Deck 4: Respect for Autonomy

Question 1

Which of the following is not a necessary condition for autonomous action?

A) Understanding
B) Second-order reflection on first-order desires
C) Intentionality
D) Freedom from external coercion

Answer 1

B

Question 2

As a positive obligation, respect for autonomy requires professionals in health care and research involving human subjects to:

A) Disclose information
B) Foster adequate decision making
C) Probe for and ensure understanding and voluntariness
D) All of the above

Answer 2

D

Question 3

Which of the following is not a moral rule derived from the principle of respect for patient autonomy?

A) Protect confidential information
B) Tell the truth
C) Never, in any circumstance, override the express wishes of the patient
D) When asked, help other make important decisions

Answer 3

C

Question 4

Because studies suggest that certain ethnic groups differ in their view toward disclosure of diagnosis and prognosis of terminal illness and toward decision making at the end of life, physicians should:

A) Inquire beforehand about their patient's wishes to receive information and make decisions
B) Leave important end-of-life decisions to the family
C) Only offer diagnosis of terminal illness to patients who belong to ethnic groups that are typically more likely to desire such information
D) Always strive to put choices in the hands of the patient, rather than the family.

Question 5

The basic paradigm of the exercise of autonomy in health care and in research is ___________ consent.

A) Implied
B) Presumed
C) Tacit
D) Express

Question 6

When teaching hospitals allow medical students to perform pelvic examinations on anesthetized patients without asking for permission, they are generally operating on the basis of ____________ consent.

A) General
B) Specific
C) Tacit
D) Express

Question 7

The criteria for judging a patient's competence to decide is relative to:

A) The presence or absence of an adequate surrogate decision maker
B) The particular decision to be made
C) Nothing-the patient is either competent or not competent
D) The patient's desire to make decisions about his or her care

Question 8

Which of the following could possibly be classified as a presupposition of obtaining informed consent, rather than as an element?

A) Disclosure
B) Decision
C) Competence
D) Understanding

Question 9

When possible, the preferable moral standard of disclosure is the:

A) Professional practice standard
B) Reasonable person standard
C) Objective standard
D) Subjective standard

Question 10

According to the American Medical Association (AMA), a placebo may not be used unless:

A) The physician believes it may be beneficial
B) There are no other alternative treatments available
C) The patient (at some prior point) has given an informed consent to the use of such substances
D) The patient's family consents on his or her behalf

Question 11

In the famous case of ____________________, informed consent was not reached because a key factor (inevitable sterilization as a result of the procedure) was not disclosed to the patient.

A) Bang v. Miller Hospital
B) The Nuremburg trials
C) Thornburgh v. American College of Obstetricians
D) Planned Parenthood of Central Missouri v. Danforth

Question 12

The voluntariness of a patient's decision may be diminished or destroyed by which of the following?

A) External coercion by another person
B) Drug addiction
C) Debilitating disease
D) Psychiatric disorders
E) All of the above

Question 13

______________ occurs if and only if one person intentionally uses a credible and severe threat of harm or force to control another.

A) Influence
B) Manipulation
C) Persuasion
D) Coercion

Question 14

____________ is a form of influence in which a patient comes to believe in something through the merit of reasons another person advances.

A) Disclosure
B) Manipulation
C) Persuasion
D) Coercion

Question 15

In the ______________ syphilis study, researchers unjustifiably used various offers (free meals, transportation, and burial assistance) to stimulate and sustain subjects' participation.

A) Lynchburg
B) Tuskegee
C) Nuremburg
D) Belmont

Question 16

To be ethically justifiable, an "opt-out" policy of organ donation would require:

A) Vigorous efforts to ensure public understanding
B) An easy, reliable mechanism to opt out
C) Neither A nor B
D) Both A and B

Question 17

Which of the following is a single core meaning of the word competence that applies in all contexts?

A) The ability to perform a task
B) The state of complete control over all of one's faculties
C) Acting voluntarily
D) Consistent and irreversible capacity for self-determination

Question 18

The ____________ strategy for establishing competence holds that as the risks of a medical intervention increase for patients, so should the level of ability required for a judgment of competence to elect or refuse the intervention.

A) Complexity
B) Sliding-scale
C) Standard
D) National Bioethics Advisory Committee

Question 19

The ___________ ___________ standard of surrogate decision making applies exclusively to formerly autonomous, now-incompetent patients who have expressed a relevant, autonomous treatment preference.

A) Substituted judgment
B) Pure autonomy
C) Best interest
D) Justified paternalism

Question 20

The term "___________ ____________" refers to a circumstance in which research subjects fail to adequately understand the purpose and aims of research, mistakenly believing that their participation is primarily therapeutic in nature.

A) Therapeutic misestimation
B) Therapeutic misconception
C) Therapeutic optimism
D) Therapeutic pessimism

Question 21

According to Beauchamp and Childress, the principle of respect for autonomy, being more foundational, has moral priority over other principles.

Question 22

Intentionality, as a condition for autonomous choice, is a matter of degree.

Question 23

The lines between adequate and inadequate degrees of understanding and degrees of control must be determined in light of specific objectives of decision making.

Question 24

According to Beauchamp and Childress, there is a fundamental inconsistency between autonomous action and the authority of institutions and/or religious traditions.

Question 25

Because moral status and moral respect are dependent upon the autonomy of the agent, one ought to resist making judgments about a patient's level of autonomy.

Question 26

Voluntary, informed consent is a necessary and sufficient condition for medical interventions and research involving human subjects.

Question 27

The level of competence necessary for a patient to decide rises as the risk of the outcome rises.

Question 28

The level of evidence for determining competence should vary according to the level of risk involved in making the decision.

Question 29

Informed consent is another way of articulating the ideal of mutual (bilateral) decision making.

Question 30

Research involving human subjects is always morally unjustifiable if it involves deception or incomplete disclosure.

Question 31

If ignorance prevents an informed choice, it may be permissible or possibly even obligatory to promote autonomy by attempting to impose unwelcome information.

Question 32

Evidence suggests that the placebo response or placebo effect can sometimes be produced without nondisclosure or deception.

Question 33

The most appropriate standard of surrogate decision making for never-competent patients is the substituted judgment standard.

Question 34

A decline in executional autonomy (i.e., the inability to carry out personal choices because of physical impairments) will necessarily be accompanied by a decline in decisional autonomy.

Question 35

The word autonomy derives from the Greek autos, which means "_________," and nomos, which means "____________."

Question 36

Virtually all theories of autonomy view the following two conditions as essential for autonomy: _________ and __________.

Question 37

Expressed as a ____________ obligation, the principle of respect for autonomy requires that autonomous acts not be subjected to controlling constraints by others.

Question 38

Expressed as a ____________ obligation, the principle of respect for autonomy requires both respectful treatment in disclosing information and actions that foster autonomous decision making.

Question 39

The __________ ___________ standard for surrogate decision making requires the surrogate to make the decision the incompetent person would have made if competent, based on intimate knowledge of the patient's values and preferences.

Question 40

____________ consent (whether implied or presumed) occurs silently or passively through omissions.

Question 41

The core meaning of the term "____________" is "the ability to perform a task."

Question 42

The level of a person's capacity to decide will rise as the ___________ of the task or decision increases.

Question 43

The ___________ _____________ standard of disclosure holds that customary standards arise within the context of the community of medical practitioners.

Question 44

The ______________ standard of disclosure judges the adequacy of information to be disclosed by reference to the specific informational needs of the individual person.

Question 45

A _____________ is a substance or intervention that the clinician believes to be pharmacologically or biomedically inert or inactive for the condition being treated.

Question 46

The term "___________ ____________" refers to a circumstance in which research subjects fail to adequately understand the purpose and aims of research, mistakenly believing that their participation is primarily therapeutic in nature.

Question 47

In exercising a ____________ of informed consent, a patient delegates decision-making authority to the physician or to a third party, or simply asks not to be informed.

Question 48

The __________ ____________ standard for surrogate decision making requires the surrogate to determine the highest probable net benefit among the available options.