Core Principles Refresher

Autonomy: Pt self-determination (overrides all if adult has decision-making capacity [DMC]).
Beneficence: Act in Pt’s best interest.
Non-maleficence: Do no harm / avoid inappropriate care.
Justice: Fair distribution of healthcare resources.

High-Yield Ethical Conflict Rules

Adult w/ DMC Refuses Life-Saving Tx (e.g., Jehovah’s Witness blood refusal): Autonomy wins. Respect decision.
Parent Refuses Life-Saving Tx for Minor: Beneficence wins. Override parents; give Tx immediately / get court order.
Leaving AMA: Allow if DMC intact. Document risks + offer outpatient follow-up.

Pt Demands Harmful/Futile Tx (e.g., Abx for viral URTI, unnecessary opioids): Non-maleficence wins. Refuse inappropriate requests; offer safe options. c
Euthanasia / Assisted Suicide: Illegal on Step 2 CK. Refuse lethal doses.

Breach Confidentiality IMMEDIATELY for:
- Tarasoff Rule: Specific, credible threat to harm a named individual (notify police + warn victim).
- Reportable Communicable Diseases: HIV, Syphilis, TB, Measles (report to public health dept).
- Impaired Driver / Colleague: Report to DMV / Physician Health Program.

Principle of Double Effect: Administer high-dose opioids for severe pain in terminal Pts, even if it secondarily risks respiratory depression/shortened life. Pain control is the priority.

Active Airborne/Contagious Disease (e.g., Active Pulmonary TB): Pt refuses Tx or isolation $\to$ Public safety wins. Initiate involuntary isolation/quarantine and Directly Observed Therapy (DOT). c
Impaired Drivers (e.g., Uncontrolled Epilepsy, Syncope, Advanced Dementia): Pt insists on driving $\to$ Public safety wins. Advise Pt to stop driving immediately; report to DMV per state-mandated laws.
Involuntary Psychiatric Holds: Pt is actively suicidal, homicidal, or acutely psychotic/gravely disabled $\to$ Public safety/Beneficence wins. Override autonomy; place on emergency psychiatric hold (e.g., 72-hour hold).

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