“I Would Rather Die than Live Like This”

2018 ◽  
Author(s):  
Andrew M. Courtwright
Keyword(s):  
Decision Making ◽  
Medical Care ◽  
Moral Psychology ◽  
Clinical Situation ◽  
Normative Ethics ◽  
Autonomous Decision ◽  
Decision Making Capacity ◽  
Life Sustaining Treatment ◽  
The Will ◽  
Individual Decisions

The medical view of autonomous decision making (MVAD)—in which a patient’s decision-making capacity is evaluated according to his beliefs and understanding of his clinical situation and how his decisions fit within the scope of other things he desires—has been extensively criticized within normative ethics and moral psychology. Using a case in which a newly disabled man refuses additional medical care because he does not want to live as a disabled person, this chapter discusses the MVAD framework that physicians use to evaluate decisions about forgoing life-sustaining treatment for otherwise survivable complications of disability. This approach is more ethically robust than is usually appreciated. However, it can be strengthened by considering autonomy as a Kantian property of the will and not merely a property of individual decisions. This chapter concludes with a discussion of how to approach the newly disabled who are struggling to adjust to their perceived impairments.

The prisoner dilemma: Inconsistent decisions for continuing life-sustaining treatment between a patient with very limited communication and their surrogate

2020 ◽  
pp. 147775092093037
Author(s):  
Abram Brummett
Keyword(s):  
Decision Making ◽  
Limited Communication ◽  
Difficult Question ◽  
Decision Making Capacity ◽  
Life Sustaining Treatment

This case raises the difficult question of how to respond to patients who appear to lack decision-making capacity, yet retain limited communication that allows them to state a preference for life-sustaining treatment that conflicts with the choice of their surrogate. I argue that the patient’s preference should be honored, even though the patient lacks decision-making capacity, and the preference contradicts the wishes of the surrogate.

Assessment of Decision-Making Capacity

2020 ◽  
pp. 19-24
Author(s):  
Kenneth V. Iserson
Keyword(s):  
Decision Making ◽  
Medical Care ◽  
System Capacity ◽  
Decisional Capacity ◽  
Value System ◽  
Decision Making Capacity ◽  
Legal Term

Decision-making capacity (rather than “competence,” a legal term) is the ability to make decisions about one’s own medical care. Having decision-making capacity rests on the patient’s understanding their healthcare options and choosing an option consistent with their stable value system. Capacity is decision relative, meaning that the criteria to have decisional capacity depend on the complexity of the decision and the seriousness of possible outcomes. Individuals can have fluctuating decision-making capacity.

Will, the

2018 ◽  
Author(s):  
Thomas Pink
Keyword(s):  
Decision Making ◽  
Late Antiquity ◽  
Human Action ◽  
Early Modern Europe ◽  
Freedom Of Will ◽  
Decision Making Capacity ◽  
The Will ◽  
To Come ◽  
Free Actions ◽  
Freedom Of Action

As traditionally conceived, the will is the faculty of choice or decision, by which we determine which actions we shall perform. As a faculty of decision, the will is naturally seen as the point at which we exercise our freedom of action – our control of how we act. It is within our control or up to us which actions we perform only because we have a capacity to decide which actions we shall perform, and it is up to us which such decisions we take. We exercise our freedom of action through freely taken decisions about how we shall act. From late antiquity onwards, many philosophers took this traditional conception of the will very seriously, and developed it as part of a general theory of specifically human action. Human action, on this theory, is importantly different from animal action. Not only do humans have a freedom of or control over their action which animals lack; but this freedom supposedly arises because humans can act on the basis of reason, while animal action is driven by appetite and instinct. Both this freedom and rationality involve humans possessing what animals are supposed to lack: a will or rational appetite – a genuine decision making capacity. From the sixteenth century on, this conception of the will and its role in human action met with increasing scepticism. There was no longer a consensus that human action involved mental capacities radically unlike those found in animals. And the idea that free actions are explained by free decisions of the will came to be seen as viciously regressive: if our freedom of action has to come from a prior freedom of will, why shouldn’t that freedom of will have to come from some yet further, will-generating form of freedom – and so on ad infinitum? Yet it is very natural to believe that we do have a decision making capacity, and that it is up to us how we exercise that capacity – that it is indeed up to us which actions we decide to perform. The will-scepticism of early modern Europe, which persists in much modern Anglophone philosophy of action, may then have involved abandoning a model of human action and human rationality that is deeply part of common sense. We need to understand this model far better before we can conclude that its abandonment by so many philosophers really was warranted.

A suicidal, dysarthric patient who wishes to discontinue life-sustaining treatments: A case report

2018 ◽  
Vol 53 (4) ◽  
pp. 306-309
Author(s):  
Zachary Orlins
Keyword(s):  
Decision Making ◽  
Case Report ◽  
Ethical Principles ◽  
Suicidal Patient ◽  
Best Interest ◽  
Decision Making Capacity ◽  
Life Sustaining Treatment

Psychiatrists may be among the clinicians to encounter a depressed and suicidal patient who wishes to discontinue life-sustaining treatment. A patient who is suffering from a condition such as dysarthria makes decision-making capacity (a physician’s determination of a patient’s ability to medically consent) increasingly difficult to assess. The clinician must balance ethical principles of autonomy, non-maleficence, beneficence, and justice in order to achieve a plan of care that is in the patient’s best interest.

Who Decides?

2020 ◽  
pp. 41-48
Author(s):  
Kenneth V. Iserson
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Living Will ◽  
Care Physician ◽  
Power Of Attorney ◽  
Health Care Decisions ◽  
Decision Making Capacity ◽  
State Statutes ◽  
Hospital Policies ◽  
Life Sustaining Treatment

To make a health care decision, individuals (whether it be the patient or an adult surrogate) must have decision-making capacity. Based on the principle of patient autonomy (respect for persons), such adults can make their own health care decisions, even if they contradict what their health care provider recommends. However, if a patient lacks decision-making capacity, his or her previously completed health care directive(s) take effect. These can be a living will, durable power of attorney for health care, Physician Orders for Life-Sustaining Treatment (POLST) form, or a similar document. In a similar manner, if an adult patient wishes to orally designate another adult to make his or her health care decisions (as in the case in this chapter), they may do that. These surrogates’ decisions carry the same weight as and replace any previously named surrogate. When no surrogate has been named, most hospital policies and many state statutes list the general hierarchy of people to be the patient’s surrogates.

Issues of Capacity and Decision-Making in the Context of Delirium

2015 ◽  
Vol 24 (4) ◽  
pp. 140-145
Author(s):  
Kevin R. Patterson
Keyword(s):  
Decision Making ◽  
Patient Autonomy ◽  
Care Setting ◽  
Cognitive Change ◽  
Treatment Team ◽  
Precipitating Factors ◽  
Term Care ◽  
Decision Making Capacity ◽  
Fundamental Consideration

Decision-making capacity is a fundamental consideration in working with patients in a clinical setting. One of the most common conditions affecting decision-making capacity in patients in the inpatient or long-term care setting is a form of acute, transient cognitive change known as delirium. A thorough understanding of delirium — how it can present, its predisposing and precipitating factors, and how it can be managed — will improve a speech-language pathologist's (SLPs) ability to make treatment recommendations, and to advise the treatment team on issues related to communication and patient autonomy.

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