Philosophy 2 Flashcards
supports autonomy (ADC) (autonomy is the abcs)
Determining the patient’s ability to understand the issues, consider the consequences of different options, and communicate these thoughts to professionals is necessary
personhood (babies to comatose are persons)
newborns, cognitive impairment, comatose, children
Competence (in legal terms) (your dad)
Competence is a legal presumption that a person who has reached the age of majority has the requisite cognition and judgment to negotiate legal tasks, such as entering into a contract, making a will, or standing for trial.
decisional capacity (in medicine)
clinical context it is customary to refer to the patient’s decisional capacity, a clinical determination of the ability to make decisions about treatment or health care
Elements of Decisional Capacity (DPT BRD) decision to dip bird - this is basically informed consent
Decisional capacity refers to the patient’s ability to perform a set of cognitive tasks, including • • • • • understanding and processing information about diagnosis, prognosis, and treatment options; weighing the relative benefits, burdens, and risks of the therapeutic options; applying a set of values to the analysis; arriving at a decision that is consistent over time;
Capacity can be seen as an index of a person’s…
ability to exercise autonomy by making decisions that reflect personal preferences, values, and judgments at a given time.
Having capacity enables but does not obligate patients to…
to act independently. Despite our good intentions, we cannot force people who are unwilling to exercise their capacity for self- determination to do so.
delegated autonomy - assisted autonomy
These patients often entrust to others the authority to make decisions on their behalf
Capacity is not global, but…
decision- specific, referring to the ability to make particular decisions. ie - can decide what to have for lunch, but not specifics about surgery
Just as capacity is not global in its application to all decisions, it is not always…
constant. Elderly patients and sundowning.
The fact is, we only question the capacity of people who
not agree with us.
mini mental status exam (MMSE) - pros and cons
good for “orientation of the subject to person, place, and time, attention span, immediate recall, short- term and long- term memory, ability to perform simple calculations, and language skills” (Lo 2000, pp. 84– 85), it is less helpful in assessing an individual’s ability to grasp situations, weigh alternatives, and appreciate consequences— the skills required for capable decision making
Three standards are customarily invoked in attempting to make decisions as the patient would have made them (p (prior) is)
prior explicit articulation, substituted judgement - inferring, best interest
most problematic decision making standard (hardest for the substitute)
substituted judgement most problematic because, as commonly formulated, it requires the intellectually convoluted task of imagining what the now-incapacitated patient would choose if she were magically capable and in possession of all the relevant clinical facts.
how to use decision making standard (decisions must be authentic bc life is cohesive) AND what is it called
Apply Authenticity, which expresses the value of having one’s life be a coherent narrative, and surrogate decisions guided by this value seek to maintain the coherence of the patient’s life through the decisions that are made on her behalf, rather than to honor her hypothetical choices
advanced directives (disease is advancing) use by whom?
used for the formerly capacitated, ie dementia
2 types of advanced directives (instructions for the appointment)
instruction directives, also known as living wills, and appointment directives, also known as health care proxies or powers of attorney for health care.
hybrid advance directive, Five Wishes (5 hybrids decide my treatment, comfort, treat me, and loved ones)
provides the opportunity to communicate decisions about (1) the person I want to make care decisions for me when I can’t; (2) the kind of medical treatment I want or don’t want; (3) how comfortable I want to be; (4) how I want people to treat me; and (5) what I want my loved ones to know.
Without the patient’s explicit instructions in an advance directive, health care decisions made by surrogates have traditionally been based on the remaining two decision- (BS - is this judgement in the best interest?)
making standards— either substituted judgment (when the patient’s wishes can be inferred) or the best interest standard
EDMM - steps (FEPACCD) EDMM is fee packed
1) gather the facts
2) determine the ethical issues
3) state the principles which have a Bearing on the Case
4) List the Alternatives
5) Compare the Alternatives with the Principles
6) Consider the Consequences
7) Make a Decision
8) glossary
EDMM - ethical issues compete
“Ethical issues are stated in terms of legitimate competing interests or goods. These competing interests are
what actually create an ethical dilemma. The issues should be presented in an X versus Y format in order to
reflect the competing interest in a particular dilemma”
EDMM - state the principles
In bullet point fashion, list the ethical principles involved in the case. Such principles include things like:
professional codes of conduct, constitutional principles, legal principles, commonly accepted cultural
principles, natural law principles, or religious principles. The principles should be listed in order of their
ethical weight in the given case, e.g. P1, P2, P3, P4
EDMM - Consider the Consequences
“Both positive and negative consequences should be considered. They should be informally weighted since
some positive consequences are more beneficial than others, and some negative consequences are more
detrimental than others” (Rae, p. 106). You might list the alternatives with their consequences in the order of
informal weight, e.g. A2→ C2 weightier than A3→C3
EDMM - make a decision
“Deliberation cannot continue indefinitely. At some point, you must make a decision. Realize, too, that
ethical dilemmas often have no easy and painless solutions. Frequently, the decision that is made is one that
involves the least number of problems of negative consequences, not one that is devoid of them” (
principles of autonomy (RI DC) autonomy is redic (think about signing paper at doc office)
1) Informed Consent
2) Disclosure of Medical Information
3) Confidentiality
4) Right to Refuse Treatment
Four Main principles in medical ethics (the big ones - AJNB)
1) Autonomy (self-law/self-determination)
2) Justice (fairness/make-right; “doing and
pursuing the good”)
3) Nonmaleficence (do no harm/not
harming)
4) Beneficence (benefitng)