Lecturio: Study for Medical School, USMLE, MCAT & MBBS

Videos
Quiz
Concept Pages

You're currently in preview mode. Create your free account to save your progress and access more questions.

Brain death is a legal and clinical term describing the irreversible cessation of all cerebral and brainstem functions, including the ability of the brain stem to regulate vegetative and respiratory activities. Brain death can be due to a variety of etiologies causing catastrophic injuries to the brain, including brain ischemia due to cardiopulmonary arrest, drugs, sepsis, and trauma. The diagnosis is made at the bedside based on the clinical context and performance of a neurological exam. Additional ancillary studies may be needed to support the diagnosis, and diagnostic criteria may vary among states and countries. A diagnosis of brain death must be established prior to consideration of organ donation.

Informed Consent

Informed consent (IC) is a medicolegal term describing the documented conversation between a patient and their physician wherein the physician discloses all relevant and necessary information to a patient who is competent to make an informed and voluntary decision regarding their care. Competency, disclosure, and voluntariness are the key elements upon which IC is based. The patient's well-being and autonomy are the 2 key fundamental moral values that are preserved by IC. Medical care decisions requiring IC range from the choice to undergo a defined medical or surgical treatment to participation in a research study. The IC represents shared decision-making between the patient and their caregiver and is thus mandatory for both clinical care and enrollment in research studies. Informed consent is usually documented in a signed written form.

Clinician-Patient Relationship

The physician–patient relationship is an important component of health care delivery. (The terms physician and clinician will be used interchangeably here, acknowledging that other clinicians have similar relationships with patients and are bound by the same code of ethics.) Except in emergencies, before a clinician can initiate a medical or surgical intervention with a patient, a relationship of trust and empathy must exist, allowing the patient to talk about their medical issues. The clinician–patient relationship is a bond that, in many cases, requires some cultivation and may ultimately result in better outcomes. In the United States, the American Medical Association publishes a code of ethics that details the principles physicians must adhere to in providing medical care; these standards of conduct extend to the physician–patient relationship.

Basics of Medical Ethics

Medical ethics are a set of moral values that guide the decision-making of health care professionals in their daily practice. A sense of ethical responsibility has accompanied the profession of medicine since antiquity, and the Hippocratic oath was the 1st document to codify its core ethical principles (benevolence, autonomy, nonmaleficence, and distributive justice). In the 20th century, bioethics began to explore the moral relationship between humans and their world.

Persistent Vegetative State

The term “persistent vegetative state,” also called unresponsive wakefulness, describes the condition of individuals with severe anoxic brain injury who have progressed to a state of wakefulness without any meaningful response to their environment. A persistent vegetative state is distinguished from a coma in that individuals in a persistent vegetative state have intermittent sleep–wake cycles. The individual's eyes may be open and there may be some yawning, grunting, or other vocalizations. In both cases, the individual is alive, but the brain does not function fully. Persistent vegetative state is most commonly associated with anoxic brain injury due to cardiac arrest, trauma, metabolic causes, or infections. Diagnosis is made by fulfilling specific diagnostic criteria. Treatment is controversial and ethically challenging. Recovery of consciousness from a posttraumatic persistent vegetative state is unlikely after 12 months, while recovery from a nontraumatic persistent vegetative state after 3 months is exceedingly rare.

End-of-life Issues

The end of a patient’s life has been a difficult, complex, and often controversial aspect of medicine, because, historically, death has been conceptualized as a “failure” on the physician’s part. As our understanding of death has evolved, so has the physician's relationship to it, becoming a companion to the patient in their final moments. Moreover, experienced doctors understand that during the last days of a person’s life, the focus must be on maximizing quality of life rather than on prolonging it.

Decision-making Capacity and Legal Competence

Decision-making capacity and legal competence are terms often used interchangeably in a hospital setting to describe an individual's ability to make consequential decisions regarding themselves, as a manifestation of their autonomy. More specifically, however, capacity describes a patient’s ability to make autonomous decisions regarding their care, as determined by a physician, whereas competence is a legal term that describes a person’s ability to participate in legal processes, as determined by a judge.

Patient-Doctor Confidentiality

Confidentiality is a set of rules that dictates the protection of health information shared by a patient with a physician. In general, this information should only be used to dictate medical decision-making steps and can only be disclosed to a 3rd party with the patient’s express consent. While there are some specific situations where patient-doctor confidentiality may be broken (e.g., when the patient is at risk for self-harm), these situations are considered exceptions and clinicians ought to make sure that confidentiality is not unnecessarily jeopardized.

Advance Directives

The term advance directive (AD) refers to treatment preferences and/or the designation of a surrogate decision-maker in the event that a person becomes unable to make medical decisions on their own behalf. Advance directives represent the ethical principle of autonomy and may take the form of a living will, health care proxy, durable power of attorney for health care (DPAHC), and/or a physician’s order for life-sustaining treatment (POLST). Do not resuscitate and do not intubate orders are 2 important types of ADs.

Disclosure of Information

Disclosure of information is the process through which physicians explain clinical information to their patient (or surrogate decision-maker) in a way that the patient or surrogate can understand. This process is crucial for patients to understand their clinical situation and make informed decisions about their care. In every scenario, especially when delivering bad news, the clinician must be sensitive, patient, empathetic, and professional. They must provide all relevant information and answer all questions. Disclosing medical errors can be especially difficult.

Coma

Coma is defined as a deep state of unarousable unresponsiveness, characterized by a score of 3 points on the GCS. A comatose state can be caused by a multitude of conditions, making the precise epidemiology and prognosis of coma difficult to determine. Diagnosis is made clinically with a thorough neurologic examination, including assessment of the brain stem to evaluate for the presence of brain death. Definitive management depends on the underlying cause.

Cardiopulmonary Resuscitation (CPR)

Cardiopulmonary resuscitation (CPR) is an emergency procedure used in patients with cardiac arrest. Cardiopulmonary resuscitation combines the use of chest compressions, artificial ventilation, and, when available, an automatic external defibrillator (AED) to maintain circulatory flow and oxygenation to vital structures. Cardiopulmonary resuscitation is an integral part of basic life support (BLS) and advanced cardiovascular life support (ACLS). High-quality CPR improves the likelihood of survival. Some patients in critical situations request a do not resuscitate (DNR) order, which instructs health care providers not to do CPR if a patient suffers cardiac arrest.

Introduction to Clinical Ethics (RN Nursing) 01:06 h / 11 videos

Introduction to Clinical Ethics (RN Nursing) 1 concept page 1 free

Introduction to Clinical Ethics (RN Nursing) 30 quiz questions 0 free
Communication with Patients and within the Healthcare Team 00:56 h / 9 videos 2 free

Communication with Patients and within the Healthcare Team 1 concept page 1 free

Communication with Patients and within the Healthcare Team 26 quiz questions 7 free
Informed Consent and Capacity (RN Nursing) 00:59 h / 8 videos

Informed Consent and Capacity (RN Nursing) 2 concept pages 2 free

Informed Consent and Capacity (RN Nursing) 30 quiz questions 0 free
Patient Confidentiality and Privacy 00:46 h / 6 videos 1 free

Patient Confidentiality and Privacy 3 concept pages 3 free

Patient Confidentiality and Privacy 23 quiz questions 4 free
Organ and Tissue Donations 00:17 h / 4 videos 1 free

Organ and Tissue Donations 1 concept page 1 free

Organ and Tissue Donations 9 quiz questions 2 free
Ethical Considerations in Palliative Care (RN Nursing) 01:19 h / 18 videos 6 free

Ethical Considerations in Palliative Care (RN Nursing) 6 concept pages 6 free

Ethical Considerations in Palliative Care (RN Nursing) 40 quiz questions 14 free

5 Stars		2
4 Stars		0
3 Stars		0
2 Stars		0
1 Star		0

5 Stars		2
4 Stars		0
3 Stars		0
2 Stars		0
1 Star		0

Clinical Ethics (RN Nursing)

Course Details

Content

Your Educators of course Clinical Ethics (RN Nursing)

Mark Hughes, MD, MA

Michael Erdek, MD, MA

User reviews