Knowledge Flashcards
What 2 questions are important to assess a persons’sDecision making capacity?
- if person can understand information that is relevant to making a decision about treatment
- Can person appreciate potential consequences of their decision
How do you judge a person’s competence
And it’s all person is presumed be competent to make decisions about their care unless they’re reasonable grounds to suspect otherwise the onus is on others to prove incapacity in capacity
Attributes of patient-based medicine
- identifies and respects patient feelings and values
- involves patient and significant others
- provides high-quality information
- addresses physical and emotional needs
- provides access to appropriate care
- ensures continuity of care
Listening to patients
Requires openness, humility
4 questions related to 4 principles
What are patients’ wishes and values?
What can be done for the patient? What are the harms and benefits of the options?
Is the patient being treated fairly? Given the competing claims of others, how can the needs of all be satisfied?
How to know when to say no to patient when they are asking for treatment
If treatment is not going to benefit them
How to say no to patient
Say no; don’t be vague.
Be kind, not dismissive, explain reasoning.
Offer alternatives (including follow up if no improvement)
Allow them to vent; be empathetic
Understand why they are making the request -> address the underlying reason
WHO definition of a good health system
Delivers quality health services to all people, when and where they need them
Autonomy
-prioritizing/ incorporating patients point of view into decision making = cornerstone of decision making in medicine
Patient’s: concerns, wishes, values
When patient is competent, wishes should guide decisions about their treatment
Physicians collaborate with the patient; they listen, but question the patient
Ask patient to tell you about themselves
Beneficence
Doing good for the patient
How to understand patient
Conversation
Listening
Asking focused questions (straight-forward; precise, but brief; able to elicit appropriate response)
Examination
Careful observation
Try to understand what life is like for the patient without making any assumptions
Justice
Fairness
Is their reflective of their fair share of health resources
How will the treatment affect/burden others? The family? Other patients? Professional staff?
Non-maleficence
Above all, do no harm
Recommend the intervention leading to least possibility of harm for the patient
Most interventions involve possibility of risk (even taking blood)
Can’t be the primary principle; or else therapeutic nihilism (view that any medical treatment is worse than disease)
Some skepticism is appropriate (ie overprescribing dangerous drugs)
Best choice
Option where potential benefits outweigh the risks/harms (not objective; subjective to the patient)
Non-intentional maleficience
Ignorance Conflict of interest Dishonesty Incompetence Mental illness Lack of fortitude to ration Overaggressive Prescribing unproven or ineffective therapies
Questions to ask to encourage empathic communication
Please help me understand what you’re experiencing…
What do you understand about your situation right now?
What are you hoping for?
How do you feel about all of this?
Other than ethical factors, what else influences making a decision?
Legal Familial Aesthetic Cultural Religious Emotional
Virtue
Morally upright tendencies; formed by habit
Guide one to pursue the right action
Aristotle: whether one habit or another is inculcated in us from an early age makes all the differences
What would a virtuous person do in this situation?
Virtues of good clinician
Compassion: feeling of concern inclining one to empathize with and to desire to relieve the suffering of others
Prudence: taking care, showing due diligence in actions
Altruism: putting the interests of others before ones own
Trustworthiness: commitment to patients
Humility: able to admit one might be wrong, fallible
Self awareness
Openness to criticism
Deontology
Right vs wrong = whether something is consistent with duty/ universal rule
Example: lying is wrong, goes against duty of truth telling; physician must always tell patient the truth, regardless of the consequences
Duty: respect for human dignity: Never treat someone I was merely a means to an end
Consequentialism
Right vs wrong = based on consequences
Right: promotes happiness
Wrong: causes pain
Option that causes most pain = most wrong
Medicine example: weighing potential benefits vs risks
Criticism: if focus only on outcomes, how can you be sure you can measure what outcomes mean to other people?
How do emotions contribute to ethics
Emotions guide us; strong emotions may signal something is more important than other options
Without emotions, ethical reasoning would be lifeless and calculating
Compassion!
How to learn about patients story (narrative-based medicine)
Ask patient: what would you like me to know about you?
Listen; don’t interrupt
Elicit patients view of their condition
Ask patients about impact of the illness on their lives
Assess the distress and suffering
Examine your stereotypes and assumptions and patient and their culture
If non-compliant, need to understand why; it’s their hidden story
Tests of moral reasoning (questions)
What are the consequences? Benefits/ risks? (Consequentialism)
What if everyone knew?
Is this how you would want to be treated/ how you would treat those close to you?
Can you sleep at night with your choice (conscience)?
What are the universal moral norms? (deontology)
Do your actions make sense once you know the details of the persons story?
Does your action follow from a set of similar cases?
Do your actions maximize the capabilities of others?
