Ethics & Professionalism
Medical Ethics & Communication
Ethics & Professionalism

Medical Ethics & Communication

Capacity, consent, confidentiality, end-of-life.

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◆Core principles

  • •Autonomy: patient's right to decide
  • •Beneficence: act in patient's best interest
  • •Non-maleficence: do no harm
  • •Justice: fair distribution of resources

◆Capacity vs competence

  • •Capacity: clinical decision (any physician); decision-specific; can fluctuate
  • •Competence: legal determination
  • •Capacity requires: understanding, appreciation, reasoning, expression of choice

◆Informed consent

  • •Required elements: diagnosis, treatment options, risks/benefits, alternatives, prognosis without treatment
  • •Exceptions: emergencies, waiver, therapeutic privilege (rarely), incompetent patient
  • •Adolescents: parental consent generally required; EXCEPTIONS: emancipated minors (married, military, financially independent, pregnant); STIs, contraception, prenatal care, substance abuse, mental health (varies by state)

◆Confidentiality exceptions (must report)

  • •Reportable infectious diseases (TB, STIs, HIV varies)
  • •Suspected child or elder abuse
  • •Tarasoff: duty to warn identifiable third party of imminent harm
  • •Gunshot wounds, certain injuries
  • •Imminent suicidal/homicidal risk

◆End-of-life

  • •Living will: document wishes
  • •Healthcare proxy/DPOA: surrogate decision-maker
  • •DNR/DNI: do not resuscitate/intubate
  • •Palliative care: symptom-focused; can be alongside curative
  • •Hospice: life expectancy <6 months; focus on comfort
  • •Physician-assisted death: legal in some states (Oregon, Washington, etc.); patient must be terminal, competent, request multiple times
  • •Euthanasia: not legal in US
  • •Withholding vs withdrawing treatment: ethically equivalent
  • •Surrogate hierarchy: spouse → adult children → parents → siblings (varies)

◆Common scenarios

  • •Pregnant adolescent: don't need parental consent for prenatal care
  • •STI in adolescent: don't need parental consent; don't disclose to parents
  • •Jehovah's Witness refusing blood: respect for competent adult; in pregnant woman, may compel for viable fetus depending on jurisdiction; in minors, court orders may override
  • •Doctor-patient sexual relationship: never appropriate (even after termination of care for some specialties)
  • •Gifts from patients: small acceptable; large or coercive should be declined
  • •Errors: disclose to patient; apologize without admitting liability outside protected discussion

High-yield pearls

  • ◆Capacity ≠ Competence (capacity = clinical, competence = legal)
  • ◆Tarasoff: duty to warn AND protect (e.g., notify police, hospitalize)
  • ◆Always rule out reversible causes (delirium, depression) before accepting refusal of care
  • ◆Pregnant minor: most states allow medical decisions for self and child
  • ◆Death by neurologic criteria = legal death (covered in seizures note)
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