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INTRODUCTION

Test Taking Tips

  • Know the order of who consents and makes decisions for a patient when he or she is not able to.

  • Even if there is no mention of “identifying information” (e.g. name, initials, or medical record number), it can still be a HIPAA violation if the aggregate of information allows a person to identify the patient.

ETHICAL PRINCIPLES

What is respect for patient autonomy?

  • When the patient has the capacity to act intentionally, with understanding, and without controlling influences that would mitigate against a free and voluntary act, surgeons ought to respect patient decisions, even when those decisions are different from the surgeon’s recommendations.

What is beneficence?

  • The duty of clinicians is to benefit the patient and to bring about good for the patient. Note: In some instances, the clinician’s judgement about what will benefit the patient will be in conflict with the patient.

What is nonmaleficence?

  • Clinicians may not intentionally create a needless harm or injury to the patient through acts of commission or omission. In addition, clinicians ought to take positive steps to remove harm from the patient.

What is justice?

  • In our context, it is defined as a form of fairness. This implies the fair distribution of goods and services in society that are in short supply; thus, some fair means of allocating scarce resources must be determined.

DECISION-MAKING: THE SFNO APPROACH

What is the SFNO approach?

  • So Far No Objections = Stakeholders, Facts, Norms, Options

What are the 3 major sources of uncertainty in medical ethics decisions?

  1. Different people are involved who have competing interests

  2. Uncertainty or disagreement exists about relevant facts

  3. Uncertainty, conflict, or disagreement exists regarding ethical norms

Who are the stakeholders?

  • Those who will be affected by the decision made. It helps to state why people are stakeholders or how they are affected.

What are the facts?

  • They are factual issues that might generate disagreement or are relevant to a solution. It may be helpful to refer to the experts or the literature.

What are the norms?

  • They are ethical principles (see earlier), norms, or values that are at stake. Some may be relevant, and others only appear to be. For assistance, reference can be made to professional ethical codes or regulations. The advice of colleagues should be sought when it is not clear what ethical principle or principles apply.

What defines the options?

  • They are actions or policies, as well as compromises, that deserve consideration for potential solutions. They may be best arrived at ...

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