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Chapter 48: Ethics, Palliative Care, and Care at the End of Life

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Biomedical ethics is a system of analysis and deliberation which is intended to direct physicians and surgeons to moral “goodness” in patient care. It includes consideration of all of the following EXCEPT

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A. Autonomy: The patient’s right to decide for himself/herself what care will be provided.

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B. Beneficence: The concept that proposed treatments will benefit the patient.

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C. Nonmaleficence: The avoidance of treatments which may harm the patient.

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D. Equipoise: The lack of a preference for one treatment over another.

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Answer: D

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The patient and the doctor decide together what treatment is in the best interest of the patient, and share the benefits and the burdens of this joint decision making. The physician’s role is to clarify the indications, risks, and benefits of the possible treatment courses; the patient’s role is to decide what course to take. (See Schwartz 10th ed., p. 1941.)

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Living wills are documents which are meant to guide decision making when

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A. The patient’s family cannot be contacted.

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B. The patient is rendered incompetent or unresponsive by an illness judged to be terminal.

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C. Multiple attempts at resuscitation have failed.

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D. The patient’s family disagrees with the course of treatment.

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Answer: B

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Living wills are intended to guide decisions by physicians, family members, and/or surrogate decision makers when the patient himself/herself is unable to render an opinion and the condition or disease is judged to be terminal or “hopeless.” (See Schwartz 10th ed., p. 1942.)

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“Informed consent” implies all of the following EXCEPT

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A. The patient has been provided with the pertinent details of his/her diagnosis, prognosis, and the options for and risks of treatment.

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B. The information has been provided according to what a reasonable person would be expected to understand.

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C. The discussion of the options, risks, and possible hazards has been documented.

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D. There are witnesses to the discussion who also understand the discussion.

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Answer: D

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The “reasonable person” standard for informed consent has precedent in a 1972 court case which rejected the notion that “simple consent” for treatment was sufficient. The court decided that the facts of diagnosis, treatment options, and risks that a ...

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