Ethics Flashcards
what information is necessary for informed decision making?
- diagnosis and prognosis
- recommended treatment (risks, benefits, consequences of intervention)
- alternative txs (risks, benefits, and consequences of alternatives)
- consequences of no intervention (risks and benefits)
why was the Martin Salgo case important?
implications for the duty to inform
Salgo had paralysis after aortography, sued doctors for neglecting to inform him of the possible risk of paralysis. court said doctors have a duty to inform a pt “any facts which are necessary to form the basis of an intelligent consent by the pt to proposed tx”
what was the Dax Coward case?
Dax Coward in 1972 continually requested that tx for severe burns throughout his body be discontinued. physicians refused and Coward was treated against his will
what was the Elizabeth Bouvia case?
Elizabeth Bouvia, 26, had cerebral palsy and in 1983 admitted herself into a hospital requesting that the hospital allow her to starve herself to death. eventually the hospital force fed Bouvia and her case was taken to court in which it was determined that she, as any competent patient, had a right to refuse any medical tx.
what was the William Bartling case?
William Bartling, 70, was a pt hospitalized in 1984 for a number of medical conditions but was not considered terminally ill. Bartling requested that he be removed from a respirator but the hospital refused to allow him to do so. The Supreme Court of California sided with Bartling
what is the difference between consent and assent?
consent- pts who have decision making capability have the ability to agree to or refuse any medical tx proposed by a physician
assent- pts who lack decision making capability cannot consent or refuse a proposed medical tx but health care professionals still have a moral obligation to get their acceptance of any treatment to which their surrogate decision maker has given consent
what forms can an advance directive take?
can be written or oral
living wills, oral statements to family members or friends, health care proxy, oral statements to physicians
what are three aspects to consider in evaluating the trustworthiness of advance directives?
- informed (pt preferences are informed)
- specific treatments (directive indicates what specific treatments the pt would want not want in various clinical situations)
- repeated (directive is repeated over time, in diff situations, to various individuals)
what are the standards for surrogate decision making?
use advance directive if they have one –> substituted judgment (an attempt to make decisions based upon those values known to be held by the patient) –> best interest (based upon notion of what a reasonable person would wish done in this case, should take into consideration issues of reducing potential suffering, quality of life, and the risks and benefits of any proposed medical intervention)
what is the Karen Anne Quinlan case?
22 yo woman in persistent vegetative state (PVS). doctors refused family request to remove her from ventilator. significant case for it resulted in standards that family members can act as guardians and pts can be removed from ventilators
what is the Nancy Cruzan case?
33 yo woman in PVS. family requested feeding tube be removed and physicians refused. significant case for it resulted in right of states to determine level of evidence necessary for substituted judgment
what is the Terri Schiavo case?
27 yo woman in PVS and husband requested that Schiavo’s feeding tube be removed. father and mother challenged the decision significant case only the degree by which it became a private family issue of which various political factions wished to affect the outcome
