Ethical & Legal Decision Making

Question 1

Principles of bioethics

Answer 1

• Autonomy: Patient’s right to REFUSE but NOT to DEMAND.
• Non-maleficence (DO NO HARM)

1. proportionality of the clinical intervention.
2. medical responsibility for the whole process.
3. goals and objectives.

• Beneficence
• Justice: 1st to the patient’s NEEDs then FAIR resources allocation

Question 2

Autonomy

Answer 2

• the capacity to realize acts with complete information concerning all of the facts and without internal or external coercion. To achieve this, the patient must have truthful, sufficient, and comprehensive information and must make a voluntary decision
• Does NOT extend the right to DEMAND any and all treatment REGARDLESS of its likely benefit or cost
• Does NOT require the provision of treatments that, in the judgment of the physician and IDT are likely to be harmful or futile

Question 3

Conflict

Answer 3

Conflict is a symptom that shows the need for clinicians to work with ethical values with the same skill and professional ability with which they handle clinical work.

Question 4

Competency

Answer 4

A LEGAL determination a person’s right to make decisions or do acts.

Question 5

CAPACITY

Answer 5

• A CLINICIAN determination that addresses the integrity of mental functions to make decision.
• Temporally, task-specific.
• The ability to communicate.
• The ability to understand the proposed, the consequences of accepting and of declining the treatment and OPTIONS.
• The ability to reason.

Question 6

Surrogate decision making

Answer 6

1. Voice patient’s decision
2. Benefits vs burden
3. Best interests

Question 7

5 types of serrogates

Answer 7

1. Formally designated surrogates
2. Informally designated surrogates through informing the physician provider
3. ** Default surrogates/ NOK*** common
4. Bioethics committee: Unbefriended patients
5. Court appointed/ guardians

some states require notary or 2 witnesses, A witness cannot be a relative nor employed at a facility at which the individual resides.

Question 8

Standards for extended autonomy

Answer 8

1. expressed wishes of the patient;
2. substituted judgment
3. best interest.

Question 9

Futility

Question 10

POLST

Answer 10

An PHYSICIAN order that TRANSLATES the values expressed in advance directive.

Question 11

Nonabandonment at the end of life

Answer 11

1. Providing continuity, of both expertise and the patient-clinician relationship.

• Address concerns about continuity proactively, including assurances that the physician and nurse will continue to be available
• Maintain contact with patient and family as death approaches, often by phone

1. Facilitating closure of an important therapeutic relationship.

• Anticipate and acknowledge the probable last visit with a patient
• Call the family member after death
• Write a bereavement letter