Evidence-Based Medical Ethics:

A brief introduction to medical ethics in Internal Medicine.- The underlying principles of ethical patient care.- Putting ethics into practice – realities, limitations, and roadblocks.- Advanced Directives, Living Wills, and the Health Care Power of Attorney (HCPOA).- Case-based ethical dilemmas.- Topic: Consent in the mentally ill or otherwise unfit (and ‘in between’ situations: delirium, psychiatric decompensation).- Topic: When the HCPOA neglects their responsibility, or has other personal interests/potential gains.- Topic: When the patient/their family bullies practitioners into unnecessary diagnostics/therapeutics.- Topic: When an estranged family member or spouse suddenly appears to make decisions.- Topic: How to deal with an inpatient behaving badly (psych consults, behavioral contracts, room restriction etc.).- Topic: When DSS consults are needed.- Topic: When a patient has ‘burned all bridges’ and no discharge planning is possible.- Topic: Can a practitioner refuse to admit a patient? To see a patient in the office (e.g. administrative discharge)?.- Topic: When a patient makes ‘bad’ decisions (e.g. will accept some therapies and not others, such as some blood products but not others, some procedures but not others, DNI but not DNR, etc.).- Topic: When a patient’s same-sex partner has no legal rights and is excluded by a family.- Topic: When a patient has a contagious disease (e.g. HIV) and their partner is not aware.- Topic: When a family will not accept a terminal prognosis (i.e. futile ‘full codes’).- Topic: When there is no one to make decisions for a patient (e.g. John/Jane Doe in ICU, wards of the state).- Topic: When a mistake has been made by a practitioner (what/how to/how much to disclose).- Topic: When what a patient needs cannot be obtained (e.g. financial/insurance limitations).- Topic: When next-of-kin (NOK) disagree with each other.- Topic: When a toxicology screen is ordered without patient consent and comes backpositive.- Topic: When a patient ‘signs out against medical advice’.- Topic: When a patient requests a clinical interaction be recorded.- Topic: When a family member requests patient information not be shared with the patient, or with other persons.- Topic: When a patient requests to not be seen by a (specific, or any) medical resident or student.- Topic: When a patient requires or demands large amounts of time from a practitioner.- Topic: How to prescribe medications to someone who has attempted suicide (e.g. with pills).- When a colleague demonstrates suspicious behavior.- Topic: When a language translator is not available (or only a family member/hospital employee is).- Topic: When a patient is repeatedly readmitted to the hospital due to non-adherence (e.g. with therapy, diet, etc.).- Topic: When lawyers or law enforcement want to know patient information (HIPAA/confidentiality and the law).- Topic: When a patient requests disability certification, handicap plates, etc. – or when they request renewal of a revoked driver’s license (e.g. can a practitioner-patient relationship be maintained when a patient doesn’t get what they want?).- Topic: How much resources should be spent on a single patient’s case? (i.e. public health cost v. value of human life).- Topic: How much information must a practitioner share with a patient?.- Topic: How to deal with a patient seeing two or more practitioners (same specialty, overlapping meds, etc.).- Topic: How to manage chronic pain (e.g. are ‘pain contracts’ ethical?; how is pain objectively assessed?).- Topic: At what age, if any, do you stop health maintenance disease screening?.- Topic: When can a practitioner withhold therapy from a patient based on their behavior?.- Topic: When a Jehovah’s witness needs a blood transfusion.- Topic: How far does screening go?.- Comprehensive Exam.- Suggested reading and internet resources.- Glossary of terms.- Index.