Deck 3: Paternalism and Patient Autonomy

Question 1

Court rulings have established that competent patients have a right to

A) receive any existing treatment.
B) reject recommended treatments.
C) assist a loved one in committing suicide.
D) receive the best medical care available anywhere.

Answer 1

B

Question 2

The model of the physician-patient relationship favored by the Emanuels is the _______ model.

A) paternalistic
B) informative
C) interpretive
D) deliberative

Answer 2

D

Question 3

An advance directive is a legal document that speaks for you if you are

A) incapacitated.
B) without family.
C) without legal counsel.
D) autonomous.

Answer 3

A

Question 4

A DNR is a directive telling the medical staff to

A) forgo CPR on a patient.
B) stop caring for a patient.
C) preserve life at all costs.
D) prolong treatment.

Question 5

In general, Kantian ethics views paternalism as

A) a necessary evil.
B) dependent on circumstances.
C) a violation of autonomy.
D) part of a physician's duty.

Question 6

A physician knows that if they tell their patient the truth about their diagnosis, it will complicate their treatment and recovery. However, they reason that in the long run, lies do more harm than good because they erode public trust in the medical profession and it is best to adhere to a rule of honesty in diagnosis. This physician is adhering to a _______ moral theory in their reasoning.

A) act-utilitarian
B) rule-utilitarian
C) Kantian
D) natural law

Question 7

A competent patient is refusing a life-saving treatment for religious reasons. Their physician is distressed by this refusal, but reasons that respect for the rights and autonomy of the patient trumps all other considerations. To ignore the patient's decision to refuse treatment would be to treat the patient merely as a means and not as an end. This physician is adhering to a _______ moral theory in their reasoning.

A) act-utilitarian
B) rule-utilitarian
C) Kantian
D) natural law

Question 8

A physician who refuses to pursue a treatment on the grounds that it would be pointless and inconsistent with reasonable standards of medical practice is appealing to

A) natural law.
B) medical futility.
C) patient autonomy.
D) None of the above

Question 9

In response to a physician's refusal to administer treatment they deem pointless or ineffective, a patient's family argues that the physician has a moral duty to keep the body alive at all costs. The family is appealing to

A) the sanctity of human life.
B) Kantian principles.
C) patient autonomy.
D) beneficence.

Question 10

Regarding the right of patients to forgo CPR via a do-not-resuscitate order, the AMA wrote: "The physician has an ethical obligation to honor the resuscitation preferences expressed by the patient. Physicians should not permit their personal value judgments about quality of life to obstruct the implementation of a patient's preferences regarding the use of CPR."
This line of reasoning most clearly illustrates the principle of

A) beneficence.
B) nonmaleficence.
C) patient autonomy.
D) paternalism.

Question 11

The _______ principle states that autonomous persons should be allowed to exercise their capacity for self-determination.

A) beneficence
B) nonmaleficence
C) autonomy
D) double effect

Question 12

The doctrine of informed consent was developed primarily to safeguard

A) patient autonomy.
B) physician autonomy.
C) the sanctity of human life.
D) weak paternalism.

Question 13

People opposed to _______ argue that it is wrong because it violates the rights of persons to determine for themselves what is good and what is right.

A) weak paternalism
B) strong paternalism
C) utilitarianism
D) the doctrine of double effect

Question 14

Physicians face pressure from pharmaceutical companies to use expensive treatments of limited efficacy, are penalized for low productivity, and have financial incentives to recommend procedure-oriented interventions in place of minimally invasive counseling. These all represent serious threats to

A) patient autonomy.
B) physician autonomy.
C) the sanctity of human life.
D) weak paternalism.

Question 15

A toddler is seriously injured and the only way to save her life is to give her a blood transfusion. Her Jehovah's Witness parents refuse because the procedure is explicitly forbidden by their faith. The physicians proceed with the transfusion and save the girl's life and the parents sue the physicians and the hospital by claiming _______ was violated.

A) the right to refuse treatment
B) the sanctity of human life
C) an advance directive
D) the principle of beneficence

Question 16

Early medical practice was strongly paternalistic.

Question 17

The Hippocratic Oath asserts patients' rights to decide about their own medical care.

Question 18

Physician autonomy is the freedom of doctors to determine the conditions they work in and the care they give patients.

Question 19

Courts have stretched the right of competent patients to reject recommended treatments to situations in which they become incompetent (e.g., lapse into a coma) via advanced directives or other evidence of their preferences.

Question 20

The utilitarian philosopher John Stuart Mill endorsed state paternalism.

Question 21

A person is either fully autonomous or entirely lacking in autonomy.

Question 22

Act- and rule-utilitarians do not dramatically disagree on how to balance patient autonomy and provider beneficence.

Question 23

It is an accepted truth that nurses have a duty to follow a doctor's orders even when they think those orders are questionable. Physicians must always be the ultimate authority on treatment in urgent or serious cases.

Question 24

Limitations on a person's autonomy can include psychological coercion.

Question 25

Only a few states have religious exemptions in their civil codes on child abuse or neglect.

Question 26

Although patient autonomy is a serious concern that is hotly debated, physician autonomy is rarely a cause for concern or debate.

Question 27

There is legal and medical consensus that an adolescent can be a "mature minor" to make health decisions for themselves.

Question 28

A physician is not obligated to perform medically futile treatments even if it will keep the patient's body alive.

Question 29

Ultimately, the courts affirmed Elizabeth Bouvia's right to die by starvation on the grounds that she had a constitutionally guaranteed right to refuse medical treatment.

Question 30

Natural law theory is more paternalistic than Kantian ethics.

Question 31

In your own words, define paternalism and explain the difference between strong and weak paternalism.

Question 32

A patient is pushing to receive a treatment their doctor deems medically futile. What is a widely recognized principle to which the physician can appeal?

Question 33

What is an "advance directive" and how can it extend patient autonomy?

Question 34

Explain why Kantian ethics rejects paternalism.

Question 35

Explain why act- and rule-utilitarians might disagree on cases concerning patient autonomy and paternalism.

Question 36

The Following Questions For Readings: "Paternalism," Gerald Dworkin
-Dworkin accepts Mill's view that society may sometimes justifiably restrict a person's liberty for purposes of

A) national security.
B) self-protection or the prevention of harm to others.
C) maintaining respect for society.
D) teaching the person a lesson.

Question 37

The Following Questions For Readings: "Paternalism," Gerald Dworkin
-Dworkin argues that some limited forms of state paternalism

A) cannot be justified.
B) will always be wrong.
C) are never used in practice.
D) can be justified.

Question 38

The Following Questions For Readings: "Paternalism," Gerald Dworkin
-Dworkin argues that the state's burden of proof in justifying paternalism is

A) light.
B) heavy.
C) irrelevant.
D) immaterial.

Question 39

The Following Questions For Readings: "The Refutation of Medical Paternalism," Alan Goldman
-Goldman argues that persons

A) are never the best judges of their own interests.
B) should leave decisions about their health to experts.
C) are the best judges of their own interests.
D) should accept that strong paternalism in medicine is usually justified.

Question 40

The Following Questions For Readings: "The Refutation of Medical Paternalism," Alan Goldman
-Goldman asserts that self-determination is

A) not really valuable for its own sake.
B) valuable for its own sake.
C) valuable because of its positive effects.
D) valuable in only a few circumstances.

Question 41

The Following Questions For Readings: "The Refutation of Medical Paternalism," Alan Goldman
-Goldman says that health and prolonged life

A) are always what patients want most.
B) can be assumed to be the top priorities for patients.
C) do not matter among most patients.
D) cannot be assumed to be the top priorities for patients.

Question 42

The Following Questions For Readings: "Why Doctors Should Intervene," Terrence F. Ackerman
-According to Ackerman, true respect for autonomy may require the physician to

A) never deviate from the patient's stated preferences.
B) intervene.
C) intervene only in accordance with the patient's stated preferences.
D) refrain from intervening.

Question 43

The Following Questions For Readings: "Why Doctors Should Intervene," Terrence F. Ackerman
-Ackerman says that autonomy can be compromised by

A) illness.
B) hospital costs.
C) honest physician-patient communication.
D) family support.

Question 44

The Following Questions For Readings: "Why Doctors Should Intervene," Terrence F. Ackerman
-Ackerman argues that the non-interference approach fails to genuinely respect autonomy because

A) autonomy is an all-or-nothing concept.
B) only one factor can compromise autonomy.
C) it fails to follow all aspects of the patient's preferences.
D) it does not recognize that many factors can compromise autonomy.

Question 45

The Following Questions For Readings: "Autonomy, Futility, and the Limits of Medicine," Robert L. Schwartz
-Schwartz says that in the Wanglie case, the central question was not whether the treatment requested by the patient was futile, but whether the treatment was

A) beyond the proper limits of medicine.
B) beyond the limits of futility.
C) effective.
D) understood by the physician.

Question 46

The Following Questions For Readings: "Autonomy, Futility, and the Limits of Medicine," Robert L. Schwartz
-Schwartz says that physicians are not required by the principle of autonomy to

A) respect any wishes of patients.
B) give scientifically futile treatments.
C) respect patients.
D) understand patients' wishes.

Question 47

The Following Questions For Readings: "Autonomy, Futility, and the Limits of Medicine," Robert L. Schwartz
-Schwartz says that defining the scope of medicine should be left to

A) holistic doctors.
B) patients.
C) physicians.
D) nurses.

Question 48

The Following Questions For Readings: "Four Models of the Physician-Patient Relationship," Ezekiel J. Emanuel and Linda L. Emanuel
-Which physician-patient relationship model aims to help the patient determine and choose the best health-related values that can be realized in the clinical situation?

A) The paternalistic model
B) The informative model
C) The interpretive model
D) The deliberative model

Question 49

The Following Questions For Readings: "Four Models of the Physician-Patient Relationship," Ezekiel J. Emanuel and Linda L. Emanuel
-According to the Emanuels,

A) physicians rarely advocate the paternalistic model as an ideal in routine physician-patient interactions.
B) physicians rarely advocate the interpretive model as an ideal in routine physician-patient interactions.
C) physicians rarely advocate the deliberative model as an ideal in routine physician-patient interactions.
D) the deliberative model is very unlikely to metamorphose into unintended paternalism.

Question 50

The Following Questions For Readings: "Four Models of the Physician-Patient Relationship," Ezekiel J. Emanuel and Linda L. Emanuel
-According to the Emanuels, the dominant model in bioethics has been the _______ model.

A) interpretive
B) informative
C) autonomous
D) professional

Question 51

The Following Questions For Readings: "Confronting Death," Dax Cowart and Robert Burt
-Dax Cowart refused to consent to the treatments for his injuries because

A) the treatments were expensive.
B) he was judged incompetent.
C) he wanted to live.
D) they were so excruciatingly painful.

Question 52

The Following Questions For Readings: "Confronting Death," Dax Cowart and Robert Burt
-Robert Burt thinks it important that anyone hearing a request to die from someone like Dax Cowart should

A) not try to talk him out of dying.
B) explore the request with him and even argue with him.
C) assume that he is incompetent.
D) try to persuade him to accept the treatments.

Question 53

The Following Questions For Readings: "Confronting Death," Dax Cowart and Robert Burt
-Dax Cowart insists that no one has the right to

A) force medical treatment on you without your consent.
B) try to persuade you to submit to treatment.
C) tell you that you're making a mistake.
D) try to determine if you are competent.

Question 54

The Following Questions For Readings: Bouvia v. Superior Court, California Court of Appeals
-The Bouvia ruling asserted that a competent patient

A) has few rights.
B) has no right to privacy.
C) may not refuse treatment that has been sanctioned by a court.
D) may refuse treatments even if they are needed to keep the patient alive.

Question 55

The Following Questions For Readings: Bouvia v. Superior Court, California Court of Appeals
-The court ruled that preferring a natural death to a drugged life attached to a mechanical device is

A) immoral.
B) illegal and contrary to tradition.
C) not illegal or immoral.
D) not legal.

Question 56

The Following Questions For Readings: Bouvia v. Superior Court, California Court of Appeals
-The Bouvia ruling asserted that competent adults have a "constitutionally guaranteed right" to

A) disobey the lawful orders of the court.
B) decide for themselves what treatments they feel are effective.
C) decide for themselves whether to submit to medical treatments.
D) decide on the treatment for others.

Question 57

The Following Questions For Readings: "Fundamental Elements of the Patient-Physician Relationship," AMA Council on Ethical and Judicial Affairs
-The AMA's medical code of ethics says that physicians should serve as

A) their patients' legal guardians.
B) their patients' conscience.
C) protectors of their own professional rights.
D) their patients' advocates.

Question 58

The Following Questions For Readings: "Fundamental Elements of the Patient-Physician Relationship," AMA Council on Ethical and Judicial Affairs
-The AMA's medical code says that physicians should respect their patients' right to

A) receive any treatment available.
B) receive complete information about treatments and their alternatives.
C) decide on the optimal course of action.
D) receive futile treatments.

Question 59

The Following Questions For Readings: "Fundamental Elements of the Patient-Physician Relationship," AMA Council on Ethical and Judicial Affairs
-The AMA's code asserts that patients are entitled to

A) receive independent professional opinions.
B) direct the physician's work as it regards the patient.
C) any futile treatment.
D) any treatment beyond the bounds of medical practice.

Question 60

The Following Questions For Readings: "Advocacy or Subservience for the Sake of Patients?," Helga Kuhse
-Kuhse argues that requiring nurses to be subservient to physicians would probably

A) benefit the practice of medicine.
B) harm doctors.
C) have no effect on the quality of care.
D) harm patients.

Question 61

The Following Questions For Readings: "Advocacy or Subservience for the Sake of Patients?," Helga Kuhse
-Kuhse says that the adoption by nurses of a subservient role would be

A) an uplifting role for many contemporary nurses.
B) an utterly demoralizing role for many contemporary nurses.
C) a way to strengthen the professional status of nurses.
D) a good way to meet the emotional needs of patients.

Question 62

The Following Questions For Readings: "Advocacy or Subservience for the Sake of Patients?," Helga Kuhse
-Kuhse insists that the nurse's obligation to follow a doctor's order

A) can be ignored most of the time.
B) must be absolute.
C) cannot be absolute.
D) can only end in mistakes.