Deck 8: Professional-Patient Relationships

Question 1

The four rules of professional-patient relationships set forth and explained by Beauchamp and Childress are:

A) Autonomy, privacy, respect, and confidentiality
B) Veracity, privacy, beneficence, and nonmaleficence
C) Respect for autonomy, nonmaleficence, beneficence, and justice
D) Veracity, privacy, confidentiality, and fidelity

Answer 1

D

Question 2

How, according to Beauchamp and Childress, have codes of medical ethics treated obligations and virtues of veracity in medicine?

A) The original Code of Medical Ethics of the American Medical Association (AMA) institutes veracity as an obligation for physicians when they treat patients.
B) Although veracity is mentioned in various AMA codes, it has traditionally been unspecified and relatively neglected.
C) Veracity was praised in earlier codes of ethics of the AMA, but issues of truth and honesty are not mentioned at all in the most recent codes.
D) In codes of medical ethics, veracity has only been discussed in terms of other principles such as respect for autonomy.

Answer 2

B

Question 3

What is Beauchamp and Childress's understanding of the place of veracity as a moral obligation?

A) Beauchamp and Childress understand obligations of veracity to be specifications of more than one of the four basic principles (respect for autonomy, nonmaleficence, beneficence, justice).
B) Beauchamp and Childress claim that it isn't clear whether veracity is an absolute and independent obligation or a special application of another principle.
C) Beauchamp and Childress think that veracity is an independent principle and virtue, on the same level as respect for autonomy, beneficence, nonmaleficence, and justice.
D) Beauchamp and Childress think that veracity is a specification of the principle of respect for persons' autonomy.

Answer 3

A

Question 4

What is the moral status of the obligations of veracity, privacy, confidentiality, and fidelity, according to Beauchamp and Childress?

A) All are absolutely binding on health care professionals at all times.
B) Fidelity is an absolutely binding principle, whereas veracity, privacy, and confidentiality are only prima facie binding.
C) All are prima facie binding and can sometimes be outweighed by other moral considerations.
D) Privacy and confidentiality must be respected at all times, but conflicts of interest sometimes necessitate difficult moral decisions regarding issues of veracity and fidelity.

Question 5

In the case described by Beauchamp and Childress of a ninety-year-old patient with a squamous cell carcinoma who was extremely fearful of cancer, which of the following was NOT set forth as a justification for "intentional verbal inaccuracy" on the part of the physician who treated the patient?

A) The patient was in need of "effective reassurance."
B) The patient's family urged the physician not to tell him that the ulcer on his lip was cancer, because of the patient's fearfulness of the disease.
C) In the physician's judgment, it was "more truthful" to tell the patient he did not have cancer, because the patient was unable to accept the idea that he had a treatable and curable cancer.
D) Addressing the patient and his concerns in his own language expressed respect, not paternalistic arrogance.

Question 6

Beauchamp and Childress argue that the following is a primary moral responsibility regarding medical errors:

A) Developing systems, including training programs, to reduce medical errors
B) Removing professionals deficient in personal character, knowledge, or skills who make or are likely to make medical errors
C) Disclosing specific medical errors to patients and their families
D) All of the above

Question 7

Beauchamp and Childress make the following argument about deception of third-party payers in the health care field:

A) Physicians should place a premium on seeking alternative, nondeceptive courses of action, such as formal appeals, and should work to alter unduly restrictive systems.
B) Deception of third-party payers can never be justified.
C) Physicians should practice fidelity to their patients by doing whatever it takes to make sure the appropriate tests and treatments are paid for.
D) Third-party payers may sometimes be deceived, but only those who have demonstrated callousness toward patients or unwillingness to work with physicians to provide and pay for proper diagnosis and treatment.

Question 8

Which of the following is true about the development of laws and legal theory about privacy in the twentieth century?

A) Privacy has been considered a subcategory of "liberty" in court decisions about personal choices.
B) The case cited by Beauchamp and Childress in their discussion of laws and legal theory about privacy had to do with abortion.
C) In Griswold v. Connecticut, precedent was set that the right to privacy included the protection of a sphere of individual and familial decision making from governmental influence.
D) All of the above

Question 9

Besides informational, physical, decisional, and proprietary privacy, Beauchamp and Childress propose the following kind of privacy as important in medical ethics:

A) Familial
B) Relational
C) Medical
D) Confidential

Question 10

Beauchamp and Childress believe that the following is the primary justification of the right to privacy:

A) A cluster of personal and property rights gives rise to a right to privacy.
B) The right to privacy is instrumental, valuable insofar as it enables people to achieve other ends.
C) Privacy is justified in relation to respect for autonomy, because we owe respect to people's autonomous wishes not to be observed, intruded on, and so forth.
D) Privacy is justified based on health care professionals' obligations of fidelity to their patients and those patients' wishes.

Question 11

Beauchamp and Childress state that the following is one justification of a right to privacy:

A) Privacy is a basic right of its own.
B) A system of medical care would fall apart without respect for privacy.
C) Violation of privacy violates the principle of nonmaleficence.
D) A right to privacy is derived from respect for autonomy.

Question 12

According to Beauchamp and Childress, why was the program initiated by the Department of Health and Mental Hygiene in New York City to track citizens with diabetes ethically questionable?

A) The program does not identify persons with undiagnosed diabetes or prediabetes.
B) The program is solely informational; it does not provide any additional resources for prevention and treatment services.
C) This program and others like it may open the way for additional and more extensive registries of sensitive data, without adequate justification.
D) All of the above

Question 13

Based on Beauchamp and Childress's discussion of privacy and confidentiality, what would be an example of a breach of privacy that does not involve a breach of confidentiality?

A) A person who does not have authorization views a patient's medical record on a hospital computer.
B) One physician discusses a patient's case with another who is not involved in the patient's treatment, using the patient's name and identifying information.
C) A therapist calls a suicidal patient's family members to ask them to look out for the patient's well-being.
D) A physician talks to his or her spouse in detail about the patients under his or her care.

Question 14

Which of the following is NOT true about rules of confidentiality, as described by Beauchamp and Childress?

A) Rules of confidentiality have been followed carefully by physicians for centuries.
B) Rules of confidentiality are arguably the most widespread rules in medical ethics across time and cultures.
C) Rules of confidentiality are largely ceremonial unless an underlying medical culture values the protection of health information.
D) Rules of confidentiality have appeared in codes of medical ethics for centuries.

Question 15

What sort of cases do Beauchamp and Childress refer to as "paradigm" cases for justified breach of confidentiality?

A) Cases in which a patient may harm him- or herself if health care workers do not intervene
B) Cases in which HIV might be spread from one individual to another
C) Cases in which an illness may be spread quickly by an infected individual
D) Cases in which there is a high probability of a major harm to an identifiable individual

Question 16

All of the following are reasons that confidentiality should be breached in order to inform an individual's relatives about their genetic risks EXCEPT:

A) There is a high probability of irreversible or fatal harm to the relative.
B) The relatives are immediate family members.
C) The disclosure of information will likely prevent harm to the relatives.
D) Attempts to elicit voluntary disclosure fail.

Question 17

How have codes of nursing ethics changed from the early to the later part of the twentieth century?

A) Earlier codes stated that nurses were obligated to carry out physicians' orders; current codes stress nurses' obligations to clients and the general public.
B) Earlier codes stressed nurses' obligations to clients and the general public; current codes stress nurses' obligations to physicians.
C) Earlier codes counseled nurses always to remain loyal to their colleagues; later codes dropped this counsel.
D) Earlier codes made no clear ethical demands on nurses; later codes incorporated expectations that nurses would act ethically and make sure that others were acting ethically as well.

Question 18

The level of risk that arises from a conflict of interest in health care, according to Beauchamp and Childress, depends on:

A) The likelihood that the professional will put the interests of a third party ahead of those of his or her patients and the magnitude of harm that may result
B) The number of competing interests that a professional is balancing in a given situation and the lack of respect the professional shows for his or her patients because of those competing interests
C) The probability that the professional's personal interests will have an undue influence on his or her judgments, decisions, or actions, and the magnitude of harm that may occur as a result
D) All of the above

Question 19

Which of the following best describes the relationship between clinical research and clinical medical practice, as discussed by Beauchamp and Childress?

A) Research has been heavily regulated because it has been thought to place subjects at risk for the benefit of others and to investigate unconfirmed hypotheses about diagnoses and treatments.
B) Medical practice is minimally regulated on grounds that it focuses on the patient's best interests and relies on interventions of proven benefit and acceptable risk.
C) The sharp distinction often drawn between research and medical practice is morally questionable.
D) All of the above

Question 20

To be ethically justified, clinical research must satisfy conditions that include:

A) A goal of valuable knowledge, selection of a subject who will not be harmed by the research, and measures to protect privacy and confidentiality
B) A goal of valuable knowledge, reasonable prospect that the research will generate the knowledge that is sought, and direct benefit to each subject who participates
C) A goal of valuable knowledge, favorable balance of potential benefits over risks to the subjects, and the prospect that the treatment being tested will be available within a short timeframe
D) A goal of valuable knowledge, reasonable prospect that the research will generate the knowledge that is sought, and fair selection of subjects

Question 21

According to Beauchamp and Childress, codes of medical ethics have traditionally ignored obligations and virtues of veracity.

Question 22

Veracity is absolutely binding as a moral principle; physicians should always be truthful with their patients about their health.

Question 23

Physicians ought to take into account patients' cultural backgrounds when determining how much information about a patient's health to disclose, including consulting with family members without a patient's consent in certain cases.

Question 24

According to Beauchamp and Childress, a choice not to know information about one's diagnosis or prognosis can be as autonomous and worthy of respect as a choice to know.

Question 25

When a medical error has been made, disclosure to the patient and family members about the error may be the best policy for reducing the likelihood of malpractice suits.

Question 26

Privacy is a matter of an agent's control over access to himself or herself.

Question 27

Concerns about privacy have to do not only with information about a person but also with bodily products and objects intimately associated with the person, as well as that person's intimate relationships.

Question 28

Breaching confidentiality for the sake of mitigating harm to a patient or to a third party can sometimes be justified.

Question 29

Patients recognize that physicians have a common practice of informally discussing cases to receive second opinions, but they normally do not expect their cases to be discussed in medical journals, at parties, or with spouses or friends.

Question 30

Generally, physicians and genetic counselors should err on the side of informing a patient's relatives about possible genetic diseases they may share with the patient, even if the patient does not consent to the disclosure.

Question 31

Obligations of fidelity can be different in research ethics and clinical ethics, but trustworthiness and loyalty are morally central virtues in both areas of biomedical ethics.

Question 32

Physicians' obligations of fidelity to patients require that physicians care for all people affected by an epidemic disease.

Question 33

The ethical justification of randomized clinical trials hinges upon whether informed consent has been given by all trial subjects.

Question 34

The code of the American Nurses' Association currently stresses nurses' obligations to clients and their obligations to safeguard clients and the public from unethical practices.

Question 35

________ in health care refers to accurate, timely, objective, and comprehensive transmission of information, as well as to the way the professional fosters the patient's or subject's understanding.

Question 36

According to Beauchamp and Childress, _________ involves intentionally leading, or attempting to lead, someone to believe what is false, while lying seeks the same aim through statements.

Question 37

Disclosure of medical information over time, with sensitivity to the patient's relevant welfare interests, is called a _______ disclosure by Beauchamp and Childress.

Question 38

Forms of privacy that involve limited access to a person include informational, physical, _______, proprietary, and relational privacy.

Question 39

__________ approaches justify rules of privacy according to their instrumental value for such ends as personal development, creating and maintaining social relations, and expressing personal freedom.

Question 40

Beauchamp and Childress argue that rules of privacy are best justified with reference to the principle of __________, in the sense of deferring to persons' wishes not to be observed, touched, intruded upon, and so forth.

Question 41

When public health authorities collect, analyze, store, and use personal health information for the purpose of tracking or preventing disease on a large scale, it is known as _______ and can constitute a risk to individual privacy.

Question 42

________ is present in medical care when one person discloses information to another, whether through words or other means, and the person to whom the information is disclosed pledges, implicitly or explicitly, not to divulge that information to a third party without the first person's permission.

Question 43

If a patient or research subject authorizes release of information about himself or herself to others, then no violation of rights of confidentiality occurs, although a loss of _______ does occur.

Question 44

Obligations of __________ arise whenever a physician or other health care professional establishes a significant fiduciary relationship with a patient.

Question 45

A ______ _____ ________ exists when an impartial observer would determine that a professional's judgments, decisions, or actions are at risk of being unduly influenced by his or her personal interests.

Question 46

Clinical ________ has the objective of scientifically designed testing of a hypothesis aimed at developing or contributing to "generalizable knowledge"; clinical _______ is aimed at diagnosis, preventive treatment, or therapy that stands to provide optimal therapeutic benefit to each patient.

Question 47

Designing a clinical research trial so that the subject or the investigator does not know whether the subject is in the control group or experimental group is known as ________.

Question 48

A study and the researchers and physicians who may make use of its results are considered to be in a state of ________ when, on the basis of the available evidence, members of the relevant expert medical community are uncertain about which intervention is superior.