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AHS 321 Chapters 1-4 (Midterm)

Terms in this set (165)

Applied ethics
The application of normative theories to practical moral problems, such as abortion, euthanasia, and assisted suicide. The philosophical search (within western philosophy) for right and wrong within controversial scenarios.
Autonomy
Involves recognizing the right of a person to make one's own decisions.
Beneficence
Describes the principle of doing good, demonstrating kindness, showing compassion, and helping others.
Bioethics
Addresses such difficult issues as the nature of life, the nature of death, what sort of life is worth living, what constitutes murder, how we should treat people who are especially vulnerable, and the responsibilities we have to other human beings.
Code of ethics
Prescribes standards of conduct/ethics, states principles expressing responsibilities, and defines the rules expressing duties of professionals to whom they apply.
Commitment
The act of binding oneself intellectually or emotionally to a course of action or person.
Compassion
The deep awareness of and sympathy for another's suffering
Conscientiousness
Moral integrity and strict regard for doing what is considered the right thing to do.
Consequential theory
Emphasizes that the morally right action is whatever action leads to the maximum balance of good over evil. Revolves around the premise of the rightness or wrongness of an action depending on the consequences of an action.
Cooperation
The process of working with others.
Courage
The mental or moral strength to persevere and withstand danger.
Deontological ethics
Focuses on one's duties to others, and others' rights. Involves ethical analysis according to a moral code or rules, religious or secular. Although doing the right thing is good, it might not always lead to or increase the good and right thing sought after.
Descriptive ethics
Study of what people believe to be right and wrong, and why they believe it
Detachment
The lack of concern for a patients needs. Often translates into mistakes that result in patient injuries.
Distributive justice
Principle requiring that all persons be treated equally and fairly.
Discernment
The ability to make a good decision without personal biases, fears, and undue influences from others.
Employment-related paternalism
At its best: A shared and cooperative style of management in which the employer recognizes and considers employee rights when making decisions int he workplace.
At its worst: Employer's style of management becomes more authoritarian, sometimes arbitrary, and unpredictable.
Ethical principles
Universal rules of conduct, derived from ethical theories that provide a practical basis for identifying what kinds of actions, intentions, and motives are valued.
Ethical relativism
Morality depends on the moral norms of the culture in which an individual lives.
Ethical theories
The foundations of ethical analysis. They provide guidance in the decision-making process.
Ethics
The branch of philosophy that seeks to understand the nature, purposes, justification, and founding principles of moral rules and the systems they comprise. Signifies philosophical, general pattern/way of life, and a set of rules of conduct (moral code).
Fairness
Requires each person to be objective, unbiased, dispassionate, impartial and consistent with the principles of ethics.
Fidelity
The virtue of faithfulness, being true to our commitments and obligations to others.
Freedom
The quality of being free to make choices for oneself within the boundaries of law.
Honesty
Involve confidence that a person will act with the right motives. Assured reliance on the character, ability, strength, or truth of someone or something.
Hopefulness
Involves looking forward to something with the confidence of success
Instrumental value
Something that helps to give value to something else (ex. money is valuable for what it can buy)
Integrity
Involves a steadfast adherence to a strict moral or ethical code and a commitment not to compromise this code.
Intrinsic value
Something that has value in and of itself
Justice
The obligation to be fair in the distribution of benefits and risks.
Kindness
Involves the quality of being considerate and sympathetic to another's needs.
Macroethics
Involves a more global view of right and wrong
Medical paternalism
Involves making decisions for patients who are capable of making their own choices.
Autonomy
Medical paternalism directly violates __________________.
Metaethics
The study of the origin and meaning of ethical concepts. Seeks to understand ethical terms and theories and their application.
Microethics
Involves an individual's view of what is right and wrong based on one's personal life teachings, tradition, and experiences
Moral dilemmas
Often arise when values, rights, duties, and loyalties conflict
Moral judgements
Judgements concerned with what an individual or group believes to be the right or proper behavior in a given situation
Morality
Describes a class of rules held by society to govern the conduct of its individual members. Implies the quality of being in accord with standards of right and good conduct. "Code of conduct"
Moral values
The relative worth placed on some virtuous behavior.
Nonconsequential ethics
Denies that the consequences of an action are the only criteria for determining the morality of an action. The rightness or wrongness of an action depends on the intention, not the outcome.
Nonmaleficence
Ethical principle requires caregivers to avoid causing patients harm.
Normative ethics
This attempts to determine what moral standards should be followed so that human behavior and conduct may be morally right. Concerned with establishing standards for conduct and investigating how one ought to act.
Paternalism
People sometimes believe that they know what is best for another and make decisions that they believe are in that person's best interest. Form of beneficence.
Religious ethics
Serve a moral purpose by providing codes of conduct for appropriate behavior through revelations from a divine source.
Respect
An attitude of admiration or esteem
Secular ethics
Based on codes developed by societies that have relied on customs to formulate their codes.
Situational ethics
Concerned with the outcome or consequences of an action in which the ends can justify the means. Refers to times when a person's beliefs and values can change as circumstances change.
Spirituality
Implies that there is a purpose and meaning to life. Generally refers to faith in a higher being.
Tolerance
Implies that a person accepts differences in others and that one does not expect others to believe, think, speak, or act ash he or she does. Or, one will reluctantly put up with another's beliefs.
Truth telling
Involves providing enough information so that a patient can make an informed decision about his or her health care.
Utilitarian ethics
The concept that the moral worth of an action is determined solely by its contribution to overall usefulness. Doing the greatest good for the most people.
Values
Standards of conduct used for judging the goodness or badness of some action.
Veracity
Devotion to and conformity with what is truthful. Obligation to be truthful.
Virtue ethics
Focuses on the inherent character of a person rather than on the specific actions he or she performs.
Virtues
Positive trait of moral excellence.
Rightness/wrongness of actions & goodness/badness of motives and ends. It lets us make sound judgments, good decisions, and right choices. Healthcare providers help caregivers to make sound judgments. Doing this helps protect people from harm.
Explain the importance of ethics & application to ethical dilemmas
Implies the quality of being in accord with standards of right and good conduct. It is a code of conduct.
Describe morality
Standards, principles, and rules that guide a healthcare professional in their profession
Describe codes of conduct
Judgments concerned with what someone believes to be the right behavior in a given situation
Describe moral judgments
Virtue ethics and values focus on the inherent character of a person (not their specific actions) and how a person judges the goodness or badness of an action. A person's virtues and values describe their morals, and therefore their moral character.
Describe virtue ethics & values. How do they describe moral character?
It is the strength of character necessary to continue int he face of fears and the challenges in life. Without it, we can't take risks necessary to achieve things most valued.
Explain why courage is often considered to be the "ladder upon which all other virtues mount."
The idea of divine justice helps us tolerate the injustices in this life (being good doesn't mean having peace, happiness, wellness, or prosperity). It is also often used as a reason to justify behavior that is otherwise unjustifiable.
How can religious ethics affect one's moral character?
End justifies the means. A person's beliefs and values can change as circumstances change. Depending on the situation, person may contradict what they think is the right thing to do, and do what they morally consider wrong (ex. using extraordinary means to sustain the life of an unknown 84-year-old may result in a different decision if the 84-year-old is one's mother).
Explain the concept of situational ethics. How can changes in circumstances affect one's behavior?
One's moral compass depends on their personal ethics, which are often relative to the culture they grew up in.
Describe the concepts of "ethical relativism" and one's "moral compass."
a
The ethical theory that denies that the consequences of an action or rule are the only criteria for determining the morality of an action or rule.

a. non-consequential
b. consequential
c. normative
d. distributive
e. paternalism
e
The theory of ethics that focuses on one's duties to others

a. discernment
b. normative
c. teleological
d. consequential
e. deontological
b
One's need to survive can change his or her __________ character in order to survive.

a. paternalistic
b. moral
c. normative
d. virtuous
e. deontological
b
A form of beneficence that may involve, for example, withholding information from a person because of the belief that it is in the best interest of that person.

a. justice
b. paternalism
c. autonomy
d. deontology
e. normative
c
A moral __________ is something that has worth.

a. virtue
b. situation
c. value
d. virtue
e. reality
b
A person is one who has moral integrity and has a strict regard for doing what is considered the right thing to do.

a. virtuous
b. conscientious
c. committed
d. compassionate
e. ethical
d
A person who is said to have a steadfast adherence to a strict moral or ethical code is considered to have __________.

a. moral values
b. discernment
c. compassion
d. integrity
e. humility
e
One's moral character can sometimes change as circumstances change, thus the term _________ ethics.

a. discerning
b. integrity
c. compassionate
d. normative
e. situational
abortion
The termination of a pregnancy by removal or expulsion from the uterus of a fetus or embryo before it is viable.
Rights of the mother (autonomy), rights of the fetus, rights of state (protecting life), rights of spouse
-states protect fetus that can survive outside the womb
-spouse has no rights
-parental notification
Explain how concepts from chapter 1 relate to abortion.
first trimester- between physician and woman
second trimester-state can reasonable regulate
third trimester-state can prohibit all abortions unless needed for mother survival
What are the rights of people involved in an abortion during the first-third trimester?
AIDS
destroys bodies ability to fight bacteria and viruses
spread of aids, issues of confidentiality, discrimination, education
wrongful life
are generally not successful because the courts unwillingness to permit financial recovery for the "injury" of being born

-harm suffered as a result of being born (not giving parents time to abort)
wrongful birth
for a breach of duty by the defendant(s) (e.g., improper sterilization), child would not have been BORN
wrongful conception
claim by parents of unexpected child regarding negligent sterilization, failed contraception
homologous artificial insemination
husbands sperm
heterologous artificial insemination
random guys sperm
sterilization
vasectomy or tubal ligation
elective sterilization
voluntary sterilization
therapeutic sterilization
to preserve life or health
her ability to conceive, husbands ability to impregnate
eugenic sterilization
involuntary sterilization
mentally incompetent/criminals
negligent sterilization
improper sterilization
uniform anatomical gift act
allows people to donate organs at time of death and carry a donor card
roe v. wade
women's right to privacy in the context of matters relating to her body, including how a pregnancy would end
undue burden
If its purpose or effect is to place a substantial obstacle in the path of a women seeking an abortion, it is a what?
ethical dilemma
something good is sacrificed or bad has to be chosen
partial birth abortion
partial delivery of baby prior to being aborted
genetic marker
genes or DNA that have a known location on chromosomes and can be associated with particular genes or traits
institutional review board
approving and overseeing research
stem cell research
create tissues and organs for transplants
active euthanasia
intentional commission of an act that will result in death
passive euthanasia
potentially lifesaving treatment is withdrawn or withheld
voluntary euthanasia
incurable condition gives consent
involuntary euthanasia
decision to end life of incurable person is made by someone else
withholding of treatment
not to initiate treatment of medical intervention
withdrawal of treatment
discontinuing treatment
futility of treatment
further treatment will not be of benefit to the patient
substituted judgement
surrogate attempts to make a decision that the patient would have made if the patient were competent
surrogate decision maker
person who acts on behalf of patient who lacks the capacity to participate in a particular decision
healthcare proxy
patient appoints a person who makes treatment decisions in the event they become incompetent
guardianship
court declares a person incompetent and appoints a guardian
durable power of attorney
gives legal power
living will
describes persons wishes and not wishes
advance directives
allows patient to make end of life choices
Physician assisted suicide
An action in which a physician voluntarily aids a patient in bring- ing about his or her death
Oregon Death with Dignity Act
Allows a terminally ill Oregon resident to obtain a lethal dose of medication from his or her physician.
euthanasia
Mercy killing of the hopelessly ill, injured, or incapacitated
Reasonable man standard
Describes a person in society who exercises average care, skill, and judgment in conduct and who serves as a comparative standard for determining liability
Surrogacy
Refers to a method of reproduction whereby a woman agrees to become pregnant for the purpose of gestating and giving birth to a child she will not raise but hand over to a contracted party.
Patient self-determination act of 1990
Health care organizations have a responsibility to explain to patients, staff, and families that patients have legal rights to direct their medical and nursing care as it corresponds to existing state law
Tuskegee Study of Syphilis (1932-1972)
Used African American men to analyze the natural progression of untreated syphilis. Participants weren't told that there was a cure for syphilis, and thought they were receiving adequate care.
The Holocaust (1933-1945)
One of the most violent events in human history. Over 6 million Jews were murdered as well as millions of people from other cultural groups, including Slavs, homosexuals, and Gypsies. Nazi doctors violated the trust placed in them by humanity, and for the most part the doctors escaped their crimes against Humanity and lived a life, unlike their victims.
Military Tribunal for War Crimes (1946)
Began criminal proceedings against 23 German physicians and administrators for war crimes and crimes against humanity. As a result of this, the Nuremberg Code was established, which made it clear that the voluntary and informed consent of human subjects is essential to research and that benefits of research must outweigh risks to human subjects involved.
WHO Guidelines for Conducting Biomedical Research (1964)
The World Medical Association 7 established guidelines for medical doctors conducting biomedical research involving human subjects. The Declaration of Helsinki is the basis for advanced clinical practices today.
Substitute Judgment - Karen Ann Quinlan (1976)
The New Jersey Supreme Court in the Matter of Karen Ann Quinlan 16 rendered a unanimous decision providing for the appointment of Joseph Quinlan as personal guardian of his daughter, Karen Ann Quinlan. The record was remanded to the trial court to implement without further testimonial hearing.
First Durable Power of Attorney Legislation (1983)
California enacted this, permitting an advance directive to be made describing the kind of health care that one would desire when facing death by designating an agent to act on the patient's behalf. The California Health Care Directive form was established. Compassion and Choices.
Patient Self-Determination Act (1990)
Enacted to ensure that patients are informed of their rights to execute advance directives and accept or refuse medical care. The act was intended to reinforce a person's constitutional right to make his or her own health care decisions. The act requires that federally funded health care organizations explain to patients their right to complete an advance directive.
- Cruzan could have feeding tube removed
- Kevorkian's assists terminally ill patients in suicide
- Timothy Quill & Prescription for Death
- Derek Humphry's author's the "Final Exit"
Oregon - Physician Assisted Suicide Legal (1994)
Oregon's Death with Dignity Act, involving physician-assisted suicide, became a legal medi- cal option for terminally ill patients in Oregon. The Oregon Death with Dignity Act allows terminally ill Oregon residents to obtain from their physicians and use prescriptions for self- administered, lethal medications.
Health Insurance Portability Act (HIPPA) (1996)
This (Public Law 104191) was enacted to protect the privacy, confidentiality, and security of patient information. Cloning of Dolly
14th Amendment and Terminally Ill (1996)
The Second and Ninth U.S. Circuit Courts of Appeals ruled that there is a constitutional right under the Fourteenth Amendment for a terminally ill person to receive help from a physician when dying.
Human Genome System Fully Sequenced (2003)
Allowed molecular genetics and medical research to accelerate at an unprecedented rate. The ethical implications of this are as immense as the undertaking of the totality of the research that was conducted to do this (e.g., cloning of humans).
Written protocols
Federal regulations require that hospitals have and implement _______________ __________________ regarding the organization's organ procurement responsibilities.
Organ donations
These are needed for treating patients with end-stage organ disease facing organ failure.
Research, experimentation, & clinical trials
Ethical principles that are relevant to the ethics of research involving human subjects include respect for person, beneficence, and justice. These principles cannot always be applied to resolve ethical problems beyond dispute. The objective in applying ethical principles is to provide an analytical framework that will guide the resolution of ethical problems arising from research involving human subjects.
Birth: if it weren't for breach of duty by defendant, child wouldn't have been born
Life: parent or child claims to have suffered harm as a result of being born (generally unsuccessful)
Conception: damages were sustained by the parents of an unexpected child based on the allegation that the child's conception was the result of negligent sterilization procedures or a defective contraceptive device
Wrongful birth, life, and conception
Human genetics
Describes the study of inheritance as it occurs in human beings. Includes stem cell research, clinical, and molecular genetics.
Human genetics
What is the most promising frontier of the future of medical practice?
Appointed decision makers
If a patient lacks the ability to make a decision regarding a DNR order, this person can make such decisions provided it can be demonstrated that they are following the patient's wishes
DNR
physician orders not to resuscitate a patient in the event of a cardiac or respiratory arrest
Do not resuscitate (order)
What does DNR stand for?
Durable power of attorney for health care
a legal device that permits one individual, known as the "principal," to give to another person, called the "attorney-in-fact," the authority to act on his or her behalf
Pain management, fear of death, self-worth, hopelessness
Explain the issues involved in "end of life" dilemmas/
e
Abortion issues

a. may involve breaking some ethical norm or value system
b. mother's right's
c. rights of a fetus
d. state's interests in protecting life
e. all of the above
a
The third trimester of a pregnancy involves

a. a state's right to prohibit all abortions except those deemed necessary to protect maternal life or health
b. an abortion decision between a woman and her physician
c. a state's right to prohibit all abortions
d. the Supreme Court's right to decide a woman's right to abortion on a case by case basis
e. a state's right to decide a woman's right to abortion on a case by case basis
b
The injection of the spouse's seminal fluid into a woman to induce pregnancy is referred to as

a. heterologous artificial insemination
b. homologous artificial insemination
c. impregnation
d. sterilization
e. abortion
d
The principle of justice, as it relates to research, involves whether or not each person is treated

a. according to merit and one's value to society
b. according to family needs
c. according to societal contribution
d. equally
b
Wrongful life suits are generally unsuccessful

a. primarily because of the court's willingness, for public policy reasons, to permit financial recovery for the "injury" of being born into the world.
b. primarily because of the court's unwillingness, for public policy reasons, to permit financial recovery for the "injury" of being born into the world.
c. primarily because of the court's unwillingness, for the court's reasons and personal bias of each judge individually, to permit financial recovery for the "injury" of being born into the world.
d. primarily because of the court's unwillingness, for public policy reasons, to permit financial recovery for the "injury" of being born into the world.
e. none of the above
b
Euthanasia is defined broadly as a

a. Greek word for "help me"
b. mercy killing of the hopelessly ill
c. DNR order
d. futility of treatment
d
Passive euthanasia occurs when

a. physician assisted suicide
b. there is an intentional commission of an act that will result in death
c. hope for survival still exists
d. lifesaving treatment (such as a respirator) is withdrawn or withheld, allowing the terminally ill patient to die a natural death
a
Voluntary euthanasia occurs when

a. a competent adult patient with an incurable condition, who has been informed of the possible ramifications and alternatives available, chooses death by, for example, the self administration of a lethal dose of a medication
b. a person other than the incurable decides to terminate the life of one who is competent to make his or her own decision
c. there is an intentional commission of an act, without the patient's consent that will result in death
d. treatment is involuntarily discontinued without the consent of a competent patient
d
A Durable Power of Attorney for health care is

a. a legal device that permits one individual known as the "attorney-in-fact" to give to another person called the "principal" the authority to act on his or her behalf to make health care decisions
b. a legal device that permits one individual known as the "principal" to give to another person called the "attorney-in-fact" the authority to act on his or her behalf in all financial matters but not health care decisions
c. an illegal device that permits one individual known as the "principal" to give to another person called the "attorney-in-fact" the authority to act on his or her behalf.
d. a legal device that permits an individual known as the "principal" to give to another person called the "attorney-in-fact" the authority to act on his or her behalf in making
a
Futility of Treatment

a. relates to medical occurrences where the physician recognizes that the effect of treatment will be of no benefit to the patient
b. describes those instances where there is a reasonable likelihood of success in further treatment
c. should not be considered in end-of-life decision-making
d. none of the above
d
When there exists an element of uncertainty regarding a patient's wishes in an emergency situation, the situation should be resolved

a. if there is guardian whose whereabouts are unknown
b. if a judge is contacted for a court order
c. if there is a parent who would object to care.
d. in a way that favors the preservation of life.
Involves addressing external issues that affect internal operations. Because of ethics committee's potential to bring about change, they shouldn't be limited to internal (/end of life) issues.
Describe the expanding role of ethics committees.
Available to those who request ethics consult. They are available 24/7 by calling the hotline. They need to be requested on a form made by the ethics committee and reviewed and approved by hospital administration, legal counsel, and board of directors.
What is the ethics committee's policy on requests for consultations?
Clarification of issues (decision making capacity, informed consent, advance directives, & withdrawal of treatment). Patient records are reviewed and discussed with physician, family members, and caregivers involved. If issue can be resolved easily, just one person, if not the whole committee.
What happens during a committee consultation?
Policy & procedure development, staff & community education, consultation & conflict resolution. It is a resource tool in resolving ethical dilemmas, which patients and families should be encouraged to participate in addressing,
What are the functions of an ethics committee?
Promote rights of patients, promote shared decision making (b/t patients and clinicians), and assist patient and family in coming to a consensus when faced with ethical dilemmas
What are the goals of the ethics committee?
Structured to include a wide range of community leaders in positions of political stature, respect, and diversity
Describe the structure of an ethics committee.
Circular reasoning
Describes a form of reasoning where the premise and the conclusion is the premise of an argument. My premise is correct, therefore my conclusion is correct
Ethical decision making
The process of determining the right thing to do when faced with moral dilemmas
Health care ethics committee
An advisory body whose purpose is to facilitate discussion and consultation on ethical issues arising in the patient care setting.
Ethics consultation
Helpful in resolving uncertainty and disagreements over health care dilemmas. Provides options and suggestions for resolution of conflict in actual cases.
Partial reasoning
Involves bias for or against a person based on one's relationship with that person.
Reasoning
The logical applications of _________ is important in the decision making process.
e
An ethics committee serves as a hospital resource to

a. patients
b. families
c. caregivers
d. guardians
e. all of the above
e
The goals of the ethics committee are to

a. promote the rights of patients
b. promote shared decision-making between patients & their clinicians
c. assist the patient & family, as appropriate, in coming to consensus with the options that best meet the patient's goal for care
d. promote fair policies & procedures that maximize the likelihood of achieving good, patient centered outcomes
e. all of the above
e
The functions of ethics committees are multifaceted & include

a. development of policy guidelines to assist in resolving ethical dilemmas
b. staff & community education
c. conflict resolution;
d. case reviews, support, & consultation; & education
e. all of the above
d
Decision-making is not easy when there are

a. alternative choices
b. unlimited resources
c. a variety of value beliefs from patients, family members, & caregivers
d. a & c above
c
Circular Reasoning describes a person that

a. has no known beliefs
b. believes in situational ethics
c. has already decided the correctness of something
d. has no concern for right and wrong
e. takes all opinions under advisement prior to deciding right from wrong
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