Ethics and End of Life Flashcard
Rationale
A. Rationale: The principle of non maleficence is part of the Hippocratic Oath: “first do no harm”. The pediatric surgeon is refusing surgery to avoid doing harm to the patient because hypotension can worsen when general anesthesia is given to the patient. The risk of failure is too much. Under this circumstance, the neonatologist must stabilize the patient first, such as using medications that can help with the hypotension before considering any surgery.
Question
A pediatric cardiac surgeon refuses to perform an open-heart surgery to correct a right-to-left shunt because the newly born cannot be inducted under anesthesia because of a low normal blood pressure. What ethical principle is being demonstrated by the pediatric surgeon in this case?
a. Non maleficence
b. Justice
c. Autonomy
d. Beneficence
Answer
a. Non maleficence
Rationale
A. Rationale: In cases where the parents have not decided to perform neonatal resuscitation, it is the prerogative of the neonatal team to perform resuscitation because it is a time-sensitive matter. Withholding resuscitation and life-support measures is ethical if the attending physician and the parents have concluded that the treatment is no longer in the baby’s best interest.
Question
After discussing the benefits and risks of performing neonatal resuscitation in a baby born extremely preterm, the parents cannot decide whether to stop resuscitation efforts. What should you do in this case?
a. Perform resuscitation immediately
b. Give the parents more time to decide
c. Look for a healthcare surrogate and have them decide
d. All of the above
Answer
a. Perform resuscitation immediately
Rationale
A. Rationale: Informed consent requires relating all the available options to the parents so they can decide upon potential interventions for their newborn. Parents must gain relevant and accurate information about the risks and benefits involved. Though there are many things to consider, parents must ultimately decide what is in the baby’s best interest.
Question
In high-risk cases, the role of the parents in difficult decision-making is critical. Parents are encouraged to base their decisions on which one of the following factors?
a. The baby’s best interest
b. Cost of management
c. Risks of the procedure
d. Benefits of the procedure
Answer
a. The baby’s best interest
Rationale
D. Rationale: The ethical principle of autonomy is the act of respecting a person’s right to make choices that can affect their life and well-being. The principle of non maleficence aims at avoiding harm to others, and the principle of beneficence is acting for the benefit of others. Justice aims to treat people truthfully and impartially.
Question
Which ethical principle promotes respecting an individual’s right to make choices that affect their life?
a. Non maleficence
b. Beneficence
c. Justice
d. Autonomy
Answer
d. Autonomy
Rationale
D. Rationale: The provider must first ask the parents if they want to see the baby before presenting a dying newborn to them. The provider must inform them about what to expect. They should be told beforehand about the baby’s appearance and current conditions such as agonal gasps, changes in color, slowed heart rate, and special equipment being used. It may help to point out the baby’s memorable features.
Question
You are the person responsible for presenting a dying baby to the parents. What is the first course of action that you should take?
a. It is not appropriate for the parents to see the baby this way
b. Clean the baby of any blood or secretions
c. Disconnect unnecessary tubes, tapes, leads, or equipment
d. Ask them if they want to see the baby
Answer
d. Ask them if they want to see the baby