ETHICS Part 2

Language Barriers: ***

Deaf man. Worsening depression and anxiety. History of depression. Uses
gestures and nodding his head in agreement. Through writing, the patient
indicates hes not suicidal. Next course of action in evaluation of this patient?
A: Obtain assistance from a qualified sign language INTERPRETER
[NOT: Communicate with patient through writing. NO bc info can be
misinterpreted or left out for brevity]
[NOT: Have pt complete written evaluation forms on depression and anxiety
NO doesnt substitute for complete evaluation or having a conversation with
a patient]
[Use of Sign Language interpreter leads to fewer Clinical Errors,
better clinical outcomes]
Use of INTERPRETERS to ensure optimal medical care!!

Consent for Prenatal Care BABY/ABORTION:***

14yogirl pregnant positive. She does not want her parents to know of the
pregnancy. She is unsure about keeping the baby and asks if her parents
must be notified prior to prenatal care or elective termination. Appropriate
Response?
A: You can consent to prenatal care
[TRAP: you can consent to prenatal care or elective termination = two-thirds
of states required PARENT consent prior to abortion. 1/3 require Parent
Notification, but not consent]
[Minors age <18yo usually require parental consent for non-emergency
medical treatment.] however, in MOST STATES: minors can consent to
prenatal care, STD treatment, Contraception.]

Confidentiality: - (crowded area). Lets step off the elevator and talk
privately
GOAL: Discuss pt in Private setting

Gifts from Patients: I appreciate your thoughtfulness and will

treasure the care you have made for me. HOWEVER, it would NOT BE

RIGHT for me to accept the tickets

[Tickets to game]

Boundary Violations:
26yo F. asks doctor if he was married. Tells physician should consider going
out for dinner sometime. Dr. Finds patient attractive and would like to accept
the invitation. Which is most appropriate response to Pts request?
A: Decline the invitation, explain that dating the patient is ALWAYS
UNETHICAL
[Trap: politely decline the invitation and explain that it is inappropriate for
the patient to ask for a date This is a critical statementmay make the pt
feel embarrassed or ashamed]
[Trap: Decline the invitation, explaining that the Physician-Patient
Relationship must be terminated prior to dating a patient - NO, this response
might encourage the pt to end the pt-dr. relationship in hopes of dating the
physician]
Romantic Relationships between Psychiatrists and former patients
are always considered unethical.

DNR: Next of Kin:

82yo M,.non communicative, end-stage lung cancer. Pt has not designated
a specific power of attorney. WIFE of many years said pt had mentioned on
several occasions NOT to resuscitate him He wants to die in peace when
time comes. Course of action?
A: Attend to the patients COMFORT and allow his family to be
PRESENT with him as he is dying.
[TRAP: Inform the nursing staff that the patient is do not resuscitate and
suspend all treatment. wrong bc Still needs COMFORT CARE:
Supplemental oxygen, pain medication]

Dr-Patient Relationship:
28yo woman. Multiple failed fertility treatments. She confides the fetus is
not her husbands Child. Her husband is also the physicians patient, and she
asks the Dr. Not to tell him about this because it will ruin everything. Which
of the following is the most Appropriate response by the physician?
A: I will not tell your husband
[TRAP: I will not inform your husband, but lets discuss ways that you could
tell him yourself. This I judgmental and coercive DR. should be neutral
with regard to patients decision and NOT FORCE her into actions which she
may be Uncomfortable]

Exception to keeping CONFIDENTIALITY : Suspected Child/Elder abuse.

Knife/Gun wounds,, Diagnosing a communicable disease, Threats to harm self
or others and reasonable ability to carry out the threat in future]

Consent: Use of Interpreter:

65yo Vietnamese M. Attending surgeon and surgical resident meet with the
patient and his adult daughter. Surgeon explains to daughter who speaks
both Vietnamese and English.. asks daughter to TRANSLATE this info for
patient and assist with translating the consent form. Couse of action by
surgical resident?
A: Speak with attending surgeon privately about using a TRAINED
Vietnamese Language Interpreter
[Physicians must ENSURE appropriate use of medical Interpreters to
promote adequate patient understanding and participation in decision
making process..this is important during informed consent process]

Impaired Collegue:
Intoxicated colleague while on duty. Case: what do you do?
A: Contact the colleagues on call supervisor to report the problem
now
[Trap: Report the incident to the hospitals physician health program =.
YES if NON-Emergency situation]
[Dr is ETHICALLY AND LEGALLY obligated to report IMPAIRED
colleagues in a timely manner]

Confidentiality:****
Having dinner with colleague, a physician notices one of his patients at other
table.. Colleagues asks how you know her? Shes a family friend who was
recently diagnosed with breast cancer and have been worried about her.
Can I assume she is a patient of yours and ask how shes doing?
A: No, I cannot say whether she is my patient
[Trap: She is my patient, but I am unable to discuss her treatment due to
patient confidentiality]
GOAL: Protect patient confidentiality in all situations
[Physician should NEITHER CONFIRM nor DENY whether person is a patient]

Elder Abuse:
84yo brought in by daughter after falling and hitting her head on bathroom
sink. Physician interviews patient. Daughter interrupts and answers all
the questions while patient remains quiet. Daughter describes concerns

about worsening fecal incontinence and says, Im constantly cleaning her

up, its exhausting. Next step?
A: Ask the daughter to leave and ask the patient additional questions
[Trap: Order home safety evaluation, or TRAP: Notify adult protective
services of potential abuse]..Elder abuse should be reported AFTER Careful
documentation of findings that support abuse. History taking interview
PATIENT ALONE & PE.
IF daughter refused to allow physician to speak privately to patient.then
NEXT step would be reporting

Error: 82yo Alzheimer. Brought in by Daughter.

Error made. Next action?
A: Inform the daughter and disclose the error with an apology

Error made:
Next step: Interview Pharmacy, nursing, and medical staff on the
units where this occurred

Friend as Health Care Proxy:

Pt designated the friend has her PROXY. Friend presents notarized health care
proxy document signed a month ago. Vs. Husband. Who makes the
decision?
A: FRIEND
Health care proxy [Durable power of attorney for health care] - = a
legal document specifying a person chosen by the patient to make health
care decisions in event the patient becomes incapacitated and cannot make
decisions for him/herself. Proxy is obligated to Speak for Pt and make
decisions according with what pt would have wanted.
Health care proxy = a Person LEGALLY designated to make medical decisions
in event the patient loses decision-making capacity. Proxy OVERRULES all
other possible surrogate decision makers, includes family member.

Patient Literacy and number: - Use visual aide to educate patient

about the procedure
[Pt seems to be illiterate]

Confidentiality:
46yo Manchest pain 30minutes ago. Has hx alcohol and cocain abuse A
woman came in says she is his wife and asks about his condition. Im so
worried please tell me if my husband is okay. Action?
A: Inform the woman that the patient is stable, but that she will have
to wait until he can give permission to share any details
Goal: Protect Pt privacies.. requires Pts explicit CONSENT to share medical
information with others including family and friends.

Challenge to Parent Refuse: ******

3yo Boy. Still neck.. mom wants to take kid home without vaccination.
Action?
A: Obtain a court injunction to mandate continued treatment
[Dangerous conditions. Physicians have ETHICAL duty to advocate best
interest for CHILD]

Obtaining a sexual History: Have your sexual partners been women, men,
or both?