CONRAD FISCHER ETHICS PDF
book by Conrad fisher cases in medical ethics. The YouAreMost on the ConradFischer,M.D. AssociateChiefof Medicinefor Education. Features: Coverage of ethics and legalities surrounding the major issues most likely to be covered on the Ethics section of Steps 2 and 3 of USMLE and the. I would really appreciate,if someone can send me cases of ethics by Conrad Fischer,please. zetom.info ENJOYYYYYY.
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Kaplan Medical USMLE Medical Ethics: The Cases You are Most Likely to See on the Conrad Fischer, MD, is Director of Educational Development for the . Download cases by Conrad Fischer PDF Free. Includes advice and information about the ethical issues addressed on the USMLE, as well as practice. *Re:Does anybody cases of ethics by Conrad Fisc # apju/25/ Sorry to bother you again, drn By continuing to.
Consent is alwaysimplied for emergencytrcatment. A physician should not withhold blood or surgery in a life-threatening accident just becausethe parent is not Present. What should you clo? Emergency treatment of a minor does not neeclexpressrrritten consent.
Seekinga court ordcr i, olrn u tv. The mature minor is genera'y one. USMLE wilt not make hairsplitting distinctions like giving you a r4-year-old the day before her r5th birlhday.
She is generally healthy but is not accompanied bv a parent.
What should ,voudo? Saying thut 1. These interventions u'wantecrpregnan. Somestatesrequireparentalnotificationand somedon,t. I A'I. Whatshouldyou do? Inthiscase,thereisno clearansweraboutwhetheror not thephysiciansl.
Thereisno clearnationalstandardandit dependsupon the stateyou arein. The mostlikelyrightansrverwill indicatethenceclto encouragethc child to notify the parcnts herself,whichwouldbebest. Sothe corrcctanswerchoicewill saysomethir. EmancipatedMinor A smallnumber of minors, particularlyat older agessuchas l6 or 17,may bc considered 'emancipated' or freed of the necd to haveparental consent fbr any medical care.
The critc ria arethat the minor is married, self-st4rporting and living indepenclently,in the military, or theparcntofa child that they themselvessupport. The criteriafor beingan emancipated n]inor relateto being no longer dependent on one's parentsfor support, In other words, if theminor does not livc with his parents,has a. Seriousmedicalconditionsor procedures suchas organ donation, surgery, or abortion may require a specific court order to allotv the legal standing of enancipation to be fully valid.
Only answer "court order,',. LimitationsonParentalRightofRefusalforMinors Although a competent adult can refuse any medical care she wishes,the same right does not automatically extend for parents concerning their children. Aspart of the surgerythe child will needa blood transfusion.
The parentsareJchovah's Witnessesand refuseto giveconsentfor the transfusion. Ihe parents'statedreli giousbeliefsarethat acceptingblood for their child would be a fateworsethan death. If the child needsblood to savehis life you must givetheblood evenoverthe objection of the parents. It may seemcontradictoryto seekparentalconsentfor a procedurethat you will perform evenif they refuse,but in this case,you shouldattemptto obtain their permissionnonetheless.
Withholding lifesavingtherapyfor a child is consideredcomparableto child abuse. The parents'right to practicetheir religionin termsof healthcarewould covertheir abilityto refusea transfusionfor themselves,but not for their child. Thisethicalconcepthasonly expanded. Parentscannotrefusetherapyfor childrenevenif theyareseverelybrain damagedor otherwisedevelopmentallydisabled. Societydoesnot distinguishbetweenindividualsbasedon theirrelative 'worth.
From this point of view,treatmentagainstparents'wishesin a life- threateningsituationisequallyvalidfor both afuturegeniusandachildwith cerebralpalsy who will not achievea mentalageabove2. One of the only timesparentsareallowedto refusecarefor their child is when the child is soill or deformedthat deathis inevitable.
This is not a true refusalon the part of the parent. This is reallyjust sayingthat parentscanrefuseonly the futile carethat thedoctor shouldn'tbegivingany. A patientwith the clearcapacityto under- standor onewho clearlydoesnot havecapacitydoesnot needa psychiatricevaluation. However,a psychiatricevaluationcanbe usefulto help makea determinationof capacity in ecuivocalor questionablecases. In addition, thc level of compctence necessaryto make financial decisions is different fron.
In other words, a patient rnay have a history of bipolar disorder making it impos- siblefor him to manage his financial decisions. Howevel the same person might still be consideredto have capacity to refuserrearment. There is r'virylimitiil iteiriiril liliced on p,ricnlto estJblih dp. The criteria to determineconlpetencein areasof finance are at a higher standard than those for refus- ing nedical procedures.
Your patient might have schizophrenia, mental retardation, or autismto the point of needing to live in a group home, but that does not mean they are incapableof understanding medical procedures. This means that an adult with a mcntal ageof 8 or l0 nay still be allowed to refuse medical procedures. Our society is reluctant to strapa patient to his bed and perform procedures that would be painful or uncomfort ablefor the patient without his consent.
For irlstance,certain court casesin the past have allorveda patient with mental illness to refuse diagnostic procedures even though two out of three of the reasonsfor the refusal were delusional. This is an affirn. In addition, it shows that beneficence-trying to do the right thing for patients is considered lessimportant than autonomy. Autonomy is given more wcight in decision making than beneficience.
Autonomy haspriority. A personmay meet the legalstandard of competenceto refuseor acceptmedical careeven if sheis not consideredcompetent in other arcasof life, such asfinancial matters. Thc explanationmustbe in languagethatthe paticntunder- standsandincludefull infbrnation regardingalternativetreatments.
You fully inform the patient about the risk of transplantation,including the possibility of deveJopinggraft versushost disease. Afier the transplantationthe patientdevelopsgraftversushost disease,which is hard to control. The patient learnsthat there is an alternative treatmentcalledimitanib gleevec ,rvhichtloesnot includc the risk of graftversus host disease,but which rvill not cure the lcukemia.
The patient filessuit against you. What rvill be the most likely outcomc of the suit? In this casethe patient rvill probablywin the suit becausehe wasnot fully intbrned about the alternativesto the therapics mentioned. The physician has an ethical duty to ir. In the casedescribcd in the previous exantple,the error was not that graft versushost cliseasedeveloped. Thc patient wasfully informed that this could occur and he chose the bone marrow triursplantation anyway.
The error rasnot informing thc patient of an alternatir. At the same time, a patient could potentially die as an adverseeffect of treatment. This is only an ethical and legalproblen if the adverseevent happcns and the patient was not told that it could have happened. The patient n. The patieitt must be ir. If thcy havethe capacityto understandand thcy chooseto do it ar.
For example, a man underploescoronary angioplasty. He is inforned that tl. He knorvs he could havebypasssurgery instead. He understandsand choosesthe angioplasty. He dies from a ruptured blood vessel. The fanily files suit against you. What will be the n. Although it is unfortunatethal the patientdied in this case,thereis no liability with regard to informed conscnt or ethical error. The patient mlrst undcrstand the risks of a procedure just as a drivcr rrust understand the risks before getting behind the wheel of a car.
Why can't you sLlca car manufacturer if you die in a car accidcnt? Predominantlybecauseyou are an adult with the capacityto ur.
Each time you get in a car,there is i. For example, a patient comcs to the emergencydcpartnent with appendicitis. He is inforrned of the risks of surgery,and refusesthc procedurc both verbally and in rvriting.
Vhat was done rvrong here? Thepatientsmust be informcd both of the risk of thc treatmentasrvellasu,hatwill happcn iftheydon'tundcrgothe procedure. In this casethe physicianis liablein court becausehe neverdocunented that he infornred the patient of the possibility of appendiceal rupturc anddcathif the patient did NOT havethc procedurc. If apatientsignsa consent for an appcnclectomy,but when you open her up you find colon cancetyou cannotjust do the colectomvwithout first informing the patient of the acldi- tionalprocedureand obtainingher consent.
Thcre can be no presumptionfor conscntfor anythingbeyond what the patient specifically saiclsheconsenteclto. For example, a 40 year-old man is undergoing a nasalpolypectomy. In the opcrat- ingroom you seea lesionon thc nasalturbinatethat the frozenscctiondetermines to be a cancer,You have found the cancer early but will need to rcsect the nasal turbinate to cure it.
What should you do? This is true evcn if the physicianis sincere,tale'ted, accurate,and helpful. Beneficcncedoes not elirninate the need for informed consent.
You must col]sent to the cleaning. His good intcntions are not asimportant asyour right to do what you wanl n'ith your otvn property. Although it is preferable to have thc patient's last k'own wishes docunented in writing, following verbally expressedwishesis perfectly valid.
The basisfor varidit. A patient cal. For example, a ycar-old nran with leukemia repeatcdly refuseschenrotherapy. He losesconsciousless and his rnother tclls you to givc the chentotherapy. What should you tell l.
You must rcspectthe l. If the paticr. If this rverepermissible,ther no one courdhavean estatewiI. The ultimate form of ross of decisitur naking capacitv is death.
For example, a ycar-old roman accontpanied by her husband comes to the emergency room seeking treatment for chest pain. The patient clearJytells you that shewants to haveher aorta repaired and shesignsconsent for the procedure. Shelater becomeshypoter. Her l. Informedconsent I ts e eyell: In the case above,becausethe patient exprcssedthat shewoulcr riketo haveher aorta repaired her hus- bandcannotgo againstthis aftershclosesconsciousness.
The samereasoningholds true if apatientrefusesa procedure or treatnent and then losescolrsciousDess. He has lost so much blood he rsunconscious. There is no family member availableto sign consent. What should youdo?
Thcmanagementof an emergency is different. Becauscwe must inform the patientabout all the optionsof treatment,risksof the options,and risksof not performingthe procedurein a languagethe patientcanunder- stand,theconsentmustbeobtainedby a personqualificdto maketheexDlanation. Forexemple,you arean intern who hasconsultedsurgeryto placea subclavian centralvenousline,Youonlyknow accessmustbeobtained. On thephonethesurgicalresident says,"Can.
Youmustnot bein a position to explainthe risksof proceduresthat you did not decide on. Ifthe patientdevelopsa pneumothoraxandyou do not knowwhy theinternaljugular approachisnot beingused,you cannotadequatelyinform thepatient. You must, at the risk of seeming difficult, tell the surgical residentthat he must obtain the consenthimsell If a complication occurs,you cannot say, "l wasjust gettinga papersigned;I didn't know what it meant.
If you tell the patient that he could havea pneumothorax and might need a chesttube and document this, and the patient still signs consent, then you are not at risk. The patient also cannot say latel "l rvasjust signing a piece of paper. I didn't know rvhat it meant. This is a legitimate form of consent by an authorized surrogate decision maker.
Forexample, a 65 year-old r. The head CT shows a ring or contrast-enhancingi lesion consistent with a brain abscess.
Kaplan Medical USMLE Medical Ethics: The Cases You Are Most Likely to See on the Exam
The patient remains persistently confused, but is not deteriorating. You need to perform a brain biopsy but there is no family member or health-care proxy who comes to visit hini.
His wife is housebound from multiple sclerosisand cannot get to the hospital. You have hcr on the phone but the nurse is refusing to be the witness for the consent, saying that telephone consent is not valid.
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As with all forms of verbal communication, oral advancedirectives,and telePhoneconsent are more difficult to prove if contested. However, they are equally valid. If a health-care worker is uncomfortable taking the telephone consent,useanother member of the health- care team to act asyour witness for the consent.
You can educatethe nurse later.
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You can take consent tbr cardiothoracic surgery over the phone if that is the only way to speakto the surrogate. The real questions about telephone consent are these: Is the personyou arespeakingto reallythe surrogate? Doesthe personknow the paticnt'swishes? Hence, no matter whatyour personal feeling may be, the fetus doesnot haveany intrinsic 'rights' asa person. So,even though a week-old fetus would be a viable child if the fetus were removed from the uterus, all health-care decision making and ethics are basedon the choicesof the motherand her interests.
Ifparents havea child born at 34 weeksof gestationalagein need of a blood transfusion to saveits life, they cannot refuse lifesaving therapy for the child evenifthey are Jehovah'sWitnesses. The statewould intervene in the interestsof the child. However,if the same child at 34 weeks of gestational ageis still in the uterus, the mother canreluse or accept whatever therapy she wishes without specific regard for the fetus. Hence,a pregnant woman may refusea lifesaving transfusion.
Shemay refusea Caesarian sectionto remove the child even if this will put the life of the fetus at risk. The father has no legal right to make an informed consent fbr any pregnancy- relatedissuebecausethe questions concern the body of the mother. A mother's autonomy overher own body is felt to be more important than the rights of the fetus or of the father. Onlythe mother can sign informed consent for any procedure or treatment during preg- nancy.
Any answerchoice that has 'Ask the father. Ifthe patient hasDown syndrome andhasa family member to make decisions for her then the question will be straightfor- ward-ask for the consent of the parent or guardian.
If there is no parent or guardian, the circumstanceis much more difficult. A third party court designeemust make a decision1, basedon the bestinterestsof the patient even though the patient may neverhur,. This is an advance directive written or formal. An advancedirective cannot even be given by a patient who hasnever had capacity. The same is true of a living will.
The next best method of giving consentis "substituted judgment. This is also not possiblefor a person who hasnever been competent. The weakestform of consentis to act: However, it is thc best method of obtainins consent for doctors treating a person who has never had capacity. A legalguar. In the absence of a family member the guardian is either appointed by the courts or is the administrator of the health carefacility, such asthe medical director. I rg ause ning hich ence 'ator Chapter4: Communications betseen paticnt and physician are highly privileged and this confiden tialit,vcar.
Medical information cannot be passedto anyone l ithout thc direct consent of thc patient. Confidentiality also includes keeping a patient's medicalinformation priyate even from his friends and family unless the patient expressly saISit is okay to releasethe information. The fact that a patient may have a good rclation shipwith his familv and fiiends is absolutely no excuseto assumethat the patient wants his medicalinformation passedon to them.
I have an exccllent relationship with my mother; hon'ever,even though I am a doctor or mavbe becauseofit shedoesnot want me to know herlist of medications. Shehasno obligation to give me a reasonrvhyshedoesnot want rne to know which mcdications she is taklng.
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If I call her doctor and sa1 "l just want to help mom vvith hcr mecls. What is she on? I know you mean well, but I iust can't talk to you about your mother's medical problen. The patient is arake and alert.
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His wife comesto you demanding inforn. She shorvsher identification card verilying this. What shouldyou tcll her? For example, the wife becontesinfuriatcd and storms off the floor, threatening to sueyou. You apologize to the patient for upsetting his wife by not speaking. The patient responds "On the contrary, Doctor, you did great. Although she is still my wife, we arc finalizing our divorce and we do not live together. I expect to be clivorced and rcmarriecl lvithin the next few months.
Sheonly wanted information about me to useagainstme in thc divorce proceeding. Thanks for protecting my confidentiality. However, the information can only be transferred if the patient has signed a consent or releaseform requesting the transfer of information. It is the patient who must sign the consent to releasethe infornation, not the health,care provider. This is how the system guarantees that the patient's medically privileged inforrnation only transfers to those people to whom the patient rvants it to go.
For example, yott receivea phone call from another physician who is rvell known to you in your local community. What do you tcll him? You should tell another physician requesting information to send you the patient's signed releaseform befbre you send him the infonration.
Her soncallsyou anclasksyou to givehim the infornation bccausc the family is concerned that the bad news will depresshis mothcr. He is sincerc and genuine in his concern.
There is no basisfor informing the family and not the patient. It is exactlythe oppositc: Maybethe patient wantsher family to know and maybeshedoesn't. It is alwaysthe patient's decision. There is a rare exception in the caseof a patient with a psychiatricdisturbancein rchom to inform if a meclicalcondition might induce a suicide attel1lpt. He shows 'ou proper identification stating that he is a government employee.
He is looking for your patient's immigration statusand for his medical condition. What do you tell the investigator? Ifthe investigator doesnot havea searchwarrant, then you must refusehim access to the files. You are not under any obJigation to make immigration statusinvestigations of vour patients nor to provide this information to third parties unless it is at the request of thepatient.
This right of privacy also coversgeneticinformation. You must keepthe medi calinformation private from a patient's co-workers aswell. The Tarasofcasc ,in whicha mentally ill paticnt toid thc psychiatristof his intent to harn sonreoDe,is a famousexample of this ln this type of case,thc physician must inform larvenlorcement asrvell asthe potential victim. Other casesin which it is lawfrl. Horvever,all effortsmust first bc made to enlist the patient to inform tr.
No lawsuit agai'sta physicia' for brenkingc. Although the medical record as ap,hysicaloblect rcnrains al. For example, you have a new patient with a complex history r,ho hasbecn tryingto get a copy of her record from her previous doctor. The practice administrator inforns you that thc paticnt is extremely unpreasantand aim.
The patient rcturns to seeyou thc tbllowing iav anclasksr. What tlo ,ou tell her? No one has a right to interfere with this for anyreason. You should tell her that she should be allowed a copy of the chart. A patient doesnot have to give her doctor a reason for requesting hcr own property, and she is entitledto this information whether or not she is "pleasant.
The need for information to take care of patients outweighs the physician'sright to payment. Anish rated it did not like it Feb 04, Mahmoud Salma rated it really liked it Mar 10, Bogdan Molfa rated it it was amazing Dec 30, Ryan rated it it was ok Jan 16, Sana rated it liked it Apr 08, Dr Rishi rated it really liked it Oct 21, Giancarlo Javier rated it it was amazing Aug 27, Yara rated it really liked it Dec 29, Shivam rated it it was amazing Jun 10, Bharati rated it it was amazing Apr 29, Odai rated it really liked it Feb 05, Vlad rated it it was amazing Jan 05, Mahrose rated it really liked it Jan 04, Aseel Nassar rated it it was amazing Jan 25, Sonal rated it it was amazing Oct 17, Dossou rated it liked it Dec 08, Adrian rated it it was amazing Dec 20, There are no discussion topics on this book yet.
Readers Also Enjoyed. About Conrad Fischer. Conrad Fischer. If the bill is enacted, companies including Apple, Facebook and Google parent Alphabet probably would have to pay European artists more and do more to keep work that appears online from being used without permission. The most controversial section would make companies responsible for copyrighted material that is uploaded to their platforms Outside parliament, a French band performed music to push the point that artists need higher payments and better copyright protection.
By a to margin, MEPs approved a final version of the Directive on Copyright in the Digital Single Market, including two controversial provisions: Article 11, which will require web aggregators like Google News to negotiate with media companies for sharing snippets of their works; and Article 13, which observers say will require web platforms hosting user-generated content to filter uploads for intellectual property violations.
While the ruling in Dynamex Operations West Inc. Superior Court of Los Angeles was intended to prevent employers from reclassifying certain types of workers as contractors as a way to avoid providing them with the same benefits and opportunities as full-time workers, the ruling has had unintended negative consequences for those workers who are and wish to have the option to remain independent contractors On Oct. This legislation creates a voluntary small claims board within the Copyright Office that will provide copyright owners with an alternative to the expensive process of bringing infringement claims in federal court.
Hatch-Bob Goodlatte Music Modernization Act MMA " makes important revisions to copyright law to accommodate the changes in music licensing practices that resulted from the rise of digital music streaming services. The law provides for a new collective licensing scheme that ensures that licensing income will be paid to songwriters, recording artists, and for the first time, sound producers and engineers for streaming and downloads of their work.
It also creates a federal right to pre sound recordings for the first time and makes them subject to the same statutory licenses as post sound recordings. The legislation also would make key changes to rate-setting proceedings for ASCAP and BMI songwriters by allowing for consideration of royalty rates for digital audio transmissions of sound recordings and randomly assigning a district court judge to hear rate-setting disputes The bill includes another important step toward realizing that principle.
Under current law, digital streaming platforms are able to profit from certain pre sound recordings without compensating the artists and copyright owners of these recordings. Extending the digital performance right to include all pre sound recordings helps ensure that the law recognizes and protects the contributions of all creators, and that legacy artists in particular are appropriately compensated for their work.They m.
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