FDN2_Ethics

Question 1

If a patient lacks decision making capacity and an advance directive is unavailable, how are decisions made about treatment?

Answer 1

A surrogate decision maker

Question 2

What are the two standards for surrogate decision making for adults?

Answer 2

1. Substituted Judgement: Surrogate attempts to make decisions based upon the known values of the patient
2. Best Interest: Descisions are bade based upon what a “reasonable person” would wish done in the given case. One should consider reduced suffering, quality of life, and risks and benefits of proposed intervention

Question 3

A surrogate decision maker who is using best interest standards should take into accout…

Answer 3

• Reduced potential suffering
• Quality of life
• Risks and benefits of proposed treatment

Question 4

If a surrogate is using the patient’s values to make a decision about their treatment, they are using…

Answer 4

Substituted judgement

Question 5

If a surrogate is basing treatment desisions upon what a reasonable person would wish for, they are using…

Answer 5

Best interest standards

Question 6

Name 3 surrogate desision court cases

Answer 6

1. Karen Anne Quinlan
2. Nancy Cruzan
3. Terri Schiavo

Question 7

Describe the Karen Anne Quinlan case

Answer 7

The first “right to die” case

• Karen Anne Quinlan was a 22 year old woman in a persistent vegetative state
• Physicians refused the family’s request to remove her ventilator
• The court decided that family members can act as guardians and patients can be removed from ventilators

Question 8

Describe the Nancy Cruzan case

Answer 8

• Nancy Cruzan was a 33 year old woman in a persistent vegetative state
• Her family requested that her feeding tube be removed, but physicians refused
• The court decided that states have the right to determine the level of evidence necessary for substituted judgement

Question 9

Describe the Terri Shiavo case

Answer 9

• Terri Shaivo was a 27 year old woman in a persistent vegetative state
• Terri’s husband requested that her feeding tube be removed
• Terri’s parents challenged the decision
• Extended/multiple court cases (lasting 15+ years!); Pro-life groups and governors (Jeb bush) got involved to affect the outcome (significant because of how much it blew up)

Question 10

How is a living will different from an advance directive?

Answer 10

A living will is a type of advance directive that is written down

Question 11

What is the difference between a healthcare proxy and a surrogate decision maker?

Answer 11

A healthcare proxy is a type of surrogate decision maker appointed by the patient while they still have decision-making capacity

Question 12

What is the order for determining a surrogate decision maker?

Answer 12

Highest to lowest priority:

1. Court appointed
2. Proxy appointed by the patient
3. Family
   
   1. Spouse
   2. Adult children
   3. Adult siblings
4. Friend
5. Physician consulting with hospital ethics committee

Question 13

How shoudl physicians assist surrogates in making decisions for the patient?

Answer 13

• Discuss the process
• Give a recommendation (especially if the surrogate wants one)
• Get help from other healthcare workers (ethics committee)

Question 14

When should “best interest” standards be used in surrogate decision making?

Answer 14

• When it is unclear what decision the patient would have made
• When a reliable surrogate is unavailable or doesn’t know what to do