decision making … principles & process …

April 3, 2012

in Bioethics,Hospice & Palliative Medicine,KU Med School,Uncategorized

principles …

 Standard of Care … Know your medical facts – diagnosis – prognosis – treatment. Get second opinion … go to the literature.

 

Substituted judgment … “If for whatever reason you are unable to make your own medical decisions … Who should make them for you?”. Put yourself in the patient’s place – their values, goals, hopes, dreams … How would they decide?”If your loved one could be with us for just 15 minutes to help make this decision … What would they say?”

 

Whose need is it? … All involved (including the medical team) find it difficult to really put the patient’s best interests first. We all have our (hidden) agendas.

 

Fiduciary decision maker … Who knows the patient best and has their best interests at heart? This is often not the ‘legal’ decision maker who falls in the ‘cascade’ (spouse, adult children, parents …). You as the physician are in covenantal (fiduciary) relationship with the patient.

 

Legal decision maker … Not defined by statute in KS (other than DPOAHC). By precedent = patient, DPOAHC, spouse, adult children, parents.

 

process …

 

  1. “If for whatever reason you are unable to make your own medical decisions … Who should make them for you?”
  2. Is there a DPOAHC named?
  3. Clarify/Define … Diagnosis/Prognosis/Treatment
  4. Clarify/Define … Goals of Care
  5. Negotiate … negotiate … negotiate … This takes both time and expertise to navigate the waters of conflict, troubled relationships, secondary gain, mistrust, our own many miscues. Get help.
  6. Remember your fiduciary bond to the patient.
  7. Who knows the patient best and has their best interests at heart?
  8. Consider getting second opinion … clarify standard of care.
  9. Getting the lawyers/judges involved is the last thing to do. They don’t want to adjudicate medical issues they don’t have expertise in.
  10. Remember … it always comes back to standard of care.

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