CPR APPLICATIONS FOUNDATION · CHAPTER 21 · NORMAL
Normal Foundations of Ethics and Communication
Organize the chapter before drilling into individual CPR concepts.
Supplemental foundation map: this page orients the detailed CPR Applications for Chapter 21. It is not part of the canonical CPR object inventory.
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Abnormal Foundations
Treatment Foundations
21.1 · SOURCE CPR FOUNDATION
Concept
Ethics and communication questions test clinical judgment under pressure. The right answer usually protects autonomy, safety, privacy, and fairness while meeting legal duties. Step 1 is not asking for abstract philosophy first. It is asking what a competent clinician should do next.
Pattern
Step 1 presents emotionally charged situations with incomplete information, family conflict, privacy concerns, safety risk, refusal of care, medical error, or unclear decision authority. The correct answer usually begins by clarifying capacity, identifying the decision-maker, checking legal exceptions, and communicating directly with the patient.
Rule
- Start with capacity and decision authority. A patient with capacity generally makes their own decisions.
- Then check safety and confidentiality limits. Abuse, credible threats, reportable disease, and imminent self-harm change privacy duties.
- Use the least coercive safe action. Protect the patient without overriding autonomy unnecessarily.
Applications
- Patient who demonstrates decision-specific capacity after an informed discussion refuses surgery → generally respect refusal, subject to applicable law
- Acutely confused patient refusing urgent care → assess decision-specific capacity rather than presuming incapacity; use a surrogate or applicable emergency exception if capacity is absent
- Family asks clinician to conceal a diagnosis → privately assess the patient’s information preferences and discuss truthfully in accordance with those preferences
- Suicidal patient with plan and means → protect safety
- Medical error caused harm → disclose promptly and honestly
- Expensive patient gift → decline if it creates obligation or influence
- Tip: Ethics questions usually test the safest respectful next step
CPR APPLICATIONS · ACTIVE REASONING
Protect autonomy through informed decisions
Predict the mechanism and consequence before checking. Worked explanations remain accessible without scripts. Responses are not stored or transmitted.
Reveal worked reasoning and transfer
Best answer: Confirm understanding and voluntariness, explore acceptable alternatives, respect the informed refusal, and document.. Decision-specific capacity and informed, voluntary refusal generally require respect even when the clinician disagrees.
Change one variable: How would new delirium affecting the patient’s appreciation of consequences alter the capacity assessment?
Reveal worked reasoning and transfer
Best answer: Respect the patient’s preference and clarify any permitted exceptions or future authorized contacts.. Confidentiality includes honoring the patient’s disclosure preferences unless a lawful exception applies.
Change one variable: How does the answer change if the patient explicitly authorizes information sharing with that child?
Reveal worked reasoning and transfer
Best answer: Clarify the patient’s wishes, verify permissions, involve the chosen person, and preserve the patient’s opportunity to decide.. Respecting a patient’s information preferences can coexist with informed consent and careful documentation.
Change one variable: If capacity subsequently becomes impaired, how would formal surrogate authority be established?
Change the mechanism
See all mechanism comparisons without scripts
- Capable adult refuses a treatment: Ensure an informed voluntary choice and generally respect refusal; document reasoning and options.
- Acute fluctuating delirium impairs appreciation: Evaluate decision-specific capacity and reversible causes; follow surrogate or emergency pathways if necessary.
- Patient authorizes a family participant: Confirm scope of permission while preserving the patient’s role and confidentiality preferences.
Explain it back: For one question, explain why your choice is better than the strongest alternative, then identify the clinical finding that would change the conclusion.
Unscored educational exercises. Not independent clinical recommendations, validated assessments, or a substitute for local policy and expert evaluation.
How to use this foundation map
- Identify the organizing mechanism.
- Recognize the pattern.
- Restate the rule without looking.
- Test transfer with applications and question practice.
Pair CPR with the 5P Approach™ when solving cases and questions.