Updated: 5/16/2022

Ethical Principles

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Core Ethical Principles
  • There are 4 core ethical principles
  • Autonomy
    • respecting patients as individuals
    • honoring patient's preferences in medical care 
      • the patient's preferences take priority when making medical decisions
      • therefore, the decider of decisions is patient word > living will > next of kin 
    • respecting confidentiality  
      • Exceptions include: danger to self or others, verbal or written consent from patient to share their information with another party, notifiable infectious diseases, elder/child abuse 
    • pregnant patients may decline treatment, regardless of potential harm to the fetus 
      • once the child is born, its parents cannot decline to treat the child for life-threatening conditions 
  • Beneficence
    • acting in patient's best interest
    • balance autonomy and beneficence, but autonomy trumps beneficence 
  • Nonmaleficence
    • "do no harm"
    • physician-assisted suicide is considered unethical 
  • Justice
    • distributive Justice
      • governs allocation of limited resources
    • formal Justice
      • equals must be treated equally
Other Principles
  • Health proxies and power of attorney
    • patients may designate a health proxy or power of attorney that can make decisions for them if they are incapacitated
    • if patients do not designate a proxy, typically family is consulted
    • trainees may perform procedures on deceased patients for educational purposes with permission of the proper patient proxy or family member 
  • Breaking bad news 
    • set up the interview
    • assess the patient's perception
    • obtain the patient's invitation (i.e. permission)
    • give the patient the necessary knowledge
    • address the patient's emotions with empathetic responses
  • Patients (in general) have a right to know their diagnoses  
    • if patient's do not want to know the diagnosis always assess why rather than merely obeying first 
  • Open-ended questions are the best way to elicit a patient history; closed-ended questions are useful for follow-up or clarification
  • Many patient encounters necessitate a combination of the above ethical principles--a few general principles include: 
    • encourage open communication between patients and other treating physicians
    • attempt to preserve the patient's relationship with other health-care providers.
    • nonetheless, ensuring that the patient is receiving the best available care is always the primary priority 
    • if a mistake is discovered the physician should disclose that to patient/family 
    • for difficult patients demonstrate empathy and make a plan together so they feel involved 
  • Privacy and the doctor-patient relationship
    • all patients, regardless of age, should have the option of speaking to their physician alone
    • this includes adolescents, spouses, and elderly adults
    • inappropriate patient requests should be politely denied since it can encourage future inappropriate behavior  
  • Conflicts of interest:
    • physicians should report conflicts of interest
    • physicians can accept honoraria and be compensated for travel expenses, but cannot have assistance with slide presentations from pharmaceutical companies 
  • Capacity
    • physician's can determine capacity which is the ability for the patient to understand their treatment as well as the risks, benefits and alternatives
    • competence is a legal designation and can not be determined by a physician
  • Pediatric considerations
    • parents cannot refuse life or limb saving treatment for their child  
    • with the exception of life-threatening treatment, parents have autonomy to make medical decisions for their children  
      • this includes vaccinations

 

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Questions (13)
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(M2.OMB.18.1) A 73-year-old man is admitted to the hospital for jaundice and weight loss. He is an immigrant from the Dominican Republic and speaks little English. A CT scan is performed showing a large mass at the head of the pancreas. When you enter the room to discuss these results with the patient, his daughter and son ask to speak with you outside of the patient's room. They express their desire to keep these results from their father. What is the appropriate response in this situation?

QID: 210452
1

Consult the hospital ethics committee

17%

(2/12)

2

Deliver the information in Spanish

17%

(2/12)

3

Explore the reasoning behind the children's request

42%

(5/12)

4

Respect the children's wishes to hold prognosis information

0%

(0/12)

5

Tell the children that you are obligated to tell the father

25%

(3/12)

M 5 B

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(M2.OMB.18.1) A 72-year-old man is admitted to the hospital with a productive cough and fever. A chest radiograph is obtained and shows a lobar consolidation. The patient is diagnosed with pneumonia. He has a history of a penicillin and cephalosporin allergy. The attending physician orders IV levofloxacin as empiric therapy. On morning rounds the next day, the team discovers that the patient was administered ceftriaxone instead of levofloxacin. The patient has already received a full dose of ceftriaxone and had developed hives overnight which were treated with diphenhydramine. He is currently feeling better. Which of the following is the most appropriate next step in management?

QID: 210454
1

Continue with ceftriaxone and use diphenhydramine as needed

19%

(4/21)

2

Desensitize the patient to ceftriaxone and continue treatment

14%

(3/21)

3

Discuss the error that occurred with the patient

48%

(10/21)

4

Inform the patient that nursing gave the wrong medication and it has been corrected

5%

(1/21)

5

Switch the medication to levofloxacin

14%

(3/21)

M 8 B

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