Vulnerability and Medical Decisions Concerning Children

When life-threatening illness robs a patient of the ability to express their desires, medical personnel must work through the issues of management and prognosis with relatives. Management decisions are guided by medical judgement and the relatives’ account of the patient’s wishes, but difficulties occur when distance grows between these two factors. In these circumstances the counselling process may turn into a doctor-led justification of the medical decision. This article presents two strands of dialogue, in which a doctor, counselling for and against continuation of supportive treatment in two patients with liver failure, demonstrates selectivity and inconsistency in constructing an argument. The specific issues of loss of consciousness (with obscuration of personal identity), statistical ‘futility’ and removal of autonomy are explored and used to bolster diametrically opposed medical decisions. By examining the doctor’s ability to interpret these issues according to circumstance, the author demonstrates how it is possible to shade medical facts depending on the desired outcome.

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Medical Autonomy and Modern Healthcare

10.1093/oso/9780190684549.003.0007 ◽

2017 ◽

Author(s):

Jessica Flanigan

Keyword(s):

Product Liability ◽

Medical Decision ◽

Medical Providers ◽

Public Officials ◽

Public Provision ◽

Self Medication ◽

Medical Decisions ◽

The Public ◽

Patient’S Rights ◽

Access Information

Though rights of self-medication needn’t change medical decision-making for most patients, rights of self-medication have the potential to transform other aspects of healthcare as it is currently practiced. For example, if public officials respected patient’s authority to make medical decisions without authorization from a regulator or a physician, then they should also respect patient’s authority to choose to use unauthorized medical devices and medical providers. And many of the same reasons in favor of rights of self-medication and against prohibitive regulations are also reasons to support patient’s rights to access information about pharmaceuticals, including pharmaceutical advertisements. Rights of self-medication may also call for revisions to existing standards of product liability and prompt officials to rethink justifications for the public provision of healthcare.

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Advance care planning in chronic disease: finding the known in the midst of the unknown

10.1093/oso/9780198802136.003.0025 ◽

2018 ◽

Author(s):

Karen Detering ◽

Elizabeth Sutton ◽

Scott Fraser

Keyword(s):

Heart Failure ◽

Chronic Obstructive Pulmonary Disease ◽

Advance Care Planning ◽

Chronic Obstructive ◽

Care Planning ◽

Health Care Teams ◽

Management Options ◽

Medical Decisions ◽

Obstructive Pulmonary Disease ◽

Advance Care

People are living longer lives with a greater burden of disease. Diseases which contribute significantly to this burden are chronic kidney disease; chronic obstructive pulmonary disease and heart failure. Technologies exist that can sustain life for patients with these disease, however patients and their families/loved ones need to know the likely outcome of their disease, its course, and all management options. Advance care planning (ACP) can assist with this process as well as ensuring that patients, families, and health care teams are aware of what treatment a patient wants—or does not want. ACP also enables the appointment of a decision maker to act on behalf of the patient should they lose capacity to make medical decisions. This chapter discusses the benefits of ACP and why it needs to be introduced early in the course of any life-limiting illness.

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Patient Autonomy, Capacity, and Consent

The Oxford Handbook of Comparative Health Law ◽

10.1093/oxfordhb/9780190846756.013.52 ◽

2020 ◽

Author(s):

Jessica Berg ◽

Emma Cave

Keyword(s):

Patient Autonomy ◽

Medical Decision Making ◽

The United States ◽

Best Interests ◽

Medical Decision ◽

Human Rights Law ◽

Federal Law ◽

Medical Decisions ◽

General Overview ◽

Best Interests Standard

This chapter discusses patient autonomy, capacity, and consent involving children. It first provides a general overview of children’s rights with respect to making medical decisions in both the United States and Europe. The chapter then discusses the best interests standard (which is usually applied in cases of minors) and how to consider capacity in the context of children. In the discussions of European approaches, the chapter covers relevant international and regional human rights law. The jurisdiction of England and Wales are used as examples. The chapter also provides a general overview of US state approaches and federal law. The chapter concludes by noting some new areas of medical decision-making which challenge the traditional models.

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Hospital chaplains as ethical consultants in making difficult medical decisions

Journal of Medical Ethics ◽

10.1136/medethics-2020-107096 ◽

2021 ◽

pp. medethics-2020-107096

Author(s):

Waldemar Głusiec

Keyword(s):

Roman Catholic ◽

Medical Decision ◽

Medical Decisions ◽

Hospital Chaplains ◽

Specialist Knowledge ◽

Hospital Ethics ◽

Bioethical Education ◽

Further Development

Background and aimsFew Polish hospitals have Hospital Ethics Committee (HECs) and the services are not always adequate. In this situation, the role of HECs, in providing, among others, ethical advice on the discontinuation of persistent therapies, may be taken over by other entities. The aim of our research was to investigate, how often and on what issues hospital chaplains are asked for ethical advice in reaching difficult medical decisions.MethodsA survey of 100 Roman Catholic chaplains was conducted, that is, at least 10% of all chaplains currently working in Polish hospitals.ResultsOf the participants, 29% confirmed receiving requests for advice in making a morally difficult medical decision. Receiving this type of request was not conditional on the place of their service, duration of their pastoral mission or HEC membership. The largest group of chaplains (21%) encounter questions concerning the ethical dilemmas associated with discontinuing persistent therapy. Patients and their families most often raise issues related to the methods of birth control, and the medical staff raise the issue of termination of pregnancy—as reported by 9% and 15% of chaplains, respectively. Most of the chaplains asked for help (79%) experience a deficit of specialist knowledge in the area of medicine or ethics.ConclusionsIn order to improve the quality of ethical consultations in Polish hospitals, in addition to further development of HECs, it is postulated to develop a system for bioethical education of chaplains.

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Webster and the Fundamental Right to Make Medical Decisions

American Journal of Law & Medicine ◽

10.1017/s0098858800012156 ◽

1989 ◽

Vol 15 (2-3) ◽

pp. 184-188

Author(s):

David Orentlicher

Keyword(s):

Health Care ◽

Health Care Professionals ◽

The State ◽

Medical Decisions ◽

Fetal Health ◽

Religious Issues ◽

Roe V Wade

The interest of the eight major organizations of health care professionals was not in debating the philosophical, ethical, moral or religious issues surrounding abortion. The members of the organizations differ on how to balance the woman's privacy right against the state's interests in maternal and fetal health, and in particular about whether the state has a compelling interest in fetal health before viability. Given the diversity of views, the brief neither endorsed nor opposed the Supreme Court's holding in Roe v. Wade that the state's interest in fetal health becomes compelling at viability.

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Public knowledge, preferences and experiences about medical substitute decision-making: a national cross-sectional survey

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2020-002619 ◽

2021 ◽

pp. bmjspcare-2020-002619

Author(s):

Marcus Sellars ◽

Julien Tran ◽

Linda Nolte ◽

Ben White ◽

Craig Sinclair ◽

...

Keyword(s):

Decision Making ◽

Online Survey ◽

Public Knowledge ◽

Cross Sectional Survey ◽

Medical Decisions ◽

Cross Sectional ◽

Minimal Support ◽

Substitute Decision Maker ◽

Final Sample ◽

Advance Care

ObjectiveTo describe the Australian adult public’s knowledge and experiences regarding substitute decision-making for medical decisions and their preferences for obtaining information about the substitute decision-maker (SDM) role.MethodsThis is a national cross-sectional online survey of the Australian adult public. The survey examined participants’ advance care planning (ACP) awareness and experience, SDM experiences and preferences for obtaining more information about SDM, and participant knowledge about SDM.ResultsOf 1586 people who opened the survey, 1120 (70.6%) were included in the final sample. 13% (n=142) of participants indicated they had acted as an SDM. A median score of two correct responses out of five showed low to moderate knowledge about the SDM role among all participants, with only 33% reporting awareness of SDM laws existing in Australia. While most (59%) participants ranked a health professional as their preferred source of obtaining information about supporting SDMs, few participants who had been an SDM (n=64, 45%) reported obtaining any support in making medical decisions. The median SDM knowledge scores for people who had discussed ACP (3.0 vs 2.0, U=1 45 222, z=6.910, p<0.001), documented their ACP preferences (3.0 vs 2.0, U=71 984, z=4.087, p<0.001) or acted in the SDM role (3.0 vs 2.0, U=56 353, z=−3.694, p<0.001) were significantly higher compared with those who had not.ConclusionsThe Australian public may have low to moderate knowledge about the SDM role and access only minimal support when making challenging medical decisions.

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