Medical Indications Flashcards

Question

What are 8 *general goals *of medicine?

Answer 1

1. Cure disease 2. Maintain/improve of quality of life (relief of symptoms, pain, suffering) 3. Promote of health and prevention of disease 4. Prevent untimely death 5. Improve functional status or maintain compromised status 6. Education and counseling of patients regarding their condition and prognosis 7. Avoid harm to patient in course of care 8. Provide relief and support near time of death \*\*sometimes goals conflict\*\*

Answer 2

- clarify goals of intevention - set & reset goals _realistically_

Answer 3

_interventions **non-indicated** when..._ 1. intervention has no scientifically shown effects on disease (but is desired or requested by physician/patient) 2. intervention may not be successful in a particular patient 3. intervention migh *become** ***non-indicated as patient's condition changes 4. intervention not applicable to dying/terminal/progressive lethal disease patient

Answer 4

when the **_application of intervention = improvement_** in condition (case specific)

Answer 5

"what a sound clinical judgment determines to be physiologically and medically appropriate in the circumstances of a _particular_ case."

Answer 6

A situation when clinical conditions indicate definitvely that **patient's organ systems are deteriorating repidly and irriversibly**. - death is expected within hours - "actively dying" or "imminently dying"

Answer 7

**no standard clinical definition.** - Medicare/Medicaid: "prediction of having 6 months or less to live" - clinical definition *SHOULD *be: " A patient whom experienced clinicians expect will die from a lethal, progressive disease, despite appropriate treatment, in a relatively short period of time" (i.e. days, weeks, a few months)

Answer 8

assess **how much risk is justified** by intended benefit *(don't forget to consider: patient's preferences/quality of life, context)*

Answer 9

A condition in which physiological systems have deteriorated so drastically that no medical interventions can reverse the decline.

Answer 10

"a condition that's not terminal, but an acute episode may threaten to kill the patient"

Answer 11

...offers no therapeutic benefit to patient. ## Footnote *(ethical justification for the physician to recommend withdrawing all interventions)*

Answer 12

**A**cute **P**hysiology **A**nd **C**hronic **H**ealth **E**valuation

Answer 13

**M**odified **O**rgan **D**ysfunction **S**core

Answer 14

justifying withdrawing or withholding treatment

Answer 15

A process where clinicians attempt to make consistantly good decisions in the face of uncertainty

Answer 16

- evidence-based medicine - clinical data - medical science - logical reasoning - development of practice guidelines * "[Medicine] A science of uncertainty and an art of probability" - Dr. William Osler*

Answer 17

- _Objective_ data about survival - Sound _clinical discretion about probabilities_ of improvement * (**quality of life** and **appropriate use of resources** becoe appropriate ethical resources)*

Answer 18

...the _first ethical ground_ that **further life-sustaining treatment can be omitted. **

Answer 19

the treatment is very _unlikely_ to achieve its goal (statistically; based on clinical data)

Answer 20

not physiologically futile, but there is a vanishingly low probability of restoring patient's health *(if* it is maintained, quality of life will be decreased)

Answer 21

1. What level of statistical or experimental evidence is required to support judgment of futility? 2. Who decides whether an intervention is futile, physicians or patients? 3. What process should be used to resolve disagreements between patients (or surrogates) and the medical team about whether a articular treatment if futile?

Answer 22

- judgment that intervention is highly unlikely to produce desired results - studies demonstrate low level of success - there is no definitive "how low?" level; suggested that \<1% chance of success in a clinical study = futile

Answer 23

generally thought that **physicians** should make decisions about treatment futility** in light of subjective views, values, goals of patients and their surrogates**. (in theory physician has the final say; can withdraw from case)

Answer 24

- institutions should design a policy - should be _nonunilateral decisions_ (unless physiologically futile) - should allow physician to withdraw from a case - stress the need for valid empirical evidence - negotiations should occur between medical personel, family, and/or surrogates

Answer 25

... it highlights the necessity to make decisions about treatments that are of questionable benefit

Answer 26

**physiological futility**