Healthcare Ethics Midterm

Resolve moral disagreement by talking it out and coming to an agreement among the interested parties. This is which approach?

"postmodern" approach

Match the belief with the year: Physicians should only lie to their patient if the lie is purely for the patient's benefit.

1903

Match the belief with the year: Physicians should not tell a patient that they have cancer.

1961

Match the belief with the year: Physicians should tell a patient that they have cancer.

1979

Match the belief with the year: Physicians should deal honestly with patients, and should expose colleagues who engage in fraud or deception.

1980

Match the belief with the year: Physicians should disclose information when it is important to the patient's understanding of his or her diagnosis or condition, treatment, and prognosis.

2005

Check to see what others have done in similar situations and, if it turned out well, follow their example. This is which approach?

Case-based approach

The first well-developed, widely used approach to health care ethics. This is which approach?

Principle-based approach

Follow ten basic moral rules, including "do not kill" and "do not cheat." This is which approach?

Rule-based approach

Develop good moral character, then all your decisions will be ethical. This is which approach?

Virtue-based approach

How does violating patient confidentiality harm the patient? Choose the best answer: a. All of these. b. The patient may lose trust in the health care system and may not seek health care when they need it. c. Revealing someone's health information may open them up to discrimination. d. The patient may learn not to share sensitive information with health care providers, and thus may not be properly diagnosed or treated. e. Revealing someone's health information may cause them embarrassment or shame.

a

Which of the following accurately describes the difference between crossing a professional boundary and violating a professional boundary? Select one: a. Crossing a boundary tends to be done with good intentions and generally happens in response to a specific situation, while violating a boundary is often done repeatedly with full awareness of wrongdoing. b. Health care providers generally try to hide evidence that they've crossed a boundary, but are more open about boundary violations. c. All of these. d. Crossing a professional boundary involves personal boundaries like having a romantic relationship with a patient, while violating a professional boundary involves commercial boundaries like encouraging patients to choose treatments that will benefit you financially.

a

Which of the following best describes professionalism? a. Professionalism involves the conduct, aims, or qualities that characterize or mark a profession or a professional person. b. Professionalism requires adherence to the ethical principles set by your profession. c. Professionalism helps health care providers make choices that will enhance the well being of their patients. d. None of these.

a

Which of the following best describes why professionalism is important in health care? a. All of these. b. Because health care providers by necessity must have a relatively intimate relationship with their patients while simultaneously maintaining a professional distance and not getting overly involved in their lives. c. Because professional boundaries help health care providers maintain a professional relationship with their patients without becoming so distant as to appear disinterested or negligent. d. Because health care professionals are making choices that affect other people's health and well-being.

a

Which of the following does not describe the concept of ethics? a. The study of the fundamental nature of knowledge, reality, and existence. b. A feature of human choice and action. In other words, a way to describe behavior. c. A field of scholarly inquiry within philosophy, theology, and other disciplines. d. A set of rules or principles that guide human behavior

a

Which of the following is not a quality of a culturally humble health care provider? a. They refuse to criticize the moral beliefs of other cultures, and uphold the beliefs of their patients regardless of the implications. b. They are respectful of their patients, are culturally aware, and engage in good communication practices. c. They talk to their patients about their cultural beliefs and treatment preferences. d. They are aware of perspective of their own cultural background, as well as its limitations.

a

Which of the following was responsible for the dramatic increase (from 30% to 60%) in the number of hospitals with ethics committees between 1983 and 1985? a. The Baby Doe case b. The Tuskegee Syphilis Study c. The story by Shana Alexander about the Seattle Artificial Kidney Center d. The Karen Quinlan case

a

Why are cultural issues becoming a major source of moral disagreement in health care in the US? a. Because our society is becoming more diverse, with people from many different cultural backgrounds coming together in a health care setting. b. Because most health care providers in the US do not speak foreign languages. c. Because our society is becoming less diverse, with most of us coming from similar cultural backgrounds. d. Because US society represents a homogeneous community where we all share most of the same values.

a

Why are ethical issues related to health care the focus of so much attention and debate relative to ethical issues in other fields (e.g., education, national security, etc.)? a. Because health care-related issues are universally important to all people. b. Because health care spending is extremely high c. Because of the frequent need to sacrifice individual liberties for the greater public good d. Because there are great disparities in access to health care

a

The process of distributing resources:

allocation

According to the concept of resource stewardship, who should be responsible for controlling the ever-increasing costs of health care? a. Patients themselves b. Providers c. Insurance companies d. The government

b

In which of the following situations can treatment be provided without obtaining informed consent? Choose the best answer from the following: a. When a patient says that they don't want to go through an informed consent process and asks their provider to make treatment choices on their behalf. b. All of these. c. When a patient has a highly infectious disease that could easily spread to others if untreated. d. When an unconscious patient is brought to an emergency department in critical condition.

b

The American Medical Association's "Principles of Medical Ethics" confirms that physicians must maintain the privacy and confidentiality of their patients. However, they give physicians a loophole that they can use to share confidential information about a patient. What is that loophole? Select one: a. Physicians can share confidential information with the patients' immediate family members. b. Physicians can share confidential health information as required by law. c. Physicians can share confidential information if the patient dies. d. Physicians can share confidential health information if the patient is a good friend of theirs.

b

When did the field of health care ethics and its associated methods gain widespread recognition as a distinct field of inquiry? a. Back when medicine itself was established in classical antiquity b. Beginning in the 1950's and '60's when major advances in medical technologies made it possible to prolong life in even the most critically ill patients. c. When improvement in sanitation greatly increased the average American's lifespan in the early part of the 1900s d. In 1847, when the American Medical Association published the Code of Medical Ethics

b

Which aspects of resource stewardship does the "Choosing Wisely" campaign promote? Choose the best answer from the following: Select one or more: a. Cost-effectiveness b. All of these c. Preventing economic waste d. Preventing medical waste

b

Which of the following is not a valid justification for overriding patient privacy and confidentiality? a. Notifying legal officials if they suspect their patient was a victim of violent crime. b. Notifying a patient's family if the patient is making poor decisions about medical treatment options. c. Notifying public health authorities of a case of sexually transmitted disease d. Notifying a patient's family if the patient appears to be suicidal.

b

Which of the following was not one of the high-profile events in the 1970s that focused public attention on the importance of ethics in health care? a. News coverage of the Tuskegee Syphilis Study b. The adoption by the American Medical Association of a professional code of medical ethics c. The Karen Ann Quinlan case described in the case study at the beginning of chapter 2 of the Moskop text d. The Supreme Court's decision on Roe v. Wade

b

Why is it important for health professionals to pay attention to ethical issues in health care? a. Because public officials and health care facility experts are required to address ethical issues b. Because health conditions are complex and the most appropriate treatment options are often unclear. c. Because people devote so much time and energy to staying healthy d. All of these

b

What can health care providers do if a law is preventing them from doing what they think is best for their patient? Choose all correct answers. Select one or more: a. Nothing. They must follow the law no matter what. b. They can engage in civil disobedience by not following the law. c. They can work to revise or repeal the law.

b & c

The number of hospital ethics committees was growing rapidly in the mid-1980's, but many physicians opposed this change. Why was this? a. Physicians felt that the new ethics committees were not adequate, and wanted a more comprehensive system. b. Physicians were uncomfortable with the idea of acting as clinical consultants. c. Physicians were worried that ethics consultants would be intrusive and limit physicians' authority. d. Physicians preferred the Institutional Review Board (IRB) model.

c

Which of the following describes the principle of justice? Select one: a. All of these. b. Do not provide treatments more likely to cause harm than benefit. c. Treat equals equally, but unequals unequally. d. Provide equal care to people from different backgrounds.

c

Which of the following is a modern interpretation of nonmaleficence? a. Act for the benefit of others. b. Honor the choices and actions of autonomous persons. c. Do not provide a treatment or therapy that may do more harm than good. d. Do not inflict harm.

c

Which of the following is not an appropriate course of action for a health care provider who is concerned about the treatment decisions made on behalf of a patient by a surrogate decision maker? a. Discuss the treatment decisions with the surrogate to try and understand their choices b. Transfer the patient to a provider who understands and will honor the surrogate's choices c. Respect the decisions by not questioning the surrogate's choices d. Seek legal intervention to override the surrogate's choices

c

Which of the following represent the three required components of informed consent? a. Decision-making capacity; The ability to reason; The ability to express a choice b. The ability to understand relevant information; The ability to reason; The ability to express a choice c. Decision-making capacity; Information disclosure; Voluntary choice d. Emergency treatment; Public health requirements; Therapeutic privilege

c

Which of the following represents the best way for a health care provider to demonstrate cultural humility in their interactions with patients from foreign cultures? a. Learn about the patient's culture before meeting them, and only offer treatment recommendations that align with the values of their culture. b. Encourage patients to approach their health care from a scientific perspective and to detach from their cultural beliefs or preferences. c. Treat each patient as an individual, and work to understand their unique perspectives and beliefs. d. Provide each patient with a list of hospital policies, and explain that treatments that do not fall under those policies will not be offered.

c

Which of the following strategies represents the best way for a health care provider to avoid potential liability? Select one: a. Rely on the law to make treatment decisions. b. Refuse to offer treatment to patients with comorbidities and complications. c. Gather accurate information about their legal duties and the risk associated with offering different treatments. d. Rely on their moral judgment to make treatment decisions.

c

Why is telling a patient the truth important in terms of respecting their autonomy? a. All of these are correct. b. Because telling the truth builds trust in the therapeutic relationship. c. Because patients cannot make choices in their own best interest if they do not understand all the relevant information. d. Because patients may be harmed by truth.

c

You are working in a health care facility treating patients, and a co-worker asks you to describe the details of a patient's diagnosis. Under what circumstances can you share this information? a. When the co-worker has worked with the patient in the past. b. When the co-worker is a physician. c. When the co-worker needs to know so that they can perform their job duties. d. When the co-worker is your manager.

c

You have just determined that your patient has breast cancer - specifically, a stage 1A invasive ductal carcinoma (note that stage 1A breast cancers have not metastasized to the lymph nodes). Which of the following represents the most truthful communication with this patient? Consider Richard Cabot's definition of truthfulness, which is described on page 96 of your textbook. a. "You have a small lump, but it isn't cancerous so you shouldn't worry. We'll take care of it for you and you will be fine." b. "You have an invasive ductal carcinoma, but it hasn't metastasized to the lymph nodes. Full mastectomy followed by radiation therapy has yielded a 90% survival rate at five years in women with a similar diagnosis." c. "You have a very early stage of breast cancer. The cancer cells have not spread beyond your breast, so treatments are highly successful. Depending on your family history and risk, you could choose to have a full mastectomy removing your whole breast, or to simply remove the tumor itself."

c

Boundaries that define how a provider should separate their business interests from their treatment recommendations:

commercial boundaries

Not sharing someone else's information with others:

confidentiality

Health care provider has a low degree of control in the decision making process, while the patient has a high degree of control in the process:

consumerism

Choosing the less expensive treatment when multiple treatments are similar in terms of efficacy:

cost effectiveness

Understanding that different cultures have different values and beliefs:

cultural awareness

Learning about the specific beliefs and values held by different cultural groups:

cultural competence

Understanding that an individual may not hold all the beliefs implied by their cultural background:

cultural humility

Which of the following is not one of the steps in conducting a case analysis? a. Define the problem or dilemma. b. Think about possible options to resolve the case, and consider the consequences of each. c. Decide what to do. d. Present the case to an ethics consultant.

d

Which of the following most accurately describes the Baby Doe case and its outcome? a. Baby Doe was an otherwise healthy baby born with an inoperable medical condition. His death prompted Congress to expand funding for research into childhood illnesses. b. None of these c. Baby Doe was born with mental and physical handicaps, but his parents could not afford to pay for necessary surgeries or therapies to support his medical conditions. Congress passed the Affordable Care Act to ensure that children like him would be guaranteed health care. d. Baby Doe was born with Down's Syndrome and with a serious medical condition. When his parents decided not to pursue surgery to repair his condition, Congress passed laws to prevent treatment from being withheld for babies born with disabilities.

d

Which of the following should be a health care providers first choice of surrogate decision maker for a patient without decisional capacity? Select one: a. The patient's next of kin (e.g., spouse, parent, adult child, etc.) b. A legal guardian appointed by a court c. A close family friend d. A health care proxy appointed by the patient

d

A patient's ability to choose between different treatment options:

decision-making capacity

Making your own decisions:

decisional privacy

Which of the following is not one of the four general principles of health care ethics? a. Nonmaleficence b. Beneficence c. Justice d. Respect for autonomy e. Dignity

e

A treatment in which the value of the benefit does not outweigh the cost of the treatment:

economic waste

True or False? "Institutional Review Board" (IRB) is the formal name given to hospital ethics committees.

false

True or False? Coercion, or forcing someone to agree with you or to do what you tell them to, is never appropriate.

false

True or False? Ethical principles are established and enforceable social rules for conduct or non-conduct.

false

True or False? Health care providers can rely on the law to solve all their moral dilemmas.

false

True or False? Healthy boundaries are those that conform completely to professional standards, and do not allow for any flexibility or room for interpretation

false

True or False? Hospital ethics committees were tasked with identifying unethical behavior on the part of staff, and with providing mandatory ethics training to staff who had violated regulations.

false

True or False? Imagine that a loved one has designated you as their health care proxy. The best way for you to fulfill your responsibilities in this role is to make treatment decisions for your loved one based on how you yourself would want to be treated.

false

True or False? Informed consent is not necessary when providing therapeutic treatments to sick or injured patients who require care. Informed consent is only necessary in a research setting, where researchers must obtain informed consent from research subjects prior to collecting data or administering an intervention.

false

True or False? Patients have the right to access their own medical information. This means that people who work in a health care facility can use their employee access privileges to access their own health records.

false

True or False? Resource stewardship is a responsibility of health care providers, and refers to the conduct, aims, or qualities that characterize or mark a profession or professional person

false

True or False? Resource stewardship is one of the least understood of the moral foundations of the therapeutic relationship because it is an ancient idea that goes back to the early days of medicine

false

True or False? The following 1914 quote from Justice Benjamin Cardozo is the origin of the concept of informed consent: "Every human being of adult years and sound mind has a right to determine what shall be done with his own body; and a surgeon who performs an operation without his patient's consent commits an assault, for which he is liable in damages."

false

True or False? The rule-based approach to health care ethics has its roots in the common law tradition in British and American jurisprudence.

false

True or false: To fulfill their obligation to tell the truth, health care providers must tell their patients about their diagnosis and treatment options even if the patient does not want to learn the information.

false

Collecting fees for services never provided, or providing services under false pretenses:

fraud

The process of facilitating access to scarce resources by exaggerating need:

gaming the system

The process of assigning someone to determine who may access scarce resources:

gatekeeping

Health care provider and patient both have a low degree of control in the decision making process:

indecision

Conveying an understanding of a patient's diagnosis and treatment options, along with potential risks and benefits associated with the different options:

information disclosure

Not sharing information about yourself with others:

informational privacy

A process whereby health providers ensure that patients are able to make health-related decisions, inform patients about their diagnosis and treatment options, and allow competent patients to make their own choices about which treatment is best for them:

informed consent

Boundaries that promote the right of a professional to act in a way that is consistent with their values and beliefs:

integrity boundaries

Boundaries that define the role that different health professions have in delivering care:

inter-professional boundaries

Referring a patient for a test or treatment that is unnecessary or futile:

medical waste

Believe that their own cultural background is superior to that of other people:

moral imperialists

Believe that we should engage with different cultures to find a mutually acceptable resolution:

moral negotiators

Believe that we shouldn't criticize the moral values of another culture:

moral relativists

Health care provider has a high degree of control in the decision making process, while the patient has a low degree of control in the process:

paternalism

A patient's decision not to receive medical information relevant to their diagnosis or treatment options:

patient waiver of consent

Boundaries that define the range of acceptable relationships a provider may have with their patients:

personal boundaries

Not allowing others to touch you in ways you don't like:

physical privacy

The process of distributing scarce resources

rationing

Health care provider and patient both have a high degree of control in the decision making process:

shared decision making

A surrogate decision maker uses knowledge of the patient's expressed wishes (written or verbal) to make treatment decisions on their behalf:

the advance directive standard

A surrogate decision maker uses information about how to maximize the patients overall well being make treatment decisions on their behalf:

the best interest standard

A surrogate decision maker uses knowledge of the patient's values, beliefs, and goals to make treatment decisions on their behalf:

the substituted judgement standard

A provider's decision to withhold essential medical information from their patient on the basis of that information representing a potential harm to the patient:

therapeutic privilege

The process of distributing scarce resources to achieve a desired outcome:

triage

True or False? A patient may have sufficient decisional capacity to consent to a life-saving treatment, but not to refuse it.

true

True or False? Although clinical ethics consultation is now a standard of practice in most hospitals in the US, a standardized credentialing process for individual ethics consultants has not yet been developed.

true

True or False? Having respect for an individual's autonomy may require both positive and negative actions.

true

True or False? When trying to communicate the truth to a patient, sharing too many details of their diagnosis and prognosis may be just as bad as not sharing enough details.

true

True or False? While having many different sources of moral guidance can be helpful, it can also create confusion or uncertainty when the different sources disagree over a specific topic or question.

true

True or False? Rational argument is the most powerful method for resolving moral disagreement.

true