What branch of ethics deal's with individuals view?

1. Standards

2. Principals

3. Rules

Automony

Beneficience

Non-Maleficience

Justice

What is the term for unjustifiable violations to the moral rules OR failing to follow moral ideals when is is done so justifiably?

Example: taking $$$ from a wallet found on the ground

What is the term "for justifiable obeying the moral rules OR justifiably following moral ideals?

Example: returning a lost wallet fully intact to the owner

Wisdom

Commitment

Compassion

Conscientiousness

Integrity

Discernment

Honesty

Trustoworthiness

Kindness

Respect 

Consequential Ethics

Alt Definition: the morallly right action is whatever action leads to the max benefit of good over evil

Utilitarian Ethics

Alt Defintion: moral worth is determined by its contribution to overall usefullness/outcome

What is the term that describes "doing the right thing may not always lead to the good and right thing sought after"?

Example: Telling truth and keeping promises

What term is used to define individuals/institutions  that known what is best for others and makes the decision?

Example: political, military, relgious

What term describes the "right of the person to make their own descisions?

What ammendment made this possible?

Automony

14th amendment - indiviudals right to make his/her own decisions about health care

Boundary Violations

misrepresentation

Financial infractions

What is the term that describes "the state of being accountable, liable, or answerable?

Example: admitting a mistake

What is the term that is "treat them the way that you would want to be treated?"

Example: giving up seat, opening door

"Abuse of Power C.L.A.I.M.S. Greed"

1. Abuse of Power

2. Conflict of interest

3. Lack of conscientiousness

4. Arrogance

5. Impairment

6. Misrepresentation

7. Greed

What are the following examples of:

• Late for class
• reading a newspaper during class
• Surfing the web/Sleeping during class
• Inappropriate Dress
• Failure to introduce as PA-C/S

What are the following example of:

• Talking back
• Talking negatively about peers
• Vulgar language
• Cheating on tests
• Copying fellow student's paper
• Taking Rx samples
• "White Lie"

A. Structural

B. Attitudinal

C. Behavioral (civility)

self-soothe

Optimism

"w/o self awareness"

Raised not being able to express emotion

• C - catalyst for change
• A - Altering your thoughts
• L - Listen and make dx
• M - Make an agreement with the patient
• E - Education and f/u
• R - Reach out & discuss feeling after seeing the patient with trusted attendings, peers, and colleagues

1. Allow the patient to complete the angry outburst an the validate frustration w/ empathetic comments

2. involve the patient with an opportunity to discuss concerns

3. provide the patient with an opportunity to discuss his concerns

Physical

Behavioral

Psychological

Multiple sx

poor response to tx

Terminally ill

Certain disease: obseity, chronic back pain, vague sx

• rambling
• miss appoints
• demanding
• high utilization
• manipulative
• seductive
• clingy
• raises new problems @ end of visit
• noncompliant w/ tx

unrealistic expectations

vague sx

undue concern w/ minor sx

excessive preoccupation w/ physical illness

During a first trimester abortion is the decision between...

A. Physician and Woman 

B. Protecting Maternal Health

C. Viable fetus and preservation of the mother's health

direct contact of infected blood or body fluids 

(vaginal secretions, blood, breast milk)

1. Get informed consent 

2. Practice informed consent

3. MUST tell patient that if + positive HIV test screening test, there is a need for a confirmatory western blot

4. MUST tell patient, if positive, public health has to be notified by law

5. MUST Inform patient of False (-); f/u in 3-6 months

If wift does not consent to Artifical Insemination what is this characterized as?

18 y/o

< 18 y/o with parental consent

1. Respect

2. Beneficience

3. Justice

Research

Protects right and welfare of human subjects 

• Reviews protocols
• Review conflict of interest
• Ensures financial interest is disclosed
• Ensure privacy and confidentiality is protected
• Research within state and federal guidelines

1. Economic

2. Therapeutic

3. Genetic 

1. Elective - voluntary (pt doesnt want future pregnancies)
2. Therapeutic - voluntary (life/health of woman is at jeopardy by pregnancy)
3. Eugenic - involuntary, mental deficiet

What is the term that describes when a "plantiff claims that but for a breach of duty by the defendent (provider) the child would not have been born (e.g. improper sterilization). 

Damages relates to the cost sustained by a parent to raise a child with genetic deformities. Another damage could be "mom" has a condition that worsesns due to child birth.

Genetic Information Non-Discrimination Act

GINA

Alcohol Abuse

• C - Cut down your drinking
• A - Annoyed if people critize your drinking
• G - Guilty about your drinking
• E - Eye opener first thing in the morning after a hang over

0.08

1. Opoids

2. CNS depressants 

3. Stimulants

What drug class has the SE of drowsiness, constipation, and depressed breathings?

A. Opiods

B. Stimulants

C. CNS depressenants 

Rx not lasting

Multiple different providers

PPHOCC LEMM

(Fuck Legal Ethics Morals)

1. PCP
2. Psilocybin Mushrooms
3. Heroin
4. Opium
5. Cocaine
6. Crack Cocaine
7. LSD
8. Ectasy
9. Methamphetamines
10. Marijuana

Impairment

(Remember one drink can cause impairment)

What term is used to describe intentional commision of an act (such as giving a patient a lethal drug) that results in death?

A. Active Euthenasia

B. Passive Euthenasia

C. Negligence 

D. Mean Person

What is the term that describes when lifesaving tx (e.g. respirator) is withdrawn or withheld allowing a terminally ill patient to die a natural death?

A. Active Euthenasia

B. Passive Euthenasia

C. Negligence

D. Kevorkianism

1. Severe Brain Damage

2. Comatose/Vegetative State

3. According to test and other examination, patient is unlikely to recover

4. Death is imminent and inevitable, tx would cause precarious and painful prolongation of life

the patient

2 wtiness

Durable Power of Attorney for Health Care

When the person becomes incompetent

when the effect of tx will be no benefit to the patient - it is a scientific decision

MUST BE DONE BY PHYSICIAN

DNR

Only work over a short period of the time and must be periodically reviewed as the patients condition and other circumstances change

False.

They can only make recommendations; it is up the family members and pt to make final decisions

Mostly composed of hospital employees - medical staff

• Nurses
• Legal Advior
• Ethicist
• Educator
• Clinican
• Policial Leader
• Clergy
• Quality assurance/improvement manager
• Corporate leader from business

• Develop policy and procedure guidelines assisting ethical dilemmas
• staff and community education
• conflict resolution
• case reviews
• consultation
• polictical advocacy

Quality of Life

Expressed Choice

Advanced Directive

Assessment of risks, benefits, alternatives

"the thing is decided" - constitutes an absolute bar to subsequent action involving the same claim, demand, or cause of action

Common law

• Let the decision stand - future law suits applies the same rules and principles of preceding cases
• Common law
• it can be abolished when the court concludes that the rule is no longer in accord with the needs of society and they must depart fom the precendent

I. Freedom of speech, press, religion, petitiion

II. right to bear arms

III. conditions for quarters of soldiers

IV. Right to search and seizure regulated

V. Provision concerning prosecution

VI. Right to speedy trial; witnesses

VII. Right to trial by jury

VIII. Excessive bail; cruel punishment

X. Rights of the states under consitution

Legislative Branch

Congress and Senate

Supreme Court

8 justices

1 cheif justice

President (Barrak Obama)

What are the 4 objectives of Tort Law?

• Preservation of peace
• Culpability (find fault for wrongdoing)
• Deterence (discourage wrongdoing)
• Compensation (injured person of wrongdoing)

What is the following unintenional act examples of:

1. administering the wrong med

2. administering the wrong dose

3. unintentionally failing to present oral data to your preceptor

4. surgical removal of the wrong body part 

5. performing surgical procedure on wrong patient

What are the following intentional acts examples of:

1. failing to adminster meds

2. failing to order dx tests

3. failing to f/u on abnormal results

4. failure to document in medical records

5. failure to review medical record and obtain data

What is the term for execution of an unlawful or improper act?

Example: performing an elective abortion in the 3rd trimester when it is prohibited by law

What is the term for improperly performing an act, resulting in injury to another?

Example: surgery on wrong site

What is the term for failure to act, when there is duty to act as a reasonable purdent person would in similar circumstances?

Example: failing to order dx tests or prescribe rx that should have been ordered under the circumstance

1. Standard of Care

2. Ethicist and Standard of care

3. Duty to provide timely care

4. Duty to hire competent staff

What is the term for when reasonable anticipation tha harm/injury is likely to result from an act or omission of an act?

Example: not performing an eye exam of a diabetic patient that states he had blurred vision

False Imprisionment

Battery and False Imprisionment

What is the oral form of defamation?

Example: nurse aid saying "short staffed"?

What is written form of defamation?

Example: signs, photo/written cartoon

criminal law

1. Arrest - apprhension by a police office w/ filing of offical paperwork and fingerprintng for formal action in court of law

2. Arraignment - formal reading of the charges to the accoused (w/ counsel) with the defendent pleads guilty/not guilty.  If not guilty plea is entered, bail is set, and court date is arranaged

3. Conference - after plea of not guilty, plea-bargaining commences with agreed-upon disposition

4. Prosectuor - tries to prove the defendent is guilty d

5. Defense Attorney - tries to prove the defendent is innocent and that their rights are protected

6. Criminal Trial - jury selection, opening statemnets presentation of witnesses/evidence, summations, intructions to jury by the judge, deliberation, verdict, and appeal to higher court

Fraud

What are the following examples of?

1. billing for services not rendered

2. falsifying pt dx to justify tests

3. waiving pts copay/deductables

What is the term for unlawful killing of a person with the malice of forethrought and premediated

Examples:

1. Kerry Killalot executes a plan to go to someone's house w/ the intent to kill

2. Dr. Nancy Morrison removes artifical life support causing a patient to die in ICU

What is the term for unlawful killing of a person w/o a prior plan and not in the heat of passion.

Example: 

1. Sammy Schoolshooter takes gun to school with the intent to scare people, shots a teacher they die

2. Bruce Beater, gets in a fight and the person dies form injuries

3. Allen Airshot, firing a warning shot in the air and someone dies

4. Benny Burgler breaks into what he through was an empty house, gets scarred and shots the owner in the leg to get away, and the owner dies

5. Dr. Peter normann - death of 3 people from liposuction

7. Angel of Death - Genene Jones killed 11-46 children - intent was to save them after injection for praise but they died

What is the term for an "unlawful killing of another person w/o forethought and in the heat of passion"?

Example: Howey Husband w/ intent to tell Sammy Slime not to sleep with his wife anymore. Sammy Slime hits the husband and the Huband in the heat of passion is provoked into killing Sammy Slime.

What is the term for unlawful killing of person due to a negligent act?

Examples:

1. Danny Drunk goes out w/ friends to have a drink, drives under the influnce and kills someone

2. Lucy Leadfoot drives too fast for the road condiitons, looses control and kills passenger

3. Lucy leadfoot drives too fast in construction zone and kill worker

4. Sally Swerver weaves in and out of traffic, cuts truck driver off, he flips and truck explodes and kills kids in school bus under bridge

5. Dale and Shannon Hickmean didnt give son adequate medical attention b/c of relgious beliefs and he died

6. Fatal overdose by prescription painkillers

7. Dr. Conrad Murry was convicted of this in the MJ Case

1. offer

2. consideration

3. acceptance

What Ammendment States the following?

States

What act made monopolies guilty of felony?

Areas of Concern for Healthcare:

• reduced marked competition
• price fixing
• perferred provider aggangement
• exclusive contracts

HIPAA - 1996

Yes! it does require annual training

What is the act that was created by bush for promotion due diligency including:

self-regulation, leaders with moral and core values, searched for conflicts of inteest, and focused on attn to right things? This act also found former CEO of healthsouth guilty for all the bribary, conspiracy, and mail fraud brought against him. 

JCAHO - Joint Commission on Accreditation of Hospital Care Organizations

Cannot Use:

• U for Unit
• IU for International Unit
• Q.D. for dailty
• Q.O.D. for every other day
• 3.0 can only write 3
• .3 must write 0.3
• MS for morphine sulfate
• MSO4 for Magnesium sulfate
• </> must write out
• Drug Abbreviations
• Units other than metric
• @
• cc - must use mL
• ug - must write it out

What type of event signals immediate investigatior and response to an unexpect occurance involving death or serous injury (e.g. loss of limb function)?

Sentinal Event

(Advisory group, forms and tools, policy and procedures, alert statistics)

Waste Reduction

Emergency Prepardness

Pt Saftey

Organ Donation

PA Physician Team Key Points:

Communication

Coverage on vaca

Credentials

False - only in some states

Their duty is to monitor pts meds and educate pt on drugs and warn about potential OD

Risk

Benefits

Alternatives

verify med

verifty dose

verify patient

Risk

Benefit

Alternative

abandonment

Must provide reasonable notice

What act prohibits employers from giving preferential tx to younger individuals than older?

Only applies to companies w/ 20+ employees and 40+ people

Does not prevent employeer from hiring older over younger

Fair Labor and Standards Act (FLSA)

Time and 1/2 for > 40 hrs/week

even if you are salary you can still get overtime

court determines them otherwise 

or

2 physicans (usually one internal medicine and one physiatrist)

Emergency/implied consent

this is not battery

document why

AMA

sign chart or document refused tx

Red - day 1

Black/Blue - day 5

Green - day 7

Yellow - day 10

• injuries to the head, bruises to the H&N, burns or fx in a child of any age
• brusies anywhere on a child < 5 y/o
• alleging sexual abuse
• sexual transmitted dz in prepubescent child
• malnutrition
• medical neglect
• sx of serious emotional problems
• a sibling/child remaining in a home where one or more children have been pronouced dead 

• other providers caring for pt
• third-party payers
• law enforcement agencies
• serious threat to public health/saftey
• military command
• wormans comp
• subpoena
• purpose of Id by medical coroner/examiner

• be quiet and considerate of others 
• conform to rules and regulation of the hospital
• keep appointments
• follow tx plan
• paying financial obligations related to care

practicing only what duties delagated to your as the PA from your supervising physician

Hx, PE, Dx tests, Tx plan

notify your supervising physican

Then:

notify malpractice carrier, obtain lawyer, watch time frame constraint on reply, immediate review of pt chart, DO NOT change or remove anything from chart, if you made a mistake - ADMIT IT

MI

Infxn

Fx

Cancer

Failure to dx (20%)

Delay in dx