phil 2230 final
Which of the following is true according to Idaho state law regarding revoking living wills?
A patient can verbally revoke a living will, even if the patient is mentally incompetent at the time.
According to medical ethicists Culver and Gert, which of the following is NOT POSSIBLE?
A patient could be competent to consent to a medical treatment but incompetent to refuse that same treatment (at that same time).
According to policy statements of the American Nurses Association, the American Medical Association, and others, what sort of medical intervention is artificial nutrition and hydration (ANH)?
ANH is a medical treatment and should be evaluated in the same way as other medical treatments.
According to Marquis, what is the fundamental ethical reason why abortions are usually NOT permissible?
Abortion is wrong because it deprives the fetus of a future like ours.
True or False: In Idaho, a patient must be mentally competent in order to revoke his/her living will.
false
What is meant by the claim that a doctor is a FIDUCIARY?
A doctor is a professional acting on the patient's behalf to do what the patient cannot do for him/herself.
Briefly decribe TWO (2) ways in which a clinician or an institution might be contributing to a patient's difficult behavior
A clinician or institution might be contributing to a patient's difficult behavior by labelling a patient as a difficult person. They see this person as difficult and start treating them that way as soon as they walk in the door. It's a self fulfilling prophecy. Secondly, a clinician or institution might be contributing to a patients difficult behavior by dismissing a patients concerns. Having unusual symptoms may be hard to diagnose and a patient might become frustrated in the process.
With which type of ethical theory are slippery slope arguments most commonly associated?
Consequentialist theories.
The SUPPORT study (1989-1994) examined what it is like to die in a hospital in America, and how to improve the care of dying patients. What were the overall findings of this study?
American hospitals initially provided rather poor care for dying patients, and attempts to improve that care were generally not successful.
In the article, "Hospice and the End Game" (Clift, 2011), why do many patients not get moved to hospice care (and away from aggressive treatment) sooner?
Because doctors often put off having difficult conversations about patients' end-of-life care.
According to the article, "Invoking Therapeutic Privilege" (Wynia, 2004), why does the doctor decide not to tell the patient her diagnosis?
Because if the patient knew her diagnosis she would refuse the treatment that she needs.
Why is it sometimes said that we should not take all refusals of treatment (by competent patients) at face value?
Because it might not be a genuine refusal; the patient might have some other reason for saying "no."
In the article, "Doctor, Will You Turn Off My LVAD?" (case w/ analysis, 2008), the first commentator (J.R. Simon) argues that the LVAD should NOT be turned off, despite the patient's request. What reason does he offer in support of this conclusion?
Because the LVAD is inside the patient's chest, it has become a part of him; that is, the LVAD is not simply a treatment that may be stopped when you decide you no longer want it.
According to the article, "What do apple pie and motherhood have to do with feeding tubes and caring for the patient?' (Slomka 1995), why are many people very reluctant to withhold or withdraw artificial nutrition and hydration (ANH) from dying patients?
Because we are inappropriately influenced by the "social meaning" of food and drink.
In cases of PATERNALISM, which ethical principles are in conflict?
Beneficence and nonmaleficence conflict with respect for autonomy
In cases of paternalism, which ethical principle is being given priority over which other ethical principle(s)?
Benefience and nonmaleficence are given priority over respect for autonomy.
In the article, "Critical Conversations: Navigating Between Hope and Truth" (Srivastava, 2011), what does the author say about asking cancer patients to reconsider their goal of being cured?
Clinicians should raise the issue of goals early in the process, and ask patients (and families) to consider quality of life issues.
Which type of ethical theory is MOST COMMONLY used to justify cases of paternalism?
Consequentialism
According to the article, "When the Family Requests Withholding the Diagnosis: Who Owns the Truth?" (McCabe, Wood, & Goldberg, 2010), what do the authors recommend when families don't want the patient to know the truth about their diagnosis, treatment, etc.?
Develop an understanding of the family's views on the matter, including the patient's own views, and share information gradually to allow the family to adapt. But don't force patients to hear things they don't want to hear.
According to the article, "Listening to Anna" (Nelson, 2007), what was a central reason why Anna's medical treatment was so different from what she had described in her advance directive?
Even though she was incompetent to make medical decisions, Anna repeatedly said she wanted treatment to continue.
The fetus has the potential to become a person with high moral status, so we should treat it now as though it already has high moral status. What is the most significant objection to this argument?
Having potential for something is not the same as currently having it.
In the article "Saving My Appendix" what was the outcome? Did the author save his appendix?
He refused the surgery, took antibiotics, and had a good recovery.
In the article, "Should We Tell Annie?" (Salter, 2013), the author examines a case in which the parents of a 17-year-old woman do not want the hospital staff to tell the patient that she is expected to die within 3 weeks. What was done in this case?
Her parents' decision was honored, but staff continued to talk with the parents about whether Annie should be told more.
What do patient usually fear most as the end of life approaches? (Think about the study of end-of-life attitudes and the surveys filled out by those who commit suicide in accordance with Oregon law.)
Hopelessness and loss of autonomy.
How have laws and policies regarding patient confidentiality changed as a result of the Tarasoff case?
If a patient poses a credible threat to an identifiable victim, that potential victim must be warned -- even though doing so involves breaking patient confidentiality.
Explain briefly the distinction between QUANTITATIVE and QUALITATIVE FUTILITY.
If something is quantitatively futile the probability of producing the desired effect is too low. If something is qualitatively futile then the goal is not pursing, treatment would not produce a benefit.
In the article, "Sleep Deprivation, Elective Surgical Procedures, and Informed Consent" (Nurock et al., 2010), what do the authors recommend when a sleep-deprived surgeon is scheduled to perform an elective surgery?
Inform the patient that the surgeon is sleep deprived, and let the patient decide whether to continue as scheduled (or whether to reschedule, or continue with another surgeon).
Which of the following is the best definition of WEAK PATERNALISM?
Interfering in the decision or actions of someone who has a low level of autonomy.
Which of the following is the central question that must be answered when making judgments of QUALITATIVE FUTILITY?
Is the goal worth pursuing?
What two questions should we ask before we honor a patient's refusal of treatment?
Is this refusal really what it seems? Is the patient competent to make this decision?
What is the main way a capitated care system motivates clinicians to change how they treat their patients?
It gives clinicians a financial incentive to keep the costs of care as low as possible.
Which of the following is a characteristic of DECISION-MAKING COMPETENCE?
It is a threshold concept
What does ethicist Michael Tooley say about the permissibility of abortion?
It is permissible to terminate any pregnancy because the fetus/baby/child does not have moral rights until it is several years old.
According to the article "Late-Life Cardiac Interventions and the Treatment Imperative" [Shim et al., 2008], how has the "treatment imperative" affected the process of obtaining informed consent for late-life cardiac interventions?
It makes clinicians less likely to discuss the possibility of refusing treatment and more likely to discuss the possibility that the outcome of treatment will not be good
Suppose you get your medical insurance through a managed care organization such as an HMO. And suppose that you discover that your insurance makes it very difficult to schedule medical appointments, find clinicians that included in the insurer's network, challenge the insurer's decisions about whether medical care is covered under your policy, etc. What is the best explanation of that inconvenience?
Managed care organizations often deliberately make these things inconvenient because it helps to keep medical costs low.
In the article, "I'm disabled and need a ventilator to live. Am I expendable during this pandemic?" Alice Wong explains that some guidelines for rationing ventilators would result in her death. What is her criticism of using "quality of life" calculations in rationing decisions?
Quality of Life measurements (such as the QALY) are explicitly biased against people with disabilities.
What do Immanuel Kant and John Stuart Mill have to say about whether it is ever ethical to tell lies?
Mill says lying is sometimes ethically justified, but Kant says we must always tell the truth.
Which ETHICAL RULE does Judith Jarvis Thomson apply in her argument for the permissibility of abortion?
No one has a right to use your body unless you expliciy grant that person that right
What is the central objection to using Odysseus Contracts when treating patients?
Odysseus contracts do not allow patients to exercise their entitlement to change their minds about their medical treatment.
In the article, "Autonomy or Exploitation?" a case is presented in which an elderly woman refuses to be assessed for decision-making competence. What do the two ethicists who comment on this case say should be done?
One argues that her refusal should be honored, but the other argues that there is a justification to proceed with the assessment despite her refusal.
What is an ABSOLUTE moral right or duty?
One that must be followed at all times, regardless of circumstances.
Surgical consent forms often include a clause stating that the surgeon may use a different or more extensive surgical procedure than the one described on the form (doing what the surgeon deems to be best in the circumstances). What sort of consent do patients give to these deviations from the planned surgical procedure?
PRESUMED consent
In most managed care systems and HMOs, primary care doctors play a gatekeeper role. What does that mean?
Patients are not allowed to go to (most) medical specialists unless the primary care doctor makes a referral.
In which of the following settings of care would you be most likely to encounter IMPLIED CONSENT?
Patients seeking care at a primary care clinic
What is the central difficulty with applying the ethical principles of beneficence and nonmaleficence?
People often disagree about what counts as a harm or a benefit (or about which risks are worth taking, etc.).
According to Franz Inglefinger's article "Arrogance" (1980), how should a clinician present treatment alternatives to patients? (That is, what was Inglefinger's FINAL view?)
Present the "medical menu" of treatment options and then RECOMMEND the one the clinican thinks is best.
In the article, "On Being a 'Difficult' Patient" (Mayer 2008), what does the author say about her own experience as a "difficult" patient?
She argues that some patients with unusual medical problems need to act in ways sometimes seen as "difficult" in order to get proper treatment.
What assumption does Judith Jarvis Thomson make about the fetus's moral standing?
She assumes that it has the same moral standing that you and I have.
In the article, "Woman who refused treatment after 'losing her sparkle' dies," what decision was made about the patient's refusal of life-saving treatment?
She was found competent to make this decision and her refusal was honored.
Suppose a depressed patient refuses life-sustaining treatment. Should medical staff honor that refusal?
Some depression (biochemical) undermines autonomy, but other forms (reactive or situational) may not. So, this has to be analyzed case by case.
When Dax Cowart refused treatment for his burns, he was treated against his will. What sort of paternalism was this?
Strong, Hard Paternalism
In the article, "When a Patient Refuses All Assistance" (Grace & Hardt, 2008), an elderly patient refuses all medical assessments and interventions, but nurses don't simply accept that refusal. What sort of paternalism is involved in their efforts to gain this patient's trust and to change her mind?
Strong, Soft Paternalism
Which type of paternalism is HARDEST to justify ethically?
Strong, hard paternalism
Which type of paternalism is LEAST likely to be ethically justified?
Strong, hard paternalism
According to the article, "Should paramedics ever accept patients' refusal of treatment or further assessment?" (Nordby 2013), the paramedics treated the patient paternalistically (by pressuring her into accepting further medical assessment). What sort of paternalism was this?
Strong, soft paternalism, Weak, soft paternalism
According to the article, "Beneficent Persuasion: Techniques and Ethical Guidelines to Improve Patients' Decisions" (Swindell 2010), what is the central ethical justification for using the techniques described by the author to influence patients' decisions?
The Principle of Beneficence; using these techniques is in the best interests of the patient.
What does the Principle of Justice tell us about whether patients should be told about what their medical treatment will cost?
The Principle of Justice says that we SHOULD tell patients about treatment costs because not telling them would harm the poorest people the most.
According to Immanuel Kant's Categorical Imperative, what makes an action ethically permissible?
The action does not involve treating any rational being merely as a means.
According to the article, "Cynicism, with Consequences" (Plantz, 2011), what does the author say about clinicians who limit or withhold treatment from irresponsible patients to "teach the patient a lesson"?
The author argues that judging patients as irresponsible is counterproductive, and that treatment should never be withheld in an effort to educate or punish patients.
In the article, "Should health-care workers press charges against violent patients?" (Morris 2018) does the author recommend pressing charges against these patients?
The author doesn't take a clear stand, but points out several reasons AGAINST charging patients.
According to the author of the article, "Hospice and the 'End Game'" (Clift, 2011), what is the central barrier that prevents very seriously ill patients from getting timely information about their palliative care options?
The difficulty healthcare professional have in begining "the conversation" about dying.
In the article, "Moral Distress in Neurosurgery" (Stern, 2019), the author discusses a case in which he wonders whether he should perform a second neurosurgery on a patient who is not recovering well from the first procedure. What decision was made about this patient?
The doctor discussed the patient's views and values with the family, and then explained that a second surgery would not fit with the patient's wishes. So, the patient was moved to hospice care (with no additional surgery).
In the article, Refusing Treatment (Frenkel 2013), the author describes a case in which a woman refuses to allow her breast cancer to be treated with chemotherapy (even though the evidence shows this gives her the best survival rate). Instead, she chooses to have only complementary/alternative treatments. Which of these responses fit with what Frenkel says doctors should do in such cases?
The doctor should discuss this issue with patients, encourage them to continue with recommended treatment, find ways to combine traditional and unconventional therapies, etc.
In the article, "Quadriplegic Man's Death Stirs Fear of Medical Bias against Disabled..." (Cha 2020), a case is described in which a man with disabilities died of COVID. What was the central conflict between the patient's family and the hospital?
The family claimed that this patient's life was not seen as valuable because of his disabilities; the hospital says that's a distortion of what really happened.
In the lecture on surrogates in practice, we discussed the case of a husband who wanted to stop life-sustaining care for his wife so that he could marry his housekeeper. What did John Hardwig say about what should be done?
The husband may continue to be the surrogate, and he IS ALLOWED to consider his own interests in making medical decisions about his wife's treatment.
The article on small violations of medical privacy describes what the federal Office for Civil Rights typically does when one of these violations is reported. Which of these best describes the typical response?
The institution and staff involved are reminded about the privacy rules and must promise to improve their behavior.
Ethicist John Hardwig and others have discussed whether family members can ethically take their own interests into consideration when serving as surrogates to make medical decisions for a patient. What is Hardwig's position on this issue?
The interests of family members must be considered in making medical decisions for the patient, and in some cases the right choice will be one that is NOT best for the patient
In the article, "Should Feeling Tired of Life be Grounds for Euthanasia?", the author discusses the law in the Netherlands that regulates euthanasia. Does the law described in the article make it legal for someone to be euthanized if they are "tired of life" but have no other serious medical conditions?
The legality of euthanasia in this case is not clear.
The article, "She's Back Again" (Bruner 2016) describes a patient who frequently comes for treatment and is usually unsatisfied with the care she receives. According to the author, which of these is a major contributor to the problems with this patient?
The medical staff make clear that they dislike the patient and don't take her problems seriously.
In the case of Helga Wanglie's ventilator, what was the nature of the disagreement between the Wanglie family and the medical staff?
The medical team believed it was QUALITATIVELY futile, but the family believed it was QUALITATIVELY effective.
The lecture on confidentiality & privacy included a discussion of a case in which a woman who is HIV+ gives birth to a child who is also infected. The mother wants to keep this secret from the baby's father and from her other family members. What decision was made in this case?
The mother's HIV infection must be reported to the health department (as required by law), and family members involved in the chld's care must be told enough to ensure that the child receives proper care.
In the lecture on refusing treatment in practice, a case was discussed in which a patient with a broken neck refused treatment because he was convinced he had been healed. What was the outcome in that case?
The patient continued to refuse, and that refusal was finally honored.
According to the article, "Cynicism, with Consequences" (Plantz, 2011), the author argues that some instances of conscientious refusal are not really about the refuser's conscience. Instead, conscience is used as a cover for the refuser's judgments about whether
The patient in question deserves our help.
According to the Argument from Compassion (offered in support of physician-assisted suicide), in which case would there be the STRONGEST ethical justification for helping a patient commit suicide?
The patient is incurably ill, but not expected to die soon.
In Idaho, what "triggering conditions" must be met in order for a patient's living will to take effect?
The patient must be incompetent, and either terminally ill or in a PVS.
In the article, "The Role of Chemotherapy at the End of Life" (Harrington & Smith 2008), the authors describe Mr. L, a cancer patient who received chemotherapy until just a few days before he died. Why did this patient not enter hospice care earlier?
The patient was told fairly early on that hospice care was an option, but refused to enter hospice until very late in his life.
According to Marquis, in which of the following cases would abortion NOT be permissible?
The pregnancy resulted from rape or incest.
The article, "Conscience Clauses, Health Care Providers, and Parents" (Hastings Center 2008) includes a discussion of the relationship between conscientious refusals to treat and the clinician's obligation not to abandon patients. How does the obligation not to abandon patients affect clinicians' entitlement to refuse for reasons of conscience?
The rule against abandoning patients means that when a clinician refuses to provide a treatment, that patient should be referred to another clinician who is willing to provide it.
The Substituted Judgment Standard (SJS) should be used only when:
The surrogate knows the patient well enough to know medical choices s/he would make.
Suppose you have an elective surgical procedure scheduled for Monday morning, but your surgeon has been on call the preceding weekend and is seriously sleep deprived by that Monday morning. Is there a legal or moral obligation to inform you about this situation?
There is a LEGAL AND MORAL obligation to inform you of this.
Which of the following is a characteristic of LEGAL rights?
They are alienable They are created
The article "When a Patient Refuses All Assistance" describes a case in which an elderly woman refuses to go to a clinic or to have healthcare professionals come to her home. How did the nurses who approached her respond?
They took the time to build a relationship with the patient, gain her trust, and convinced her to consent to treatment.
According to the article, "Ethical considerations in the risk-benefit analysis for patients with diminished capacity" (Touhey & Young 2009), what should be done when an incompetent patient resists treatment but the patient's surrogate consents to treatment?
Treat ONLY IF the patient will be compliant and cooperative enough to keep the risks of treatment acceptably low.
In the article, "Artificial Nutrition and Hydration in Advanced Dementia" (Ying, 2015), what does the author say about how clinicians should respond to families who insist that a patient with advanced dementia should have a feeding tube?
Try to educate the family about the risks & burdens of a feeding tube in such cases, but place the tube if they continue to insist. However, the doctor may decide to set feeding levels so that they are "negligible."
In the article, "A Watchful Eye in Hospitals" (Lahey, 2014), the author discusses a case in which a decision needed to be made about whether to put a hidden video camera in a patient's room (without telling the patient's family). What did he conclude about whether that would be ethically permissible?
Using covert video recording is ethical in a few situations, but only when there is a lot at stake and there is no less intrusive way to obtain the information we want.
Why are some professionals worried about the use of virtue theories of ethics in developing nursing ethics?
Virtue theories have historically been used to make nurses into "mommies" for the patients and reinforce nurses' low status in healthcare institutions.
What does the Principle of Justice imply about how we ought to respond to difficult patients?
We ought to deal with difficult patients fairly and compassionately; justice does not allow "double standards."
When the ambulance arrives at the scene of the collision, they find that the driver of one of the cars is conscious and standing up. However, he seems disoriented. He has cuts on his face and hands, and may have other, more serious injuries. However, he refuses all attempts to examine or treat him. When asked to explain his refusal, his speech is slurred and he doesn't seem to understand what has happened. The EMTs then use gentle force to get him to lie down and submit to an examination. What sort of paternalism are they using?
Weak, soft paternalism.
What sort of moral right is the right to basic medical care?
Welfare right
In which of these situations would it be appropriate to apply the concept of presumed consent?
When a patient is brought to a hospital emergency department unconscious, and needs immediate medical interventions.
Which of the following is NOT among the questions one should ask to evaluate a slippery slope argument?
Which moral rights would be violated?
The article "Saving My Appendix" (Gray, 2013) describes what happened when the author attempted to refuse surgery for acute appendicitis. What was the author's primary reason for wanting to avoid surgery?
Worries about the cost of surgery.
Is it ever ethical to use placebos in therapy?
Yes, it is ethical to use them -- but ONLY when the patient is told clearly that this is a placebo.
One of your patients has been criticizing you on social media, posting lies about how you treated that person. What is the ethical response?
You should not respond at all. You aren't allowed even to acknowledge that this person is your patient.
MORAL PERSONHOOD is a category that includes all (and only) individuals that
are conscious, sentient, have stable values, etc.
