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Advanced Directive - correct answer -*a written expression of a person's wishes about medical care during terminal illness *written instructions for use in making medical decisions if a patient is rendered incompetent or is otherwise unable to express consent *congress passed the Patient Self-Determination Act in 1990 to address the difficult issues many people were having in making health care decisions, especially decisions about the determination of treatment. -Under this act health care organizations were required to have written policies and procedures concerning adult patients and their ability to provide informed consent and refusal of treatment. Age of Consent - correct answer --Line of confidentiality and consent are more vague and unclear before the age of 14 (involve parents/guardians if <14). -An adolescents capacity for decision-making doesn't occur before 15, and some experts have said adolescent should not take part in significant autonomous decision making before age 14 *Adolescents under the age of 18 can give consent for their own care in a broad range of circumstances and services -Minors who can give consent are those who are over a certain age, mature, legally emancipated, married, in the armed forces, living apart form their parents, high school graduates, pregnant, or already parents Overtime, the adolescent can take on more, if not all, of the responsibility in the decision-making process (if level of understanding and appreciation of the content of consent increased) Autonomy - correct answer -Act in a self-determined manner; the ability to make independent decisions for oneself and to have those decisions respected by others
- 1 of 4 most well-known and frequently used bioethical principles
Beneficence - correct answer -*To do good 1 of 4 most well-known and frequently used bioethical principles Battery - correct answer -A common law, an intentional unpermitted act causing harmful or offensive contact with the "person" of another. Both a crime and a tort. Its essential element, harmful or offensive contact, is the same in both areas of the law. The main distinction between the two lies in the penalty imposed. A defendant sued for a tort is civilly liable to the plaintiff for damages. The punishment for criminal battery is a fine, imprisonment, or both. Usually battery is prosecuted as a crime only in cases involving serious harm to victim. Bioethics - correct answer -A branch of ethics specifically focused on issues related to health care/medicine *Born out of the rapidly expanding technical environment of the 1900's *As medical technology advanced , physicians, nurses, and other medical personnel were faced w/greater responsibilities and stress regarding patient issues (Who lives? Who dies? and Who decides?) -New laws and healthcare policies had to be enacted to address these questions Four bioethical principles: autonomy, beneficence, nonmaleficence, and justice Casuistry - correct answer -Means people make decisions inductively based on individual cases *Today, casuistry is often method used by health care ethics committees to analyze the ethical issues surrounding specific patient cases -Analysis of similar cases provide guidance in ethical decision-making. *The Four Topics Method of ethical decision-making is based on casuistry approach
A Common Theme in the ANA and ICN COdes - correct answer -*A focus on the importance of compassionate patient care aimed at alleviataing suffering The interest of the patient comes before all other interests Compliance Program - correct answer -AKA: Risk management program *Designed to "prevent unlawful conduct and to promote conformity with externally imposed regulations and provide a second component of background for organizational ethics (TODAY, MANDATORY) *Programs became popular in the 1980's b/c of the need to address Medicaid/Medicare fraud -Focus on obedience to legal and required details of performance, also enforcement capability *In 1991, US Dept. of Justice created the US Sentencing Guidelines to provide consistency in sentencing in federal courts -in 2004, the guidelines were expanded to include the responsibilities of senior management and boards of directors -the guidelines allow reduction in penalties if the cooperation involved had previously implemented the standards of compliance before enforcing the federal violation *Guidelines: -oversight of the organization by an administrator or officer -proper and detailed attention in the delegation of substantial discretionary authority -effective communication to people on all levels of the organization -Reasonable steps to accomplish compliance for monitoring, auditing, and reporting suspicious wrongdoing without fear of retaliation -reasonable steps to respond to and prevent offenses and violations *Not synonymous with ethics programs, yet organizations tend to use compliance programs as a way of addressing ethical issues
-Some leaders of organizations view compliance programs as a means of protecting themselves Defamation - correct answer -Damaging a person's reputation by making public statements that are false and malicious Defendent - correct answer -Person or party against whom charges are brought in a criminal or civil lawsuit Deontology - correct answer -*A branch of ethics that judges morality based on adherence to accepted rules and duties The study of duty Kantian Deontology - correct answer -A specific type of deontology formulated by Immanuel Kant, in which the morality of an action is based only on the dutifulness of the action itself, not in the actions consequences The ends can never justify the means, because people are an end in and of themselves and should merely be used to attain some goal Consequentialists - correct answer -As distinguished from deontologists, do consider consequences to be an important indication of the moral value of one's actions Utilitarianism is the most well known consequentialist theory Deposition - correct answer -Sworn testimony given and recorded outside the courtroom during the pretrial phase of a case Doctrine of Respondeat Superior - correct answer -The employer is responsible for the employee *Latin term that means: "Let the master answer" or "Let the master speak"
Active Euthanasia - correct answer -*Taking purposeful steps to end a life, such as the administration of certain drugs. One reason for inducing death in this manner might be a terminal illness Passive Euthanasia - correct answer -Taking a life by the purposeful withdrawal/withholding of treatments or procedures used to prolong or sustain life. Voluntary Euthanasia - correct answer -An autonomous patient make the decision to end his/her life (see Physician-assisted suicide) Oregon's Death with Dignity Act of 1994: prime example of physician-assisted suicide based on voluntary euthanasia Involuntary Euthanasia - correct answer -The intentional taking of one's life when the person could consent, but does not. Example: Capital punishment False Imprisonment - correct answer -A restraint of a person in a bounded area without justification or consent. A common-law felony and a intentional tort. It applies to private as well as governmental detention. Fidelity - correct answer -Principle requires loyalty, fairness, truthfulness, advocacy, and dedication to patients. *Involves an agreement to keep promises and refers to the concepts of keeping a commitment and is based upon the virtue of caring.
Four Topics Method - correct answer -*Cases are analyzed according to medical indication, patient preferences, quality of life, and contextual features *Cased based approach allows health care professionals to construct the facts of a case in a structured format that facilitates critical thinking about ethical problems. *Medical indications (nonmalefience & beneficence), patient preference (autonomy), quality of life (beneficence & autonomy), and contextual features (loyalty & justice)
Jurisdiction - correct answer -The power and authority given to a court to hear a case and to make judgement Justice - correct answer -*A moral concept of rightness based on fairness and equality
- 1 of 4 most well known and frequently used bioethical principles Refers to fairness, treating people equally and without prejudice, and the equitable distribution of benefits and burdens Kickbacks - correct answer -The provider or other staff in the system engages in a scheme to receive and illegal compensation, such as when money or gifts are accepted in exchange for the referral of a patient for healthcare services paid by Medicaid or Medicare. Gifts can include everything from money to jewelry to free paid vacations Law - correct answer -The system of binding rules of action or conduct that governs the behavior of people in respect to relationships with others and with the government Constitutional Law - correct answer -A set of rules and principles that describes the powers of a government and the rights of people.
Case Law: composed of decisions of court cases (rendered by appeal courts) and is the result of the legal principle stare decisis Stare Decisis - correct answer -Once an issue has been decided, all other cases concerning the same issue be decided the same way. Leadership Style: Authentic - correct answer - A leader who places great importance on things such as openness, honesty, and transparency in relationships with his/her followers; a deeply-rooted sense of right and wrong; and his/her own self identity They are people focused on, very aware of who they are, and how others perceive them Leadership Style: Servant - correct answer -A leader who puts the good of the group being led before his/her own personal desires or aggrandizement *Consistently makes decisions to further the good of the group of followers over any decisions that satisfies self interest Exemplify the values of moral sensitivity, altruism, caring, empathy, and on-going development Leadership Style: Transformational - correct answer -A leader who emphasizes improving the well being of his/her followers by changing the culture in which they all work or live. *Ethical obligations, relationships, and deontology are at the center *Focus on raising the moral benchmark on human behaviors on both leaders and followers Leadership Style: Transactional - correct answer -Style of leadership that is based on the setting of clear objectives and goals for the followers as well as the use of either punishment or rewards in order to encourage compliance with these goals (managerial leadership)
Malpractice - correct answer -*The breach by a member of a profession of either a standard of care or a standard of conduct *The result when a professional person causes harm by failing to meet the standards of conduct The most common unintentional tort action brought against murses Moral Distress - correct answer -The feelings of anguish and/or frustration when the "right thing" is impossible to do *Nurses with it occurs when institutional constraints prevent them from acting in a way consistent with their personal and professional values that make up their moral integrity Link btwn moral distress and the concepts of incompetent or poor care, unsafe or inadequate staffing, overwork, cost constraints, ineffective policy, futile care, unsuccessful advocacy, the current definition of brain death, objectification of patients, and unrealistic hope Moral Integrity - correct answer -Being in possession of characteristics (such as honesty and trustworthiness) that traditionally define a person with good character; following a framework of internal , consistent values in all actions or dealings Nurses with it act consistently with their personal and professional values Moral Reasoning - correct answer -Pertains to reasoning focused on moral or ethical issues *Critical thinking to examine questions of right and wrong For nurses, usually occurs in the context of day-to-day relationships btwn nurses and the recipients of their care and btwn nurses and their coworkers Socrates - correct answer -An avid promoter of moral reasoning and critical thinking
Augustine and Aquinas were influenced by_____________. - correct answer -Ancient Greek What did the Catholic Church do? - correct answer -Took on the role of educating people of Europe (belief in one God) Augustine - correct answer -*Believed that one has a duty to love God *Moral reasoning should direct one's senses in accordance with that duty to God Believed in a heavenly place of unchanging truths, which is very similar to the Realm of Ideal Forms of Plato's belief Aquanis - correct answer -Believed that people have desirable end goal or purpose, and that developing excellences of character (virtues) leads to human happiness and good moral reasoning *Emphasized the virtue of humility (he believed this represented man's need to depend on the benevolence of God) Beliefs are also strongly associated with reasoning according to the natural law theory of ethics Modern Philosophy and the Age of Enlightment - correct answer -Some scientist and philosophers were bold enough to believe that humans could ultimately be perfected and that all knowledge would be discovered *Many believed that the world and its inhabitants could be reduced through analyses into their component parts -These are reductionist hoped that by discovering all knowledge the universe and human behavior could be predicted and controlled -This is seen today in healthcare when cure is highly valued over care (focus on fixing problems as fixing as machine)
-Greatly contrast the holistic approach with acknowledgement that well-being and health occur along a complex continuum and that some health problems can't be fixed or cured. David Hume - correct answer -Argued that there is a distinction between facts and values when moral reasoning is pracitced Felt that one can't acknowledge a fact and make a valued judgement based on fact. This fact-value distinction is also known as the "is-ought gap" Post modern Philosophy - correct answer -One acknowledges that reality is constantly changing and scientific investigations can't provide one grand theory or correct view of absolute truth that can guide human behavior, relationships, and life Human knowledge is shaped_____________. - correct answer -By many factors A narrative analysis is a core component of __________. - correct answer -Knowledge development Natural Law Theory - correct answer -Believed that the rightness of actions is self-evident because morality is inherently determined by nature, not by customs and preferences *The law of reason is implanted in the order of nature, and this law provides the rules or commands for human actions *A divine being commands an action because it is moral irrespective of said divine being Often associated with rule-based Judeo-Christian ethics, and it is the basis for reilgious prohibitions against acts that some consider unnatural, such as homosexuality and birth control use Negligence - correct answer -An unintentional tort alleged when one may have performed or failed to perform an act that a reasonable person would or would not have done in similar circumstances *Most common area of unintentional torts
*Where PAS is legal, three conditions apply:
- You (the nurse) must know the person intends to end his or her own life
- You (the nurse) must make the means to commit suicide available to the person
- The person must end his or her own life Power - correct answer -*The ability to successfully influence the actions of others *When leaders use power in a positive way to guide and direct, followers more easily develop ethical ways to work Legitimate Power - correct answer -A person has been given formal authority to make demands of and expect obedience from others Referent Power - correct answer -A person is strongly liked and admired by others and often exerts a charming influence Expert Power - correct answer -A person has the knowledge and skills to outperform others; her good judgement is respected and relied upon Reward Power - correct answer -A person is able to compensate another, financially or otherwise, for complying with his.her demands Coercive Power - correct answer -A person achieves compliance from others through the threat of punishment Reflection-in-Action - correct answer -Involves stopping to think about what one is choosing and doing before and during one's actions Reflection-on-Action - correct answer -Looking back on one's actions
Rule of Double Effect - correct answer -*A set of criteria used to determine the ethics of a decision that involves weighing the benefits of an action (the intended, expected, positive outcome) with possible negative but foreseeable consequences or effects *The action is considered ethical if the action is and of itself is moral, if the actor intends only the positive outcome, or if the good outcome greatly outweighs the possible negatives *Based on an individual's reasoning that an act causing good and evil is permitted when the act meets certain conditions The use of the double effect reasoning is an area of substantial concern when the health care professional sees some good in the action but also foresees with certainty that there will be bad in the action Slippery-Slope Arguement - correct answer -Action with future hypothetically potential unethical outcomes; describes a situation that seems morally acceptable at first but later slips toward a morally unacceptable situation *Argument based around the proposition that a small action can have critical, unforeseen consequences at some point in the future *In some cases, the original action is morally justifiable, but the hypothetical potential outcomes are considered unethical or dangerous *Because they deal with potential - not actual-outcomes, often are lacking in concrete supporting evidence Statute of Limitations - correct answer -The period of time established by state law during which a lawsuit may be filed Johnson's 3 P's of Technology Ethics - correct answer -1. Privacy: respect people's privacy
- Property: protecting and respecting people's property
- A(P)propriate use: using technology appropriately
- 30 minute sessions being billed as 50 minutes or more Upcoding of Items - correct answer -The provider delivers basic equipment to a patient, such as manually propelled wheelchair, but instead bills for the more expensive motorized version of the wheelchair Utilitarianism - correct answer -*Promote greatest good with least harm *A form of consequentialism in which actions and behaviors should be judged by the usefulness of their outcomes (compare Kantian deontology) *Ethical behavior produces the most good or happiness and the least harm or unhappiness in a given situation Utilitarian ethics emphasizes the consequences of one's actions in regard to achieving the most good for the most people that may be affected by a rule or action Value - correct answer -Something of worth; refer to judgments about what one believes is good or what makes something desirable *Influence how a person's character is developed and how people think and subsequently behave Professional values are outlined in professional codes (i.e. ANA's Code of Ethics for Nurses with Imperative Statements) Virtue Ethics - correct answer -Emphasizes the excellence of one's character *Arete, Greek, referred to excellence in regard to persons or objects being the best that they can be in accordance with their purpose *Aristotle's approach to virtue ethics is grounded in two categories of excellence: intellectual virtues and moral virtues
*Plato designated the four virtues of prudence (wisdom), fortitude (courage), temperance (moderation), and justice as cardinal virtues, meaning that all other virtues hinge on these primary four "What sort of person must I be to be an excellent person?" Virtues - correct answer -For humans are habitual, excellent traits that are intentionally developed throughout one's life Hume - correct answer -Whose approach is used by some feminist philosophers, believed that virtues flow from a natural tendency to be sympathetic or benevolent toward other people *Focused on the usefulness of virtues, his approach is also associated with utilitarianism Based on emotion as the primary human motivator for admirable behavior, rather than motivation by reason Nietzche - correct answer -The best character for people to cultivate is based on a "will to power" (has little place in nursing ethics) *Strength was praised as virtuous whereas caring and kindness were considered signs of weakness Virtue is consistent with hierarchical power or power over other people Whistleblower - correct answer -A person who tells the public or someone in authority about alleged dishonest or illegal activities occurring in a government dept, a public or private organization or a company Workplace Violence; Vertical Violence - correct answer - Occurs between individuals at different power levels on the nursing hierarchy and may be directed downward (i.e. nurse manager or charge nurse to staff nurse) or upward (i.e. staff nurse to nurse manager or charge nurse).
