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Table of Contents
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
Appendix ? - Topic Summaries: Abridged
FOUNDATION: summary
A. Description
ETHICS For MEDICINE contains sixty topics. Each topic is designed to model the moral assessment process and address specific high-yield content used for all medical licensing exams.
B. Introduction
This text is valuable for MDs, PAs, NPs, RNs, PTs, PharmDs, and all other healthcare professionals who have direct and indirect responsibilities for patient care.
C. The Four Principles
Each topic assessment is conducted using the bioethical principles of: 1. Patient: autonomy (informed consent), 2. Practitioner: beneficence (do good) & nonmaleficence (do no harm), and 3. Public Policy: justice (be fair).
D. The Belmont Report
The National Commission for the Protection of Human Subjects established the Belmont report’s four biomedical and behavioral ethics principles. These principles and procedures were legislated into law by the Department of Health, Education, and Welfare, in 1979 as Common Rule 45CFR46.
E. The Hippocratic oath
Few medical schools use the original Hippocratic Oath for graduation as it is considered archaic, paternalistic, and controversial
F. The Declaration of Geneva
The Declaration adds the principle of autonomy (informed consent) so as not to be paternalistic. It also avoids some archaic and controversial topics found in the Oath.
60 Topics: Summary
1. Abortion
Abortion laws vary dramatically from state to state and are subject to the rapid change of partisan politics. However, the moral and legal responsibility for; safe and appropriate medical referrals, and for encouraging the minor who is pregnant to discuss their pregnancy with parents is a socially recognized responsibility of practitioners.
2. Abuse - Child, Elder & Spousal
A practitioner must report all suspected child and elder abuse to Child or Adult Protective Services. With intimate partner buse, encourage the victim to report it.
3. Addressing Oneself & One’s Patient
Medical students must make their student status clear to patients. Titles of respect establishes important social boundaries, and decision-making authority.
4. Advance Directives - Planning
Patient’s advance directive usually has a living will that provides accepted treatment options, and a durable power of attorney that determines who will be their surrogate decision maker once they lose their decision-making capacity.
5. Assisted Suicide
Medical profession prohibits practitioner-assisted suicide.
6. Capital Punishment - Executions
Any participation in executions are impermissible. Social trust, reputation and professional obligations are of paramount importance.
7. Chaperones & Personal Privacy
HIPAA confidentiality requires that there must be opportunity for patient privacy and confidentiality when chaperones are used.
8. Confidentiality
All medical information must only be provided to the patient, unless the patient has explicitly directed that others should also receive the medical information.
9. Conflict of Interest
For someone who has a conflict of interest they must recuse themself from the activity and disclose it to those affected.
10. Contraception
All persons, regardless of age, are to have access to contraception.
11. Death With Dignity
Aid in dying is legal in 11 jurisdictions. But for Medical Boards practitioner-assisted suicide, euthanasia, or assisted death is unaccepted.
12. Disagreements - Attending vs Resident
Always wrong for the resident to discuss with the patient their disagreement with the attending’s treatment management. Resident must immediately comply with attending’s treatment management.
13. Do Not Resuscitate Order (DNAR, DNAR, AND)
DNR order does not diminish medical care or patient management other than CPR.
14. Doctrine Of Double Effect
Doctrine Of Double Effect questions will always focus on the beneficent intentions of the provider. It is never permissible to intend harm.
15. Email & Electronic Communication
Electronic communications require security, privacy, and confidentiality along with patient-practitioner boundaries.
16. Errors
Always inform the patient of all medical errors.
17. Euthanasia
Professionally euthanasia is never permissible for a practitioner to engage in even if legal.
18. Financial Disclosures
Practitioner must disclose any financial conflict of interest to the patient.
19. Futile Treatment
Practitioner must discuss with the patient why they want to have a futile treatment so that incorrect information can be corrected.
20. Genetic Information Nondiscrimination Act (GINA)
According to the Genetic Information Nondiscrimination Act of 2008 it is never accepted for a workplace practitioner to require genetic tests for a medical history for employment decisions.
21. Gifts
Gracefully and tactfully decline all corporate gifts that have no educational value, and all patient gifts that are more than low value token gifts and cards.
22. Gunshot Wounds
Mandatory to report all gunshot wounds even if the patient objects.
23. Hospice
Only requirement for Medicare Hospice is a prognosis of less than six months to live.
24. Immunization - Vaccine Hesitancy
Practitioners have a professional and social obligation to stay up-to-date on all vaccinations, and not doing so is professional misconduct.
25. Impaired Driver
Patients are required to self-report any seizures disorders. Practitioners must report visual impairment to DMV so that DMV can decide. Practitioners do not have the authority to suspend or revoke driver’s license.
26. Impaired Practitioner
If the practitioner believes his colleague is impaired while treating patients, then there is a legal, professional, and moral duty to report the incident regardless of explanations, justifications, or promises.
27. Interrogation
Practitioners must not engage in any activity that is not in the best interests of the patient.
28. Life-Long Learning
Practitioners are life-long learners, preceptors, and teachers. The average state requirement for medical board license renewal is 50 AMA PRA Category 1 Credits™ biennially. Practicing medicine without a proper medical license is a prosecutable offense.
29. Malpractice
Must include 1) negligence and 2) Harm.
30. Media Communications
Practitioner must not disclose any patient’s protected health information (PHI).
31. Medical Records
Institutions own the electronic or paper medical records, but patient’s own the access to the information as a fundamental right.
32. Minor Patient: Rights & Liberties
Practitioner must get parental consent before treating a minor except for medical emergencies. Parents cannot deny standard recognized treatment, as to do so is considered to be child neglect.
33. Nurses & Allied Health Professionals
Practitioners have the primary responsibility for ensuring that patient management is performed competently and professionally.
34. Organ Donations
Any suggestion of the practitioner obtaining consent for organ donation will always be incorrect.
35. Palliative Care
Palliative care can be both part of hospice care or independent of hospice care. Focus on the maximization of both quantity and quality of life.
36. Patient-Practitioner Relationships
Patient abandonment is a form of medical malpractice. If a patient-practitioner relationship is terminated, then there must always be ample time for the patient to find alternative care.
37. Practitioner Disagreements
The attending practitioner has the ultimate responsibility for patient care and management.
38. Precision Medicine
Genetic testing is a complex technology that may
further increase healthcare disparities.
39. Pregnant Woman
Each state has different laws as to what medical standards of care can be provided to a pregnant patient.
40. Product Sales
It is generally impermissible to combine medicine with product sales for capitalistic economic gain as it violates the patient-centered healthcare.
41. Racial Concordance
Treating patients equally and not violating fundamental rights and liberties is always a given and unjust discrimination is illegal, unprofessional, and unethical.
42. Referrals & Fee Splitting
Practitioners must take steps to mitigate any conflict of interest and communicate openly and honestly with patients on any activity that could be perceived as a conflict of interest.
43. Reportable Illnesses
Practitioners must balance the duty of patient autonomy and confidentiality with the legal mandate to report reportable infections and illnesses to the appropriate agencies, and to warn those who are at risk of harm.
44. Research & Clinical Equipoise
Clinical equipoise and the null hypothesis is not part of the Belmont Report, or Common Rule 45CFR46 federal law for human subject protections. Clinical equipoise is an attempt to create a professionally accepted clinical research methodology.
45. Research on Human Subjects
The National Commission for the Protection of Human Subjects established the four principles of biomedical and behavioral ethics in the Belmont report. These principles and procedures were legislated into law by the Department of Health, Education, and Welfare, in 1979 as Common Rule 45CFR46.
46. Self-Treatment & Family-Treatment
The professional practice standard states:
Practitioners should not treat themselves or members of their own families. (AMA Code of Medical Ethics Opinion 1.2.1)
Self-treatment & Family treatment is a violation of all four principles of biomedical and behavioral ethics.
47. Sexual Boundaries
Patient-practitioner relationship must keep strictly to sexual, romantic, and familial boundaries.
48. Social Media
Professional and institutional obligations outweigh any personal freedoms on social media.
49. STI Sexual Transmitted Infections
Expedited partner therapy (EPT) is not an accepted practice for all states. The professional principles of nonmaleficence (do no harm) and justice (be fair) can rationally and logically have more weight than that of autonomy (informed consent) when dealing with sexually transmitted infections (STIs).
50. Sterilization
Respect the decision-making authority of the patient with decisional capacity that has provided informed consent decision to be sterilized. Sterilization can be provided and performed over the objection of the spouse, partner, parents, or anyone else.
51. Strikes
For unionization, always focus on the patient’s best interests such as more accessible and affordable patient services and technologies, and never on self-interest justifications such as increased practitioner pay, and benefits.
52. Structural Injustice
Structural injustice in healthcare occurs whenever there is unequal and unfair distribution of healthcare benefits and burdens.
53. Student Patient Care
Students must not misrepresent themself when introducing themself to the patient, get informed consent for each procedure conducted, and make sure all interactions are under the supervision of the attending practitioner.
54. Surrogate Decision-Making
Practitioner must inform the surrogate of all information necessary for informed consent, and the surrogate must make medical decisions as if they were the patient by using the patient’s reasonable goals, values, and priorities.
55. Telemedicine
With telemedicine, the fiduciary patient-practitioner relationship is still foundational for the practice of medicine, and a federal mandate for full compliance with HIPAA regulations for confidentiality and privacy must also be observed.
56. Terminal Sedation
Terminal sedation is the use of medication to decrease a patient’s consciousness to relieve refractory symptoms making the final stages of dying more tolerable. Terminal sedation is not a form of “slow” euthanasia because most patients will be at most days if not just hours away from death.
57. Testimonials & Quackery
Making exaggerated claims about one’s ability and claiming to have a medical cure that is not evidence-based-medicine is unprofessional, illegal, and unethical. Asking a patient to provide a testimonial, who may be vulnerable and dependent on the practitioner, is a violation of the patient-practitioner relationship.
58. Torture
It is impermissible for any health care provider to have any association with torture or harsh interrogation techniques. Mandatory reporting of such practices is required.
59. Triage
It is imperative that the patient and society can trust that the practitioner will always act and make decisions that will promote the patient’s best interests. Triage policies, therefore needs to be made by federal, state, or institutional bodies to avoid practitioner violation of the patient-practitioner relationship.
60. Withholding & Withdrawing
Patient’s have the legal, professional, and moral right to withhold and withdraw medical treatment. However, issues arise when surrogates cannot agree then the practitioner should encourage surrogate discussion.
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