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Questions and Answers
What is the primary concern regarding the patient's prognosis?
What is the primary concern regarding the patient's prognosis?
Which concept affirms that each person has moral value and dignity?
Which concept affirms that each person has moral value and dignity?
What does an Advance Directive allow a person to do?
What does an Advance Directive allow a person to do?
How many witnesses are typically required for an Advance Directive, and what is one mandatory stipulation regarding their qualifications?
How many witnesses are typically required for an Advance Directive, and what is one mandatory stipulation regarding their qualifications?
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Who is legally capable of making an Advance Directive?
Who is legally capable of making an Advance Directive?
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What is a crucial criterion for a person to be deemed competent in the context of making an Advance Directive?
What is a crucial criterion for a person to be deemed competent in the context of making an Advance Directive?
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Why is it a concern to keep the patient on life support?
Why is it a concern to keep the patient on life support?
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Which of the following situations allows a person to specify decisions in an Advance Directive?
Which of the following situations allows a person to specify decisions in an Advance Directive?
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What should healthcare professionals NOT ignore when making decisions?
What should healthcare professionals NOT ignore when making decisions?
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What is the distinction between an Advance Directive and euthanasia?
What is the distinction between an Advance Directive and euthanasia?
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What is one benefit of having an Advance Directive for patients?
What is one benefit of having an Advance Directive for patients?
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What is one ethical dilemma presented in the patient's case?
What is one ethical dilemma presented in the patient's case?
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Which of the following conditions qualifies as mentally incompetent regarding making an Advance Directive?
Which of the following conditions qualifies as mentally incompetent regarding making an Advance Directive?
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What kind of decisions do Advance Directives often specify in terms of treatment?
What kind of decisions do Advance Directives often specify in terms of treatment?
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What is required for a medical practitioner before they can sign as a witness on an Advance Directive form?
What is required for a medical practitioner before they can sign as a witness on an Advance Directive form?
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How does an Advance Directive aid healthcare professionals?
How does an Advance Directive aid healthcare professionals?
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What is the primary ethical principle potentially violated if a nurse chooses to keep a patient's suicide plan secret?
What is the primary ethical principle potentially violated if a nurse chooses to keep a patient's suicide plan secret?
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Why might a patient in outpatient care decline standard treatment like chemotherapy?
Why might a patient in outpatient care decline standard treatment like chemotherapy?
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Which guiding principle emphasizes the importance of respecting a patient's right to make their own decisions?
Which guiding principle emphasizes the importance of respecting a patient's right to make their own decisions?
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In a situation where a patient expresses a wish to commit suicide, what should be considered regarding confidentiality?
In a situation where a patient expresses a wish to commit suicide, what should be considered regarding confidentiality?
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What is a key role of healthcare providers in the informed consent process?
What is a key role of healthcare providers in the informed consent process?
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Which factor is NOT typically included in the informed consent discussion?
Which factor is NOT typically included in the informed consent discussion?
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In the case of Mr. Green, what ethical principle is most at stake concerning the decision to share his suicidal thoughts?
In the case of Mr. Green, what ethical principle is most at stake concerning the decision to share his suicidal thoughts?
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Which consideration might influence a patient's decision to seek alternative treatment over standard medical procedures?
Which consideration might influence a patient's decision to seek alternative treatment over standard medical procedures?
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What is one of the main ethical principles that prioritizes patient decision-making in healthcare?
What is one of the main ethical principles that prioritizes patient decision-making in healthcare?
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Which guiding principle of medical ethics is concerned with the idea of providing benefit to the patient?
Which guiding principle of medical ethics is concerned with the idea of providing benefit to the patient?
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In the context of an ethical dilemma, what might be a significant concern regarding a patient with a poor prognosis but without the funds for critical care?
In the context of an ethical dilemma, what might be a significant concern regarding a patient with a poor prognosis but without the funds for critical care?
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What does 'nonmaleficence' emphasize in medical ethics?
What does 'nonmaleficence' emphasize in medical ethics?
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Considering the provided case of a 35-year-old male with severe brain injury and slim chances of recovery, which ethical principle may be challenged?
Considering the provided case of a 35-year-old male with severe brain injury and slim chances of recovery, which ethical principle may be challenged?
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According to the ethical framework discussed, which principle is primarily concerned with fairness irrespective of various demographics?
According to the ethical framework discussed, which principle is primarily concerned with fairness irrespective of various demographics?
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If a healthcare professional encounters a scenario where an elderly patient with a terminal disease requests aggressive treatment, which principle should be foremost in consideration?
If a healthcare professional encounters a scenario where an elderly patient with a terminal disease requests aggressive treatment, which principle should be foremost in consideration?
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In the ethical dilemma of funding critical care for a patient with a poor prognosis, which response reflects an extreme ethical stance?
In the ethical dilemma of funding critical care for a patient with a poor prognosis, which response reflects an extreme ethical stance?
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What does nonmaleficence primarily emphasize in healthcare?
What does nonmaleficence primarily emphasize in healthcare?
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What is the primary focus of beneficence in nursing practice?
What is the primary focus of beneficence in nursing practice?
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In the event of a conflict between beneficence and nonmaleficence, which principle is considered more stringent?
In the event of a conflict between beneficence and nonmaleficence, which principle is considered more stringent?
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Which of the following best describes the benefit-risk ratio in healthcare?
Which of the following best describes the benefit-risk ratio in healthcare?
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What principle addresses fairness and equity in healthcare distribution?
What principle addresses fairness and equity in healthcare distribution?
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When considering organ allocation, which factor is least likely to be considered?
When considering organ allocation, which factor is least likely to be considered?
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Which of the following represents a potential benefit of surgical procedures?
Which of the following represents a potential benefit of surgical procedures?
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What is a primary concern when recommending treatment to a patient?
What is a primary concern when recommending treatment to a patient?
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What is the first step to resolve an ethical dilemma?
What is the first step to resolve an ethical dilemma?
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Which approach promotes shared decision-making in healthcare?
Which approach promotes shared decision-making in healthcare?
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What can help resolve ethical dilemmas according to the provided content?
What can help resolve ethical dilemmas according to the provided content?
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What should be considered about the patient when addressing ethical dilemmas?
What should be considered about the patient when addressing ethical dilemmas?
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Which of the following is NOT part of preparing for resolving ethical dilemmas?
Which of the following is NOT part of preparing for resolving ethical dilemmas?
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Why is it important to engage in discussions with colleagues regarding ethical issues?
Why is it important to engage in discussions with colleagues regarding ethical issues?
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Which statement about ethical consensus is true?
Which statement about ethical consensus is true?
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What is a vital aspect of planning for open communication with patients?
What is a vital aspect of planning for open communication with patients?
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Study Notes
Course Information
- Course Title: Health Ethics 1: Introduction to Ethical Approaches and Decision Making Framework
- Course Code: MEDF 1021
- Term: Term 1 2024-25
- Instructor: Yin Ting Cheung, Ph.D., Associate Professor, School of Pharmacy, The Chinese University of Hong Kong
- Email: [email protected]
Outline
- Background and Definitions
- Scenarios (poll)
- 4 Guiding Principles of Medical Ethics
- Autonomy
- Nonmaleficence
- Beneficence
- Justice
- Take-home Message
Learning Objectives
- Understand the basic bio-ethical approaches, including theories and principles
- Appreciate the uniqueness of different ethical viewpoints
- Learn about the principle of respecting patients' autonomy
What is Ethics?
- Moral principles that govern a person's behavior or the conducting of an activity
Why Health Ethics?
- A set of moral principles that guide medical decision-making
- Ethical issues are embedded in every clinical encounter
- People may have diverse beliefs, attitudes, feelings, and opinions
- Patient goals may conflict with healthcare professional goals
Ethical Dilemma 1
- When should abortion be legal?
- A. At any time the woman decides
- B. Before 6 weeks of age of fetus
- C. Before 12 weeks of age of fetus
- D. Only under specific situations (e.g., sexual harassment)
- E. Never should be legal
Ethical Dilemma 2
- When should medical euthanasia be permitted?
- A. Anytime a patient decides
- B. When certain criteria are met (e.g., age > 65, terminal disease)
- C. Never, it goes against the Hippocratic oath ("First, do no harm")
Ethical Dilemma 3
- A patient with poor prognosis who lacks funds for critical care. How much should be spent by the public hospital on prolonging life, as per the family's wishes?
- A. 250,000 HKD
- B. 500,000 HKD
- C. 1,000,000 HKD
- D. 5,000,000 HKD
- E. Cost should not be a consideration as every life matters
Case 1
- A 35-year-old male with congenital Moyamoya disease in intensive care with severe intracranial bleed and possible extensive paralysis.
- Patient's girlfriend states he does not want resuscitation.
- Patient's parents want life-sustaining care.
- Medical prognosis is very poor.
Case 1: Sorting Facts
- Prognosis = very poor.
- If he ever wakes up, he will be handicapped
- Is it in his best interest to keep him alive with machines?
- Who will take care of him after he leaves the hospital?
- Is it fair to keep this patient in the ICU when there are other patients who need the service more?
- Legally, who can make a life and death decision for the patient?
- Ethically, is it right for doctors to withdraw care?
Respect for Autonomy
- Respect for persons affirms every person's inherent moral value and dignity.
- Healthcare professionals should not ignore or override patient preferences.
- Respect patient's capacity to make decisions and their right.
Advance Directive
- A written statement allowing a competent individual to specify healthcare wishes for the future when they are no longer competent.
- Important for providing clarity regarding patient preferences and wishes for family and healthcare professionals
Who Can Make an Advance Directive?
- Any adult with the necessary mental capacity to make their own healthcare decisions
- Requires two witnesses, one of whom must be a medical practitioner
- Witnesses must not have any interest in the person's estate
Standards of Competence
- Ability to comprehend and process information
- Ability to reason about consequences
- Ability to understand and deliberate on risks and benefits
- Ability to make a decision based on this deliberation
How Does an Advance Directive Operate?
- Specifying decisions during terminal illness, irreversible coma/persistent vegetative state, or other irreversible life-limiting conditions.
- Usually involves decisions about life-sustaining treatment and basic care.
- Advance directives are legally binding.
Benefits of Advance Directives
- Protection against harmful outcomes
- Reduced stress for families
- Aids healthcare professionals in difficult choices
Drawbacks of Advance Directives
- Lack of explicit instructions
- Individual preferences can change
- Difficulty in determining whether prior decisions are still in the best medical interest
- Potential for conflict between medical needs and patient wishes
Ethical Dilemma 2
- Case about a 54-year-old teacher diagnosed with ischemic heart disease and prescribed aspirin. The patient expresses concerns about taking a blood thinner.
Ethical Dilemma 2: Case Information
- Patient diagnosed with ischemic heart disease
- Doctor plans to prescribe aspirin
- Possible benefit to reduce myocardial infarction but increased risk of bleeding
- Patient expresses discomfort taking blood thinner
- Patient's late husband died from complications of heart valve replacement
Case 2: Discussion Points
- Patient still does not want to take aspirin
- Patient is competent
- What should the healthcare provider do?
- Should listen to patient decision and respect patient autonomy?
- Should they continue to persuade patient of benefits?
- How should "bad" decisions be handled in a clinical encounter?
Patient's Rights (HK Medical Association)
- Right to information (reasonable and balanced understanding of sickness, prognosis, treatment)
- Right to operation
- Right to charges for medical services and treatment
- Right to drug use, dosage, common side effects
- Right of refusal
- Right of confidentiality
- Right to medical reports
- Right to launch a complaint
What is a "Bad" Decision?
- A "bad" decision is one that does not lead to optimal health outcomes for the patient.
- It can be subjective and vary based on clinical outcome, patient's autonomy and values.
"Bad" vs. Uninformed Decisions
- Unlike bad decisions, uninformed decisions do not involve value judgments.
- In cases when the patient lacks full understanding of information, decision-making is not fully autonomous.
Informed Consent
- Consent for medical interventions necessitates patients being informed and giving their voluntary consent.
- Patients need to agree with healthcare professionals' recommendations, considering risks.
- The plan of care requires discussing medical / treatment options to reach a mutual decision with the patient.
Reasons for Informed Consent
- Respect patient autonomy
- Understand patient values on intensity of medical care and risk levels
- Enhance patient well-being, judging based on patient goals
- Meet legal requirements
- Promote patient best interests, clarifying misunderstandings
Case in Informed Consent
- Patients may not understand medical information
- Example: A patient with Stage 2 breast cancer declines standard treatment (chemotherapy, radiation), preferring TCM
- How would oncologists advise the patient?
- How would TCM practitioners advise the patient?
Communication Skills
- Establish open communication with patients to discuss options.
- Understand patient perspectives and concerns, addressing family issues.
- Discuss with colleagues or social workers.
Case 3
- Mr. Green, a 57-year-old with aggressive prostate cancer, facing imminent death, confides in a nurse that he intends to commit suicide.
- What should the nurse do?
Sorting Facts (Case 3)
- Patient is on palliative care
- Nurse keeping the secret respects patient autonomy and confidentiality.
- But… Should the nurse act on beneficence and nonmaleficence and tell other health staff?
- How does the patient's perspective of harm differ from the nurse's?
Nonmaleficence & Beneficence
- Nonmaleficence: Do no harm to patients
- Beneficence: Do good for patients
- Understanding the concept and conflict when they arise.
Benefit-Risk Ratio
- Healthcare professionals must evaluate procedures based on a benefit-risk ratio.
- Consideration of potential benefits (relief) versus potential risks (harm).
- Crucial to discuss risk/benefit with patients, allowing them to weigh options.
Justice
- Treating every person with fairness and equity, distributing health care benefits and burdens fairly in society.
- Decision of distributing limited kidneys (example) based on different criteria, including age, projected organ survival, ability to pay, medical benefit, comorbidities, and compliance
Organ Allocation
- Examples of allocation criteria in organ transplantation (e.g., kidney, heart, liver, cornea)
- Detailed explanation and examples of a candidate scoring system for organ allocation
Genetic Testing
- Discussion on whether genetic testing should be equally and universally provided, and whether restrictions on its availability are justified.
Equitable Distribution of Genetic Services
- Equitable distribution of genetic services, including prenatal diagnosis, should prioritize those with the greatest medical needs, regardless of ability to pay.
Conclusions
- Patient welfare and best interests should be prioritized
- Healthcare teams should provide information to patients and families
- Patient welfare is more important than financial considerations
- Advocates for public health, treating citizens equally under the law
Conclusion (Resolving Ethical Dilemmas)
- Identifying ethical issues, understanding ethical consensus and controversy
- Reading on ethical dilemmas and discussing with colleagues
- Gathering information on medical situations and patient values & preferences
- Planning for open communication and patient education, leading to shared decision-making
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Description
This quiz explores critical aspects of Advance Directives, including patient prognosis, moral value, and legal competence. It addresses ethical dilemmas and the importance of respecting patient choices in healthcare decisions. Test your knowledge on the implications of Advance Directives and the responsibilities of healthcare professionals.
