Mercer Medical Ethics Course

Quiz 1

1. What are the four components of decision-making capacity?

a. Ability to understand- patient has to relay they comprehend whats going on
b. Ability to evaluate- can manipulate info rationally and compare benefits of different
options; keep a consistent choice over time
c. Ability to communicate- can communicate choices
d. The ability to deliberate in accordance with one’s own values

2. Explain four of the ten myths about decision-making capacity and why they are not true.
 Decision making capacity and competency are the same
o Incompetency has to be ruled by a court
o Decision making capacity made by medical professionals
 Lack of DMC can be presumed when patients go against medical advice
o Not about the outcome, rather decision-making capacity involves assessing the
process the patient uses
o Patients should be permitted to make even decisions healthcare providers consider
to be idiosyncratic decisions
o The responsibility of the physician is to make sure the decision is not the result of a
problem with capacity or misunderstanding
 Lack of DMC is a permanent condition
o It isn’t forever!... waxes and wanes
 DMC is an “all or nothing” phenomenon
o Can have DMC in regard to some decisions but not others

3. Name the three components to informed consent.

a. Decision Making Capacity
b. Disclosure
i. to deliberate about agreeing to treatment or refusing, the patient needs to have
information
c. Voluntariness
d. Understanding/Consent/Recommendation
i. Informed consent - rooted in the principle of autonomy; in obtaining informed
consent we respect the patient’s right to bodily integrity, to self-determination.
4. Name and define the two disclosure standards.
a. Professional Practice: disclosure is based on what the customary practice of
professionals in the providers community would deem appropriate
i. Community of physicians sets the legal standard of disclosure
ii. Physician determines when disclosure is ethically sufficient
b. Reasonable Person: Disclosure is based on what a reasonable person would consider
material in making this decision
i. (Reasonable )Patient sets the legal standard of disclosure
ii. (Reasonable) Patient determines when disclosure is ethically sufficient

5. Name and explain the three exceptions to the informed consent requirement?
a.
b.
c.

6. What does the following diagram represent and what does “Equal Partners” mean?

 this is the shared decision-making continuum- have to make sure patient feels most
comfortable… need to use clear communication and time

 In equal partners decision-making, the patient and physician work together to reach a
mutual decision.

 This process often requires a longstanding relationship, and both parties must understand
the values and biases of the other. Mutual respect and understanding are essential.

 Because the patient and physician necessarily have different perspectives, the physician
must ensure that it is the patient's values, not his/her own, that guide decision making.
 7. Name the two widely recognized types of death
a. Brain death- the absence of all clinical brain function, i.e., irreversible cessation of brain
function, including the brain stem,
i. Rule out confounding conditions –overdose, hypothermia
ii. Deep unresponsive coma
iii. No brain stem reflexes, absent respiratory efforts
iv. EEGS negative
b. Cardiac death- The irreversible loss of heart and lung functions signals the death of a
human being

8. Define and provide the difference between vegetative states and minimally conscious states?

◦ Vegetative state: Epitomized as “wakefulness without awareness”

◦ A condition of complete unawareness of self and the environment accompanied by sleep

wake cycles with either complete or partial preservation of brain stem and hypothalamic
autonomic functions

◦ Principles causes

 Traumatic Brain Injury

 Hypoxic-ischemic neuronal damage

 Brain infarction or hemorrhage

◦ Minimally Conscious State:

◦ A condition of severely altered consciousness in which minimal but definite behavioral

evidence of self or environmental awareness is demonstrated

◦ Principles causes

 Traumatic Brain Injury

 Hypoxic-ischemic neuronal damage

 Brain infarction or hemorrhage

◦ Coma  VS  MCS

◦ It is possible for these patients to experience suffering

 9. What was the key outcome from the Quinlan ruling in terms of refusing LST?

 Right of privacy encompassed right to refuse medical treatment

 Ironically by the time the decision was handed down she was already extubated and no longer
dependent on ventilator
◦ Lived another 9 years and died of sepsis
 KEY: CLARIFIED THAT SURROGATES WERE PERMITTED TO REFUSE LST ON BEHALF OF
INCAPACITATED PATIENTS AND CHANGED MEDICAL PRACTICE OF REMOVING LST FROM VS
PATIENTS ONCE IT HAD BEEN REFUSED BY SURROGATE EVEN IF THE PATIENT DIED

10. Name and explain the 5 of the ethical considerations, principles, values and concepts relevant
for case discussion (Discussed in first lecture)?
- Nonmaleficence – avoid causing harm
- Beneficence- maximize what is beneficial to the patient; greatest benefit is health
- Justice- obligation to be fair and impartial… treat people similarly
- Autonomy- obligation to respect a patient’s preferences and decisions according to their beliefs
and values (SELF RULE)
- Consequentialism - Ethical reasoning based on consequences assumes that a course of action is
right or wrong depending on the balance of its anticipated consequences, good and bad

11. Provide the definition of brain death

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