Bioethics exam| 100 Questions | With Complete Solutions

What happened in the Seattle artificial kidney program? correct answer: 1962 When dialysis was perfected, not everyone who wanted it could receive it, so they had t decide who could and could not get it. What was the Tuskegee study? correct answer: - recruited black males who needed money and were desperate to give them syphilis - The men did not have informed consent, they told that they were being treated for "bad blood" - They did not receive proper treatment - lasted 40 years What is the THBP? correct answer: Tuskegee health benefit program? - health and medical benefits What was the fetal tissue debate 1973? correct answer: - Dr. Holbrook - controversey on using not dead yet fetus for tissue expirementation What was the Roe vs. Wade 1973? correct answer: Roe- pro aboriton Wade- laywer wanted her to deliver the baby (texas) - Who is responsible for the birth of bioehtics? correct answer: national comssions, 1975 - became legendary in the field b/c what started bioethics to be a demi-dicipline; take input from society What was the Belmont Report correct answer: 1979 - the guidelines for biomedical research -protection of human subjects -covers respect for persons, beneficence, and justice What is medical ethos? correct answer: -interlocking views about the patient, physician, and medical enterprise - Historical core values - special worth endowed upon the sick What is the hippocratic oath? correct answer: - do no harm - obligations of doctors to do not harm What is social darwinism? correct answer: - Survival of the fittest - Explain Eugenics correct answer: 1883 francis Galton - Eugenics= "Good brith" - aim to enhance the quality of the population, selective breeding What is Racial Hygiene? What were the consequences? correct answer: 1894 Alfred Ploetz German - If you did not have the desired characteristics, there would be euthanasia or sterilization - Consequences: lower population, and fewer to fight in the military What was buck v. bell? correct answer: 1924 sterilization laws in the US sterilization of 60,000 persons - racial segregation What was believed by Nazi medicine? correct answer: only the healthy and hereditary sound population was allowed to reproduce - considered the sick was "useless" - had powerful and effective health programs (nutrition and exercise) What were 3 laws implmented by Nazi medicine? correct answer: Nuremberg laws Sterilization laws Euthanasia Explain the Nuremberg Laws correct answer: -excluded Jew citizenship - martial health laws to prevent 'racial pollution" Explain the Sterilization Laws correct answer: - prevention of hereditarily diseased descendants (1933) - involuntary sterilization Explain the Euthanasia laws correct answer: 1939 Physicians to grant "mercy death" to patients who were incurable sick by medical examination What was the nuremberg Doctor Trial? correct answer: medical experimentation the sick and medically vulnerable - High altitude experiments - Freezing - Malaria - Mustard gas - Sulfanilamide (wounds that we infected) (... any many more) What is the nuremberg code? correct answer: Laws of ethical experimentation ex. (consent, means for experiment, animal experimentation, degree of risk) What was the World Medical Association Declaration of Helsinki, 1964? correct answer: ethical principles for medical research involving human subjects What happened in Canada even after the nuremberg trial? correct answer: -Abroigional children were purposely starved to see how malnutrition would affect children. -children taken away from their family and home to dilute them from their families What was the enlightenment period? correct answer: What are Foundationalists? correct answer: create a foundation for the most absolute truth - there should be a distinction between fact and values What is Deontology? correct answer: Kant and Rawls It is our "duty" to do unto others as what we would want done unto ourselves Explain the 3 concepts that define categorical imperative correct answer: Developed as a formula for ethics 1) Act only on universal laws: act as if everyone followed the law 2) Treat humanity as an end in itself and never merely as a means: 3) Respect Autonomy: everyone gets to decide for themselves about what moral law is - "If it is wrong, dont do it"... Kantism (immanuel kant) What is Utiltarianism? correct answer: Bentham and Mill - greatest benefit for the greatest amount of people What is the difference between act utiltarianism and rule utiltarianism? correct answer: Act Utiltarianism: the prinicpal of utility applied to every situation of choice Rule Ultitarianism: using utility to determine the validity of rules What are 4 principles from the belmont report as well as principalists? correct answer: Belmont (al johnson), principalists (bowchamp, childress) 1) Respect for autonomy: repsect for peopel's values 2) Beneficence: help people 3) Nonmaleficence: don't harm people 4) Justice: treat like cases like What are Virtue ethics? correct answer: Right action should reflect moral character - Aristotle - Theory of the golden mean: virtue= moderation (not humility, not pride, but modesty!) What is pluralism? correct answer: The right action must satisfy multiple criteria - What is feminist ethics? correct answer: pay attention to the ways in which out decision may affect women and men differently What is consequentialism? correct answer: Jeremy Benthan - we are governed by feelings of pain and pleasure What is Libertarianism? correct answer: someone who believes the doctrine of free will not be mandated by government (ex. against being forced into vaccination) What is communitarianism? correct answer: ethics is a matter of shared understanding of the good - emphasizes the connection between the individual person and the community What is Egalitarianism? correct answer: we have a moral duty to provide either a minimum level of health care for every person or the same for all What is Macro- allocation and problems associated? correct answer: - department of health and hospitals - how is need defined? how to assess the value of life? What is microallocation? correct answer: deciding between patients - market approach: treated as a commodity - lottery approach: random - political: choice by a committee - mixed approach: combination What are QALYs? What are problems associated? correct answer: Quality adjusted life years - questioning people about how they see disorders - asked to rank living with certain disabilities/ symptoms 1= normal life 0= death and multiplied by the numbers of life expected to live - does not take into account how a person with the condition may feel; discriminate elderly and people with pre- existing conditions. What is the difference between equality and equity? correct answer: equality= giving everyone the same equity= giving everyone what they need to be successful (some people may need more then others) What percent of Canadian GDP is to help poor people in other countries? correct answer: 0,3% but the UN suggests 0.7% What is the difference between justice in a fair world for cosmopolitan view vs. political view? correct answer: Cosmopolitan view: we a re all human beings, same ethics everywhere Political view: there are political differences between societies but there must be justice within a society What does an autonomous moral agent mean? correct answer: - right to self determination - capable of making own decisions - able to make choices for self freely What does informed consent consist of? correct answer: DCC - Disclosure - Cognition - Consent ,Refusal,Choice What is the input- output model? what is another name for it? correct answer: having the patient reiterate what you said to make sure that they understand - aka event model - involves acute illness, physician provides medical facts - if the patient refuses you need to evaluate capacity What is the process model correct answer: - informed consent - chronic illness - inform them of side effects, - phasician learns to appreciate the patient values, tolerances Define competence correct answer: cognition, communication and relatively stable set of values Defines capacity correct answer: decision making capcity and ethical judgement - understand consequences for lack of a decision Who should be the substitute decision maker? correct answer: -parent/ guardian - POA - spouce - brother or sister What is the role of the substitute decision maker? correct answer: should ask "what would me loved one want if he or she could decide for him or herself" what is an Advance directive correct answer: - "living will" with their wishes - wishes under certain circumstances - If the health care team feels that a substitute decision maker is not make decision in the best interest of that person, can the team apply to the consent and capacity board for review? correct answer: YES! What is paternalism? correct answer: the intentional overriding of one person's preference or actions by another person - authority restricting freedom ex. having to get your vaccines... so it is not necessarily a bad thing What does futile mean? correct answer: when something is pointless ex. resuscitating someone who is at the end stage of their life What is the difference between soft and hard paternalism? correct answer: Hard: we know what is best for you, and we will force you to don it soft: we know what is best for you, and we will help you do it. (ex. smoking) What is NDD? correct answer: Neurological Determination of Death. - brain death - "vegetative" functions - problem with considering bread death as death-- hard to prove that there is no brain function.. best way to determine is by looking at the heart What is the difference between brain death and PVS? correct answer: PVS= permanent vegetative state - PVS- brainstem relatively intact - PVS is often due to a lack of oxygen -diagnosis is less certain then brain death - few unexpected recoveries of cognitive functions from persons with PVS What is a coma? correct answer: sleeplie (eyes closed) due to damage to brainstem (PVS eyes open) - pateints have cough, gag, or swallowing reflexes - people in coma may transition into PVS (improvement) What is POST? correct answer: Physician orders for life- sustaining treatnemt - Physician orders that helps give seriously ill patients more control over end of life care - can prevent unwanted medically ineffective treatment/ reduce pain and suffering What is the somatic criteria for defining death? correct answer: presence of decomposition and rigor mortis (the recognizable signs of death... chemical changes) What do we consider as "brain death" correct answer: irreversible of consciousness combined with the irreversible loss of all brainstem functions including the capacity to breathe - must be clinical or imaging evidence Explain the determination of cardiac death (DCD) - how many seconds until cerebral circulation is lost resulting in unconsciousness - How many min is cardiac activity monitored for? correct answer: - within 15s, absent cerebral circualtion consciousness is loss - Aus/US= 2 min - Canada/UK= 5 min - Italy= 20 min What happened in 1959 about the determination of death? correct answer: - Wertheimer's: nervous system death - Mollart and Goulon: and "coma depasse": Irriversable state of coma apnea How many physicians are required to DCD? correct answer: 2 they document the absence of palpable pulses How long do donated organs last for? correct answer: Kidney- 30 hours Panc/ Liver- 12 hours Heart/ lungs- 6 hours What is DDR? correct answer: - Dead Donor Rule - removal of organs after the cessation of life- sustaining therapy and subsequent declaration of death - doing everything you can to keep a sick person alive, even if they are potentially an organ donor. Of the following cultures, which are vs. are not against organ donation? -Amish -Baptist - Buddhism - Catholicism - Confucianism - Seventh Day Adventist - Sikhism - Taoism - Church of christ science - Episocopal - Greek Orthodox - Romas - Hinduism - Islam - Jehovah's Witness - Judaism - Luteran - Mormon - Presbyterian - Protestantism - Shinto correct answer: For organ donation: - Amish (as long as life saving, and promising that it will work) - Baptist (personal choice) - Buddhism (choice) - Catholicism (encourage) - Seventh Day Adventist (encourage) - Sikhism - Taoism - Church of Christ science (choice) - Episcopal - Greek Orthodox - Hinduism (choice) - Islam - Jehovah's Witness (choice) - Judaism - Luteran - Mormon (choice) - Presbyterian - Protestantism (choice) Against organ donation: - Shinto (extremely cautious) - Confucianism - Jehovah's witness (agains blood transfusions... blood must be removed from the organ) - Romas When was abortion first liberalized in Canada? correct answer: 1969 What is the HCCA and what does it say about consent? correct answer: health care consent act - that a person has the right to consent or refuse treatment if they have the mental capacity. In order to have capacity, that person must also have the "ability" to understand and appreciate the consequences of the treatment decision. - They should understand reasonably forseeable consequneces of a decision or lack of decision. Explain the harm principle for pediatric ethics correct answer: - must not abuse or neglect - provide basic needs - must answer "does the decision made by the parents significantly increase the likelihood of serious harm compared to other options? - If so, CAS (child aid society) should intervene. Which vaccines are necessary for children attending secondary school to get? Which ones are new? correct answer: •Diphtheria •Tetanus •Polio •Measles •Mumps •Rubella •Meningococcal Disease - NEW •Pertussis (whooping cough) - NEW •Varicella (chickenpox) - NEW What are risks associated with Diphtheria? correct answer: - can cause breathing problems, paralysis, heart failure, or death What are the risks associated with Tetanus? correct answer: - bone fracture, or abnormal heart rhythms - It is not contagious (coms from environment like soil and manure) What are the risks associated with Pertussis? correct answer: -Infants are apnea, pneumonia, seizures, encephalopathy and death. This disease is most contageous before the coughing starts What are the risks associated with Mumps? correct answer: - inflammation fo testicles in males - encephalitis - inflammation of the ovaries - temporary or permanent deafness What are the risks associated with rubella? correct answer: birth defects if acquired by a pregnant women - heart defects - development delay What are the risks associated with meningococcal? correct answer: bacterial form may result in brain damage, hearing loss, or learning disability What are risks associated with the varicella vaccine? correct answer: - bacterial infection of the skin - swelling of the brain - penumonia - shingles could be a complication What are possible side effects from the varicella vaccine? correct answer: mild: soreness of swelling, fever, or a mild rash Moderate: seizure caused by the fever - Severe: pneumonia (rare) What are some examples of optional vaccines? correct answer: Influenza Who should get vaccinated with the flu vaccines? correct answer: - everyone 6 months and older - people providing care for high risk population Who should NOT get vaccinated with with the flu virus? correct answer: - severe allergy to the chicken eggs - ppl who have had a prev. severe reaction - ppl who have developed GBS (Guillain Barre Syndrome) - people with a moderate or severe illness What are the risks associated with Hepatitis A? correct answer: - does not cause long- term illness or permanent liver damage - though people can dies from liver failure caused by severe forms of the hep A infection What is HPV? correct answer: most common sexually transmitted infection - some can cause genital warts, or cancer What is another name for Research Ethics board? (REB) correct answer: - Institutional research board (IRB) - ensures compliance with canada's tri- council policy statement on ethical conduct for research involving humans What is the McMaster Research Ethics Board (MREB) used for? correct answer: non- medical research involving human participants carried out by McMaster faculyy students and staff to ensure the safety and well- being of human participants. - also ensures compliance with Canada's tri- council policy statement - MoMac programs have to submit both to McMaster and Mohawk What is the Hamilton Research Ethics Board? (HiREB) correct answer: - combined of St. Joseph's and HHS and McaMaster faculty of health - - mandate the safeguard for the rights, safety, and well- being of all research participants - committed to protecting research participants by ensuring that all research involving humans in scientifically and ethically sound! Operates under the principles of the Tri- Council policy statement: Ethical conduct for research involving humans (TCPS), and the internatinoal conference on Harmonization: Good Clinical Practice (ICH GCP) - It would involve faculty of health science researchers OR research involving patients, staff resources or facilities in McMaster affiliated hospitals What is the goal of the office of clinical & Organizational ethics a HHS? correct answer: to build ethics capacity and nurture a culture that makes it easy to "do the right thing" What is the clinical ethics committee (CEC)? correct answer: - ethicist + multidiciplinary health care providers - meet every 3 months with organization and clinical ethicist for case reviews, policy updates, education and ethics events - meet 1-2 times. months to review policies/ educational initiatives what is organizational ethics? correct answer: addresses ethical considerations for patients, as well as non-patient related issues such as human resources, polices and processes, and resource allocation decisions. ex. - develop a police to support organ donation after cardiac death - disclosure of health risk to a cohort of affected patients - the realignment of staff roles to support a new patient care process. What is FICA? correct answer: Faith Importance (of spirituality in the patients life) Community/ support Addressed- how does the patient wish spiritual issues to be addressed What does SPIRIT stand for? correct answer: Spiritual: the belief system Personal: spirituality Integrity: with the spiritual community Ritualized: practices and restrictions Terminal: events planning What is passive euthanaisa correct answer: taking away what is keeping you alive: VRFD voulentary refusing food and drink... aka "foregoing treatment" What is active euthanasia:? correct answer: injecting something to actively kill pt. What happens in Sw. and netherlands? correct answer: allowed to do active euthanasia Who is dr. Korvokian? correct answer: a.k.a "dr. death" - did phasician assisted suicide when it was not legal 1997 injected a man with ALS and it was videotaped when did awareness of phasician assisted suicide? correct answer: What is DWDA? correct answer: dying with diginity act Oregons -phasician assisted with suicide - a lot of safeguard 1) be an adult 2) capabel 3) live there 4) terminal illness with less then 6 months to live 5) voulentarily requst- must be in writing by both patient with 2 witnesses what is the principal of double affect correct answer: -distinction between allowing and allowing to die -allowing an action that will cause a bad side affect (ex: giving pain killers alieviating in causing in death... not allowed to put pt. in coma, but a coma is allowed as a side affect) What is the date that they have to made a decision if phasician assissted suiside correct answer: June 7