__________________________________________________________________ Medical Ethics for Physicians
Medical Facts • What is the patient’s current medical status? • Are there other contributing medical conditions? • What is the diagnosis? The prognosis? How reliable are these? • Has a second opinion been obtained? Would it be helpful? • Are there other tests that could clarify the situation? • What treatments are possible? • What is the probable life expectancy and what will be the general condition if treatment is given? • What are the risks and side effects of treatment? • What is the probability that treatment will benefit the patient? • What benefits will treatment provide? Patient Preferences • Is the patient competent? Does he or she understand the need for medical care, the options that are available, and the probable results of choosing each of the various available courses of action? • Has the patient been informed about his or her condition? • How was the patient informed? • Have all the treatment alternatives and their possible consequences been discussed with the patient? • Has the patient had time to reflect upon the situation and upon the possible options? • Has the patient made a clear statement about his or her wishes? If so, what are they? • Has the patient discussed the situation thoroughly with someone other than the members of the immediate healthcare team? • If the patient is not currently competent, is he or she expected to regain competence? • If the patient is incompetent, did he or she ever make a clear statement that would indicate his or her wishes in these circumstances? • Is there an advance directive for this patient, and is it available to the healthcare team? • If the patient has not made any clear statement and does not have an advance directive, is there information from anyone regarding what the patient might have wanted or might reasonably be assumed to have wanted? Views of Family • Are there family members and who are they? Are they available to the healthcare team? • Do they fully understand the patient’s condition?
• What are their positions? • Do they agree with one another? • Are there any reasons to question their motives? • Has one person been identified as having the primary responsibility for communication and decision making? • Does anyone have legal custody of the patient (guardianship)? • If the patient is a minor, are the legal guardian(s) choosing a course of action that is clearly in the child’s best interests? • If there are problems in communicating with the family, can someone be found (e.g., translator, minister) who could be helpful as a liaison between the family and the healthcare team? Views of the Caregivers • Are the caregivers fully apprised of the facts? • What are their views? • If the caregivers disagree, what accounts for the disagreements? Can they be resolved? Legal, Administrative, and External Factors • Are there state statutes or case law that apply to this situation? • What potential liability might be present with respect to the hospital, to the providers, and to the parent or guardian? • Are there hospital policies or guidelines that apply, and would they be helpful in this situation? • Are there other persons (in or outside the institution) who should be given information or asked for an opinion? • Would it help to consult the literature for any aspect of this case? • Is expense to the patient and/or family a factor? AN ETHICAL DECISION-MAKING MODEL There are five fundamental components to the cognitive decision-making process as identified by ethicists Kenyon and Congress. They encompass naming the dilemma, sorting the issues, solving the problem, acting, and evaluating and reflecting [10; 15]: • Naming the dilemma involves identifying the values in conflict. If they are not ethical values or principles, it is not truly an ethical dilemma. It may be a communication problem or an administrative or legal uncertainty. The values, rights, duties, or ethical principles in conflict should be evident, and the dilemma should be named (e.g., this is a case of conflict between patient autonomy and doing good for the patient). This might happen when a patient refuses an intervention or treatment that the physician
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MDTX1625
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