cause other negative results
How to balance Mission and Margin
Health care must make money. Balancing the yin of quality with the yang of profit needed to survive. Mission needs to consider quality, community, and have a foundation in resources. Need to live beyond the doors of the facility.
How to assure competency?
Education, Background checks, drug screenings, etc.
What is a Fiduciary Duty?
Ethical and legal concept. Relationship exists when trust and confidence on one side results in a superior position and influence on the other. The superiority in fiduciary relationship raises duties of loyalty and influence.
Role of the ethics committees
Ethics committees play two roles of general importance: to assist in developing or reconsidering the organizational philosophy[hy (to move the organization towards a more desired culture) and the derivative vision and mission statements. The experience and range of its interdisciplinary membership are likely to produce better reasoned and more thorough results. Education is the second role. It adds a level of sophistication to the organization and improves the quality of clinical and administrative decision making.
Justice
Fairness; equals are treated equally and unequal's unequally
A relationship in which trusts and confidence on one side results in a superior position and influence on the other is which type of relationship?
Fiduciary
Discuss why patient autonomy may be violated if there is no advance directive.
If the provider is not aware of what the patient's wishes are they can very easily violate them. Providers are required to educate their staff and community about advance directives.
Discuss what John Stuart Mill wrote about utilitarianism
In his views, you weigh the consequences of actions and their effect on others. Then you use the reasoning to make your decisions based on the good that they can achieve. He wrote about utilitarianism and stressed individual freedom and noted that freedom is essential to producing happiness
When is Consent, Informed Consent?
Informed consent means that there must be full disclosure regarding condition, treatment, alternatives, consequences of treatment and non-treatment. The duty of physicians or their designees to obtain the patient's permission for treatment.
Fidelity
Keeping a promise
Importance of Accreditation on Ethics and Quality
LOOK UP
Importance of organizational culture
LOOK UP
Importance of staff competency
LOOK UP
Role of "code of ethics" or "professional codes" in ethical decision making
LOOK UP
What is the proper rule of using medical students, interns, and residents in treating patients in an academic medical center?
LOOK UP
In the presence of infectious diseases, the organizations have a responsibility to protect staff and patients; this premise is supported by which principle?
Non-maleficence (to cause no additional harm)
Role of the Institutional Review Boards
The IRB is responsible for providing guidance and oversight for the human participant protection program (experimenting, clinical lab, etc.) and for helping to maintain compliance with applicable laws, regulations, and policies.
Discuss the role of HIPAA in accessibility to medical records
The federal Health Insurance Portability and Accountability Act places substantial restrictions on how health information is obtained, managed, stored, transferred, and used. Health services organizations have a duty to ensure the confidential and appropriate use of patient information. Information that is accessed should only be accessed on an absolutely need to know basis. Provide adequate security procedures, effective staff. Ensure bylaws, rules, regulations and make sure that they are being enforced. Patient medical records are the property of the owners of the facility of which the records were created.
Discuss the personnel who should have access to medical records
The only personnel who should have access to patient's medical records are those individual involved in treatment or care of their individual (i.e. physician and nurses treating the patient) The patient also have a right to view their medical records.
What is the healthcare organization's duty to patients, staff, and the community in the presence of an infectious disease?
The organization has the duty to protect patients, staff, and the community in the presence of an infectious disease
What is the role of the organization in determining that patient have consented in a way that meets ethical criteria?
The organization must ensure that consent is voluntary, the individual is competent, and they are informed. Establish and consistently apply policies and procedures for obtaining consent, and monitoring. Involve staff to verify that consent was informed, voluntary, and competent. Provide an advocate for each patient. Establish an ombudsman office to review problems.
Veracity
Truth telling. Legal principle that states that a health professional should be honest and give full disclosure to the patient, abstain from misrepresentation or deceit, and report known lapses of the standards of care to the proper agencies
Balancing Utilitarian and Kantian Ethics
Utilitarianism is based on the idea that people's ethical decisions should be based on whatever provides the greatest useful goodness for the greatest number of people. Utilitarianism ethical theory believed that the moral benefit of an action is determined by the outcome of the action no matter what the motive behind the action was. Kantian ethics state that people have an unconditional moral duty to do what is right, not because it will profit us, not because if we don't do it and get caught we will be punished but because it is the right thing to do. Kant went on to say that the only true moral act is done from a pure sense of duty.
Beneficence
a positive duty to act with charity and kindness
What is Truth Telling?
honesty in all activities
Respect for Persons
implied duties and relationships, including a person's autonomy
Discuss Confidentiality
is act of respecting privileged information
Extraordinary Care
is all medicines, treatments, and operation which cannot be obtained or used without excessive expense, pain, or inconvenience, or which, if used, would not offer a reasonable hope of benefit.
Confidentiality
protecting information that is confidential, both employee and patient
What is Confidentiality?
protecting information that is confidential, both employee and patient
What is a DNT and what must be the healthcare organization's response in the presence of the DNR?
the do-not-resuscitate order is a type of AMD that is used at the point of service delivery. DNR policy should identify the chemical and mechanical technologies included and the specific instances in which will be applied. Patients with DNR may require surgery and anesthesia mgmt. for palliative care, pain relief/distress, or to improve patient quality of life.
Define Utilitarianism
the theory based off the idea that action should be directed towards doing the " greatest good for the greatest number of people"; "the end justifies the means"; the results of an action are determined by comparing the good brought about by a particular action compared to the good brought about by alternatives, or the amount of evil avoided.
