20th Century Medical Advancements & Ethics
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20th Century Medical Advancements & Ethics

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Questions and Answers

Which of the following is a learning outcome related to communication with patients?

  • Conduct a structured history effectively (correct)
  • Demonstrate professional behavior towards colleagues
  • Understand the principles of evidence-based medicine
  • Identify challenges faced by families

    • What is essential for demonstrating competence in physical examination?

  • Understanding of patient cultural backgrounds
  • Ability to conduct a psychological assessment
  • Evaluation of various bodily systems (correct)
  • Knowledge of social influences on health

    • Which principle is NOT considered an ethical principle in patient care?

  • Beneficence
  • Justice
  • Autonomy
  • Bureaucracy (correct)

    • The case of the three night watchmen highlights what aspect of medical responsibility?

    <p>Duty of care towards patients</p> Signup and view all the answers

    What issue arises when doctors practice in multicultural environments?

    <p>Overcoming language barriers</p> Signup and view all the answers

    Which learning outcome involves critical reflection on experiences?

    <p>Engage in professional behavior</p> Signup and view all the answers

    What is NOT a principle of evidence-based medicine (EBM)?

    <p>Utilization of personal opinion over research</p> Signup and view all the answers

    What is emphasized in the Hippocratic oath regarding treatment?

    <p>To help the sick based on personal judgment without causing harm</p> Signup and view all the answers

    What significant shift in the doctor-patient relationship is mentioned?

    <p>From paternalism to a partnership model</p> Signup and view all the answers

    How do patients usually access the healthcare system?

    <p>By understanding social influences on health</p> Signup and view all the answers

    Which advancement is NOT listed as a 20th century medical advance?

    <p>Advanced surgery techniques</p> Signup and view all the answers

    What is the most appropriate action for the surgeon when the parents insist on extended hospital stay for the girl post-tonsillectomy?

    <p>Observe for a few more hours in the post-surgery unit, then discharge her home</p> Signup and view all the answers

    Which ethical principle is reflected in the oath concerning revealing patient information?

    <p>Confidentiality</p> Signup and view all the answers

    If a patient demands a CT scan for lower back pain that you believe is due to muscle spasm, what is the best course of action?

    <p>Do not order the scan but refer the patient to another physician for a second opinion</p> Signup and view all the answers

    What does the term 'power differential' refer to in the doctor-patient relationship?

    <p>The unequal knowledge and authority between doctor and patient</p> Signup and view all the answers

    According to modern interpretations of Hippocrates' Oath, which concept is emphasized to prevent harm in medical practice?

    <p>Non-maleficence</p> Signup and view all the answers

    Which of the following was a result of the Nuremberg Trials?

    <p>Promoted universal human rights in medical ethics</p> Signup and view all the answers

    What does the term 'beneficence' in the context of medical ethics entail?

    <p>Acting in the best interest of patients</p> Signup and view all the answers

    What is described as a basic skill of physicians regarding uncertainty in medical situations?

    <p>Comfort with uncertainty and humility</p> Signup and view all the answers

    What is a potential negative consequence of a power differential in healthcare?

    <p>Diminished trust and communication between doctor and patient</p> Signup and view all the answers

    What should be valued in addition to scientific knowledge in modern medical practice, according to the oath?

    <p>Warmth, sympathy, and understanding</p> Signup and view all the answers

    Which ethical principle emphasizes the importance of respecting personal information of patients?

    <p>Confidentiality</p> Signup and view all the answers

    What does the ethical principle of beneficence primarily focus on?

    <p>Promoting the well-being of patients</p> Signup and view all the answers

    Which ethical principle is concerned with enhancing patient autonomy in decision-making?

    <p>Autonomy</p> Signup and view all the answers

    What is the significance of the principle of non-maleficence in healthcare?

    <p>It aims to prevent harm to patients.</p> Signup and view all the answers

    Which of the following principles relates to fairness in the distribution of health resources?

    <p>Justice</p> Signup and view all the answers

    What is the main purpose of nudging in healthcare?

    <p>To encourage patients to make choices in their own best interest while maintaining their freedom</p> Signup and view all the answers

    Which principle emphasizes the patient's right to make autonomous choices?

    <p>Respect for Autonomy</p> Signup and view all the answers

    What does 'bounded rationality' refer to in decision-making?

    <p>The inability to understand all aspects of a decision</p> Signup and view all the answers

    In the context of nudging, what is meant by 'choice architecture'?

    <p>Creating decision-making contexts that influence decisions positively</p> Signup and view all the answers

    Which of the following is a responsibility of the doctor regarding patient confidentiality?

    <p>To maintain and protect the patient's medical information</p> Signup and view all the answers

    What type of communication is emphasized as important in the doctor-patient relationship?

    <p>Listening to the patient without interrupting</p> Signup and view all the answers

    Which principle of biomedical ethics is concerned with preventing harm to patients?

    <p>Nonmaleficence</p> Signup and view all the answers

    What was the most effective message variant in the organ donation example?

    <p>Would you accept an organ if you needed one, if so please help others</p> Signup and view all the answers

    What is the most appropriate action when the surgeon determines there is no medical justification for the girl's extended hospital stay after a tonsillectomy?

    <p>Observe for a few more hours in the post-surgery unit, then discharge her home</p> Signup and view all the answers

    What should be considered first when a patient insists on a CT scan for symptoms deemed unnecessary by the physician?

    <p>Counsel the patient on the risks of unnecessary imaging</p> Signup and view all the answers

    According to modern interpretations, what is a crucial element that physicians should combine with scientific knowledge in their practice?

    <p>Warmth, sympathy, and understanding</p> Signup and view all the answers

    What ethical principle is represented by the phrase 'I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing'?

    <p>Beneficence</p> Signup and view all the answers

    In the context of medical ethics, what does the principle of non-maleficence primarily focus on?

    <p>Preventing harm to patients</p> Signup and view all the answers

    What basic skill is emphasized for physicians in handling uncertainties in medical situations?

    <p>Demonstrating humility regarding unknowns</p> Signup and view all the answers

    Which factor distinguishes the doctor-patient relationship from other types of relationships?

    <p>Power differential</p> Signup and view all the answers

    What significant societal change is reflected in the shift from paternalism to partnership in healthcare?

    <p>Evolution of medical ethics</p> Signup and view all the answers

    What does the reference to 'Equal respect for all' in the Hippocratic Oath signify?

    <p>All patients deserve fair treatment</p> Signup and view all the answers

    Which major historical event contributed significantly to the establishment of universal human rights in medical practice?

    <p>The Nuremberg Trials</p> Signup and view all the answers

    What aspect of medical ethics is emphasized in the principle of confidentiality?

    <p>Preventing unauthorized access to patient information</p> Signup and view all the answers

    What is the ethical principle that emphasizes acting for the benefit of patients?

    <p>Beneficence</p> Signup and view all the answers

    Which advancement in medicine was influenced by ethical standards due to shortcomings in past medical practices?

    <p>Artificial reproduction</p> Signup and view all the answers

    What does the phrase 'holding such things to be holy secrets' in the Hippocratic Oath indicate?

    <p>Confidential information must be safeguarded</p> Signup and view all the answers

    Which action exemplifies paternalism in medical ethics?

    <p>Manipulation of information</p> Signup and view all the answers

    What legal concept is reflected when a healthcare provider fails to follow professional standards of care?

    <p>Malpractice</p> Signup and view all the answers

    Which of the following is a potential weakness of the four principles of medical ethics?

    <p>They fail to accommodate cultural values</p> Signup and view all the answers

    What does the principle of non-maleficence primarily advocate for?

    <p>Avoiding harm to patients</p> Signup and view all the answers

    Which term best describes the allocation of limited healthcare resources among patients?

    <p>Distributive justice</p> Signup and view all the answers

    What does the ethical concept of due care emphasize?

    <p>Taking sufficient care to avoid harm</p> Signup and view all the answers

    Which of the following best describes a scenario of negligence in healthcare?

    <p>Providing incorrect medication due to oversight</p> Signup and view all the answers

    Which ethical principle is primarily concerned with ensuring that patients receive care that benefits them?

    <p>Beneficence</p> Signup and view all the answers

    What does the principle of autonomy in medical ethics focus on?

    <p>Respecting patients' rights to make their own decisions</p> Signup and view all the answers

    Which principle is highlighted when discussing the moral obligation to avoid causing harm to a patient?

    <p>Non-maleficence</p> Signup and view all the answers

    Which ethical principle relates to maintaining the privacy of patients' personal health information?

    <p>Confidentiality</p> Signup and view all the answers

    What is a key component of justice in the context of medical ethics?

    <p>Fair distribution of healthcare resources</p> Signup and view all the answers

    What does the principle of respect for autonomy primarily emphasize in patient care?

    <p>The right of the patient to make their own choices regarding treatment.</p> Signup and view all the answers

    How can 'choice architecture' influence patient decisions in healthcare?

    <p>By presenting choices in a way that nudges patients towards beneficial decisions.</p> Signup and view all the answers

    Which aspect of nudging is crucial for its ethical implementation?

    <p>It must be transparent and defensible.</p> Signup and view all the answers

    What does the term 'bounded rationality' imply about human decision-making?

    <p>Humans have cognitive limitations that affect their decision-making.</p> Signup and view all the answers

    What type of message was found to be most effective in promoting organ donation?

    <p>A message asking if the recipient would accept an organ if needed, followed by a plea for helping others.</p> Signup and view all the answers

    What is a major ethical principle that supports the doctor's obligation to 'do no harm' to patients?

    <p>Nonmaleficence</p> Signup and view all the answers

    In the context of the doctor-patient relationship, which behavior is essential for effective communication?

    <p>The doctor actively listens and allows the patient to express their concerns.</p> Signup and view all the answers

    Which principle of biomedical ethics is primarily concerned with fairness in healthcare distribution?

    <p>Justice</p> Signup and view all the answers

    What is the most ethically sound approach when parents insist on an extended hospital stay for a post-operative child without medical necessity?

    <p>Provide detailed explanations to the parents about medical reasoning and discharge the child</p> Signup and view all the answers

    When a patient demands unnecessary imaging for back pain that is suspected to be due to muscle spasms, what is the most ethical response?

    <p>Refuse to order the imaging and provide a clear explanation of its medical inappropriateness</p> Signup and view all the answers

    Which aspect of the modern interpretation of the Hippocratic Oath emphasizes a balance between treatment measures?

    <p>Avoiding overtreatment without compromising necessary care</p> Signup and view all the answers

    What is the underlying principle reflected in the quote regarding a physician's comfort with uncertainty?

    <p>Recognizing that uncertainty is an inherent part of clinical situations</p> Signup and view all the answers

    Which ethical consideration is paramount in ensuring appropriate medical care following the principle of non-maleficence?

    <p>Balancing potential benefits against risks of all procedures and interventions</p> Signup and view all the answers

    Which ethical principle primarily emphasizes the importance of patient privacy and discretion in healthcare interactions?

    <p>Confidentiality</p> Signup and view all the answers

    What ethical principle is best described by the obligation to act in the patient's best interest while providing care?

    <p>Beneficence</p> Signup and view all the answers

    In the context of ethical principles, which approach supports the patient's right to make decisions about their own healthcare?

    <p>Autonomy</p> Signup and view all the answers

    Which ethical principle addresses the balance of treatment and the obligation to avoid causing harm to the patient?

    <p>Non-maleficence</p> Signup and view all the answers

    What ethical principle is concerned with ensuring fairness in the distribution of healthcare resources and treatment?

    <p>Justice</p> Signup and view all the answers

    What ethical principle is primarily concerned with ensuring actions benefit the patient?

    <p>Beneficence</p> Signup and view all the answers

    In the context of the doctor-patient relationship, what does the term 'power differential' most accurately describe?

    <p>The imbalance in decision-making authority</p> Signup and view all the answers

    Which historical influence led to the establishment of universal human rights within medical ethics?

    <p>The Nuremberg Trials</p> Signup and view all the answers

    Which of the following aspects of medical ethics is significantly instantiated in the principle of confidentiality?

    <p>Protecting patient information from unauthorized disclosure</p> Signup and view all the answers

    How did the shift from paternalism to a partnership model in healthcare primarily affect the doctor-patient dynamic?

    <p>It encouraged collaborative decision-making between doctors and patients.</p> Signup and view all the answers

    Which critical shift does the phrase 'I will use treatment to help the sick' emphasize in the context of the Hippocratic Oath?

    <p>The commitment to the patient's well-being and safety</p> Signup and view all the answers

    What is the primary responsibility of a physician when faced with a patient presenting symptoms of potential poisoning?

    <p>To adequately assess the patient and provide necessary care based on symptoms</p> Signup and view all the answers

    Which principle is crucial for physicians when practicing in multicultural environments?

    <p>Culturally competent care acknowledging diverse health beliefs</p> Signup and view all the answers

    What is the central theme of the historical scandals such as Beecher and Pappworth in the context of medical ethics?

    <p>The promotion of experimental treatments without consent</p> Signup and view all the answers

    Which philosophical concept in the context of medical ethics emphasizes equality and respect between doctor and patient?

    <p>Humanism</p> Signup and view all the answers

    When discussing the doctor-patient relationship, which ethical principle focuses on the necessity of obtaining informed consent?

    <p>Autonomy</p> Signup and view all the answers

    In the context of the duty of care, what aspect becomes legally complicated when a healthcare professional is fatigued or unwell?

    <p>The fulfillment of ethical duties towards patients</p> Signup and view all the answers

    How should healthcare providers manage situations where patients show a lack of understanding of their medical condition?

    <p>By actively engaging and educating the patients about their conditions</p> Signup and view all the answers

    What consequence might arise from failing to perform a thorough physical examination in a patient with chronic disease?

    <p>Delayed diagnosis and treatment, potentially worsening the patient's condition</p> Signup and view all the answers

    What is a significant challenge faced by patients living with chronic diseases?

    <p>Lack of support from healthcare providers and family</p> Signup and view all the answers

    Which statement reflects a common misunderstanding of the principle of non-maleficence?

    <p>It suggests that some harm may be permissible if it leads to a greater good</p> Signup and view all the answers

    What does 'bounded rationality' imply about human decision-making?

    <p>Humans often make decisions contrary to their best interests.</p> Signup and view all the answers

    Which aspect is NOT required for effective nudging in healthcare?

    <p>Coerciveness to ensure compliance.</p> Signup and view all the answers

    Which principle of biomedical ethics prioritizes the ability of patients to make autonomous choices?

    <p>Respect for Autonomy</p> Signup and view all the answers

    In the context of effective physician-patient communication, what aspect is considered equally important as prescriptions?

    <p>Listening to the patient's concerns during conversations.</p> Signup and view all the answers

    Which example of nudging demonstrated the most effective results in promoting organ donation?

    <p>Asking if individuals would accept an organ if needed and promoting selflessness.</p> Signup and view all the answers

    Which of the following best describes the main function of 'choice architecture' in decision-making?

    <p>Creating an environment that promotes beneficial decisions.</p> Signup and view all the answers

    What is a fundamental right of patients regarding their medical information?

    <p>The right to have their medical information kept confidential.</p> Signup and view all the answers

    What principle emphasizes fairness in the distribution of health resources among patients?

    <p>Justice</p> Signup and view all the answers

    Study Notes

    20th Century Medical Advancements

    • Several medical advancements occurred in the 20th century including, antibiotics, cell research, cardiac resuscitation, genetics, organ transplants, intensive care units, life expectancy, assisted reproduction, and regenerative medicine.

    Medical Ethics & The Doctor-Patient Relationship

    • The text references the Nuremberg Trials and the subsequent impact on medical ethics.
    • It highlights the shift from paternalism to a partnership model in the doctor-patient relationship.
    • The Hippocratic Oath is referenced, outlining the principles of beneficence, non-maleficence, equal respect for all, and confidentiality.
    • The unique nature of the doctor-patient relationship is explored, acknowledging the potential power differential.
    • The importance of communication within the doctor-patient relationship is emphasized.

    The Four Principles & The Doctor-Patient Relationship

    • The four principles of biomedical ethics are: respect for autonomy, non-maleficence, beneficence, and justice.
    • These principles guide clinical research and clinical practice in the context of human persons.
    • The text explores the doctor's obligations to patients, focusing on respect for autonomy and the patient's right to confidentiality and self-determination.

    Duty of Care

    • Case Example: A physician, Dr. Banerjee, was found not to have a duty of care to three men who died from arsenic poisoning after being advised by Dr. Banerjee to go home and call their own doctors.
    • This case illustrates the importance of assessing the doctor's duty of care in specific circumstances.

    Nudging

    • Nudging is a technique used to encourage individuals to make choices that are in their best interest while maintaining their freedom of choice.
    • It involves framing information to influence decision-making, but only in a transparent, defensible, and non-coercive manner.
    • The text provides an example of nudging in the context of organ donation, with the most successful message being, "Would you accept an organ if you needed one, if so please help others."

    The Art of Listening

    • The text highlights the significance of listening in the doctor-patient relationship.
    • A survey by Beckman & Frankel found that doctors interrupt patients frequently, emphasizing the importance of allowing patients to fully articulate their concerns.

    Ethics in IPCP

    • The text discusses the importance of ethics assessment in the IPCP (Inter-Professional Collaborative Practice) program.
    • Students are required to reflect on a patient encounter and identify relevant ethical principles, such as consent, confidentiality, autonomy, beneficence, non-maleficence, and justice.

    20th Century Medical Advances

    • Antibiotic development
    • Cell research
    • Cardiac resuscitation
    • Organ transplants
    • Intensive care units
    • Genetic research
    • Chlorpromazine development
    • Immunisation
    • Life expectancy increase
    • Artificial limbs
    • Regenerative medicine
    • Assisted Reproduction

    Ethical Considerations in Medicine

    • Universal Human Rights
    • Bioethics
    • The Information Highway
    • The Doctor-Patient Relationship
    • The shift from paternalism to partnership in medicine

    Key Ethical Principles in Biomedical Ethics

    • Respect for Autonomy: Patient confidentiality, self-determination, informed consent.
    • Non-Maleficence: Avoiding harm, due care, absence of due care (negligence, professional malpractice).
    • Beneficence: Acting for the patient's benefit.
    • Justice: Allocating resources fairly and equitably.

    The Art of Nudging

    • Definition: Using information to encourage patients to make choices in their best interests while maintaining their freedom.
    • Characteristics: Must be transparent, defensible, and not coercive.
    • Origin: Research in psychology, sociology, and economics.
    • Application in Medicine: "Choice architecture" can help patients make decisions that benefit their health.

    The Importance of Listening in Doctor-Patient Relationships

    • Doctors often interrupt patients within 18 seconds.
    • Conversations are as important as prescriptions.

    Modern Version of the Hippocratic Oath

    • Emphasizes the importance of avoiding overtreatment and therapeutic nihilism.
    • Recognizes the art as well as the science of medicine.
    • Encourages honesty and respect for patient privacy.
    • Focuses on treating the whole person rather than the disease.

    Most Trusted Professions - 2017 Survey

    • MRBI conducted a survey in 2017 on the most trusted professions.

    20th Century Medical Advances

    • Advancements in medicine in the 20th century included antibiotics, cell research, cardiac resuscitation, intensive care units, organ transplants, genetics, chlorpromazine, life expectancy, immunization, artificial limbs, and assisted reproduction.

    Changes in Healthcare

    • Medical ethics evolved following the Nuremberg Trials and revelations of unethical medical practices during the Nazi era.
    • Universal Human Rights and scandals involving medical research by Beecher and Pappworth further emphasized the importance of ethical considerations.
    • The information highway transformed healthcare, leading to a shift from paternalistic to a partnership model in the doctor-patient relationship.

    Hippocratic Oath

    • The Hippocratic Oath, dating back to the 5th century BCE, emphasizes:
      • Beneficence and non-maleficence: Using treatment to help the sick without harm.
      • Respect for all: Providing equal care and avoiding sexual misconduct.
      • Confidentiality: Keeping patient information confidential.

    Doctor-Patient Relationship

    • The doctor-patient relationship is uniquely characterized by the potential for power differential and the importance of mutual respect.
    • RCSI (Royal College of Surgeons in Ireland) emphasizes the importance of the relationship.

    IPCP Learning Outcomes

    • IPCP (Interprofessional Collaborative Practice) aims to improve doctor-patient communication skills.
    • The program focuses on:
      • Communication: Demonstrating high-quality communication and conducting structured patient histories.
      • Physical Examination: Demonstrating basic competence in examining cardiovascular, respiratory, gastrointestinal, and neurological systems.
      • Professionalism: Demonstrating professional behavior towards patients and colleagues, engaging in critical reflection.
      • Chronic Disease Care: Identifying challenges faced by patients with chronic illnesses and their families.
      • Ethical Principles: Explaining ethical principles, particularly in multicultural environments.
      • Evidence-Based Medicine: Understanding the principles of evidence-based medicine and applying them to patient care.
      • Health Access: Understanding how patients access healthcare and recognizing social and cultural influences on health.
      • Therapeutics: Recognizing the basic principles of therapeutics and relevant issues.

    Case Example of Duty of Care

    • The Barnett v Chelsea and Kensington Hospital Management Committee (1969) case highlights the legal duty of care owed by doctors to patients.
    • The case demonstrates that a doctor's responsibility to patients may begin when a patient seeks treatment, even if the doctor has not yet formally examined the patient.

    Nudging in Healthcare

    • Nudging involves framing information to encourage individuals to make choices in their best interests while maintaining their freedom.
    • Nudging must be transparent, defensible, and not coercive, allowing patients to refuse the best option.
    • Nudging has roots in psychology, sociology, and economics.
    • Humans are often influenced by bounded rationality, leading to choices that may not be in their best interests.
    • Choice architecture involves designing decision-making contexts to nudge people toward beneficial choices.

    Nudging & Health Example

    • Nudging has been successful in increasing organ donation awareness and consent rates.
    • One successful message used: "If you would accept an organ if you needed one, please help others."

    Importance of Listening in Doctor-Patient Relationship

    • The doctor-patient relationship requires active listening and engagement.
    • Studies by Beckman & Frankel and Nirmal Joshi highlight the importance of listening to patients' concerns.

    Four Principles of Biomedical Ethics

    • Four principles form the foundation for clinical research and practice:
      • Respect for Autonomy: Protecting patient autonomy in decision-making.
      • Nonmaleficence : Avoiding harm to patients.
      • Beneficence: Acting in the best interests of the patient.
      • Justice: Ensuring fair and equitable treatment.

    Doctor's Obligations and Patient's Rights in Respect for Autonomy

    • Doctors are obligated to:
      • Maintain patient confidentiality.
      • Presume the patient's capacity for consent and refusal of treatment.
    • Patients have the right to:
      • Confidentially of personal medical information.
      • Self-determination in medical decision-making.

    Modern Version of Hippocratic Oath

    • A modern version of the Hippocratic Oath emphasizes:
      • Avoiding overtreatment and therapeutic nihilism (do no harm).
      • Recognizing the art and science of medicine, including warmth, sympathy, and understanding.
      • Acknowledging uncertainty and saying "I don't know."
      • Respecting patient privacy.
      • Treating the whole person, not just the illness.

    Ethics Assessment in IPCP

    • IPCP includes an ethics assessment component where students must reflect on a patient encounter and discuss an ethical principle.
    • Examples of ethical principles for reflection include:
      • Consent
      • Confidentiality
      • Autonomy
      • Beneficence
      • Non-maleficence
      • Justice

    References

    • The provided text references various publications and sources on topics related to medical ethics, the doctor-patient relationship, and current healthcare issues.

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    Description

    Explore significant medical advancements in the 20th century, including breakthroughs in antibiotics, genetics, and life expectancy. Furthermore, delve into the evolving relationship between doctors and patients, emphasizing medical ethics, communication, and the principles guiding this crucial dynamic, enriched by historical contexts like the Nuremberg Trials.

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