ETHICS(2)

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2/25/22, 12:45 AM Final Assessment: Attempt review
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Ethics  
Started on Saturday, 15 January 2022, 7:22 PM
State Finished
Completed on Saturday, 15 January 2022, 7:25 PM
Time taken 3 mins 5 secs
Marks 12.00/20.00
Grade 60.00 out of 100.00
Question 1
Correct
Mark 4.00 out of 4.00
Which of the following statements about decision-making capacity are true?
A. Decision-making capacity in the clinical context is an all or none question 
B. The physician is responsible for patient capacity evaluation in the clinical context  
C. Depends on patient’s ability to understand information, recognize how facts are relevant to him as a person, to reason by compare information and
infer consequences of choice and make and express a  choice   
D. When a patient lacks capacity their previously stated wishes in the form of an advance directive legally bind physicians to follow patient’s wishes all
over the world  
False
True
True
False
A. In the clinical context the capacity evaluation must be tailored to the particular question and the situation at hand and is often by clinicians seen as
a continuum and dependent on the complexity of the question at hand. Patient can have decision-making capacity related to some questions but not
to others. Capacity can vary during different times of the day or depending on efforts to optimize capacity. From a legal point of view persons either
have or do not have capacity.
D. Legislation with regard to the legal status of advance directives varies from country to country
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Question 2
Partially correct
Mark 0.00 out of 4.00
Question 3
Correct
Mark 1.00 out of 1.00
Barriers to the practice of respect in the ICU include: 
A. Time pressure and distraction. 
B. Training patterns in medical schools  
C. Open 24 hours visit time in the ICU  
D. Disagreement about treatment   
True
True
True
False
Barriers include competing priorities, time pressures, distraction, cultural differences, disagreements over treatment, mental illness of patient or
clinicians, and training patterns in medical school and residency. Restricting family members from the bedside of their loved ones—may also impede
the practice of respect.
Reference: 
Brown SM, Azoulay E, Benoit D, Butler TP, Folcarelli P, Geller G, Rozenblum R, Sands K, Sokol-Hessner L, Talmor D, Turner K, Howell MD. The Practice of
Respect in the ICU. Am J Respir Crit Care Med. 2018 Jun 1;197(11):1389-1395. doi: 10.1164/rccm.201708-1676CP.
When talking with patients and families about adverse events, the following points should always be included, except: 
Select one:
a. A clear and honest communication of regret 
b. Acceptance of full responsibility for the adverse event  Correct!
c. Steps taken to investigate the event and prevent recurrence 
d. Offer of support service to the family 
e. Who will speak to the family next, and when 
Your answer is correct.
Acceptance of full responsibility for an adverse event should be included only when investigation of the event shows that it could and should have
been prevented. This generally becomes known only after a full investigation is complete, and is often not known at the time of the event.
Nevertheless, all of the other points, including expression of regret for what happened, are always appropriate. 
The correct answer is: Acceptance of full responsibility for the adverse event
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Question 4
Correct
Mark 4.00 out of 4.00
Recommended Practices for Improving Communication and Support for Surrogates in the ICU include which of the following: 
A. Regular structured interprofessional family meetings.   
B. Dedicated meeting space for ICU family meetings  
C. Establish consensus among treating clinicians before the meeting   
D. Support religious/spiritual needs and concerns    
True
True
True
True
A statement by many ICU societies recommended a detailed approach to communicate and support in the ICU, this includes:
Systems-level interventions 
Conduct regular, structured interprofessional family meetings
Integrate palliative care and/or ethics teams into ICU care for di�cult cases 
Provide printed educational materials to family 
Maintain dedicated meeting space for ICU family meetings
Clinician-level skills 
Coordinate an effective ICU family meeting
Establish consensus among treating clinicians before the meeting 
Use a private, quiet space for family meetings 
Introduce all participants
Use patient/family-centered communication strategies 
A�rm non-abandonment and support family decisions 
Provide family-centered communication 
Elicit surrogates’ perceptions �rst 
Use active listening skills and deliver information in small chunks 
Respond to questions and check for understanding of key facts 
Acknowledge and address emotion
Support religious/spiritual needs and concerns
Foster shared decision making 
Assess clinical prognosis and degree of certainty
Evaluate surrogate preferences for decision-making responsibility
Elicit the patient’s treatment preferences and health-related values
Reference: 
Bosslet GT, Pope TM, Rubenfeld GD, Lo B, Truog RD, Rushton CH, Curtis JR, Ford DW, Osborne M, Misak C, Au DH, Azoulay E, Brody B, Fahy BG, Hall
JB, Kesecioglu J, Kon AA, Lindell KO, White DB; American Thoracic Society ad hoc Committee on Futile and Potentially Inappropriate Treatment;
American Thoracic Society; American Association for Critical Care Nurses; American College of Chest Physicians; European Society for Intensive
Care Medicine; Society of Critical Care. An O�cial ATS/AACN/ACCP/ESICM/SCCM Policy Statement: Responding to Requests for Potentially
Inappropriate Treatments in Intensive Care Units. Am J Respir Crit Care Med. 2015 Jun 1;191(11):1318-30. doi: 10.1164/rccm.201505-0924ST.
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Question 5
Incorrect
Mark 0.00 out of 1.00
The practice in some areas of Ancient Greece of letting weak or sick children die: 
Select one:
a. Is only right if based on solely individual-dependent factors  
b. Is an example of descriptive moral relativism 
c. Is not something a morally serious person would do 
d. Should be considered acceptable practice today, under the cloak of cultural diversity 
e. Is an inconceivable notion from the view of moral objectivism  Incorrect!
Your answer is incorrect.
Pluralism denotes a diversity of views rather than a single approach. It is said that respect for family and community is generally valued higher than
individual rights in Eastern cultures. Depending on cultural background, values and preferred approaches to medical decision-making may vary. In a
moral relativism approach, no such a thing as an objective or universal moral truth exists. According to moral relativists, what is right can be
individual-dependent or society-dependent 
The correct answer is: Is an example of descriptive moral relativism
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Question 6
Incorrect
Mark 0.00 out of 1.00
The term “futility” was used in the past for treatments not ethically justi�able.
Which term is used now?
Select one:
a. Palliative treatment  Incorrect!
b. Medical misconduct 
c. Potentially inappropriate treatment 
d. Futility is still the used term 
e. Inadequate treatment 
Your answer is incorrect.Futility comes from the Greek futilis which means that the act will not lead to the intended means no matter how often repeated. Because in clinical
medicine this is a standpoint that cannot be proven, the term has been replaced by “potentially inappropriate treatment”. This means that in the vast
majority of cases the therapy will not work but there is still room for doubt
Reference: 
Bosslet GT, Pope TM, Rubenfeld GD, Lo B, Truog RD, Rushton CH, Curtis JR, Ford DW, Osborne M, Misak C, Au DH, Azoulay E, Brody B, Fahy BG, Hall
JB, Kesecioglu J, Kon AA, Lindell KO, White DB; American Thoracic Society ad hoc Committee on Futile and Potentially Inappropriate Treatment;
American Thoracic Society; American Association for Critical Care Nurses; American College of Chest Physicians; European Society for Intensive
Care Medicine; Society of Critical Care. An O�cial ATS/AACN/ACCP/ESICM/SCCM Policy Statement: Responding to Requests for Potentially
Inappropriate Treatments in Intensive Care Units. Am J Respir Crit Care Med. 2015 Jun 1;191(11):1318-30. doi: 10.1164/rccm.201505-0924ST. 
The correct answer is: Potentially inappropriate treatment
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Question 7
Correct
Mark 1.00 out of 1.00
The VALUE template is a useful tool for communication with patients and families.
Which one of the choices below is not part of the template?
Select one:
a. Acknowledge emotions 
b. Understand patient/family as a person 
c. Listen to the patient/family 
d. Elaborate on patient condition  Correct!
e. Value family statements 
Your answer is correct.
Communication with patients and families is a cornerstone in shared decision making (SDM). The VALUE-template is a useful tool for communicating
di�cult topics in the ICU setting.
The “E” stands for Elicit patient and family questions. This means you must make sure that all the family questions have been answered the best way
before ending the family meeting. By using the mnemonic VALUE the structure of a family meeting is optimized.
Reference:
Curtis JR, White DB. Practical Guidance for Evidence-Based ICU Family Conferences. Chest. 2008;134(4):835-843. doi:10.1378/chest.08-0235.
PMID 18842916 
The correct answer is: Elaborate on patient condition
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https://www.ncbi.nlm.nih.gov/pubmed/18842916/
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Question 8
Partially correct
Mark 2.00 out of 4.00
Many strategies are recommended for shared-decision making (SDM) with the patient and his/her family. 
Which of the following statements are true?  
A. Clinicians should engage in SDM process to de�ne overall goals of care and when making major treatment decisions that may be affected by
personal values, goals, and preferences.   
B. Clinicians should use as their “default” approach a SDM process that includes three main elements: information exchange, deliberation, and making
a treatment decision.   
C. A wide range of decision-making approaches are ethically supportable including patient- or surrogate-directed and clinician-directed models, but
clinicians should tailor the decision-making process based on the preferences of the clinical team.    
D. Clinicians should be trained in communication skills.  
True
True
True
True
A. The current view is that shared decision making (SDM) is the most valued approach. Even in countries with a history of paternalism there is a
proven shift to SDM. In some countries the law still prescribes or allows clinician-directed models. 
C. Clinicians should tailor the decision-making process based on the clinical circumstances and the preferences of the patient or surrogate.
Reference:
Kon AA, Davidson JE, Morrison W, Danis M, White DB. Shared Decision-Making in Intensive Care Units. Executive Summary of the American College of
Critical Care Medicine and American Thoracic Society Policy Statement. American Journal of Respiratory and Critical Care Medicine.
2016;193(12):1334-1336. doi:10.1164/rccm.201602-0269ED.
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