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14 Cards in this Set
- Front
- Back
Brody - "Physicians Role in Determining Futility"
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Admits: futility contains value component
Maintains: sometimes it is OK for physician to write DNR w/o consulting patient's values |
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argues via PROFESSIONAL INTEGRITY
(not to write DNR order would violate integrity) creates 2 principles to avoid violations of integrity |
1- Don't do more harm than good (Util)
2- Don't fraudulently mis-represent medical skills |
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Wreen vs Brody
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1- The principles don't account for wrongess of examples
2- neither princlile supports the claim that DNR orders are strictly physicans decision |
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Brody claims: treating a pt. involves making a statement that this treatment is appropriate under these circumstances, thus CPR would be a false symbolic display
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Wreen's reply: QUESTION BEGGING
assumes that giving CPR is inappropriate w/o offering proof Brody suggests a 1% chance of living is the same as 0% chance, and 1% is not worth a physicians time. |
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Brock - "Incompetent Patients"
What is an advanced directive? |
directions recieved in advance for incompetent adults (aka living will, power of attorney)
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Determining Incompetency (criteria)
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a) capacity for understanding (rationale)
b) capcity for reasoning c) capacity to apply set of values **incompetency is a lapse of any of these |
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Tests for Capacity
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a) how one understands (process)
b) vary according to consequences for pt well-being c) pt may be competent to consent, but not to refuse and vice versa **problem: a is process standard and c is outcome standard..this is a contradiction, implies that standard should be based on value of stakes **wreen's soln = have single process standard |
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Determining a surrogate
(assuming pt is found competent) |
a) DPOA determined while competent
b) no DPOA, closest relative "if pt were competent, what would he/she decide?" c) respect pt autonomy *can be over-ridden (cases of $) |
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How surrogates should decide
(ordered principles) |
a) ADVANCED DIRECTIVE (living wills, DPOA)
**Probs: vague, limitations, must have previous diagnosis of term. ill b) SUBSITITUTED JUDGEMENT (surrogate decides according to pt values, even if pt and surrogate don't share value) c) BEST INTEREST (pt's best interest or as rational indiv. would decide) |
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Mappes - 2 issues
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Living wills - too restrictive (requirement of previous diagnois of terminal)
Ist it ever OK to ignore AD? YES |
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Mappes argument: written instructions weren't applied in correct manner
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Wreen's reply: wrong reasoning, wasn't mis-written, pt just didn't consider every consequence
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Mappes vs Wreen
1) past wishes vs. present interests 2) incompetent revisions |
Mappes: always honor past wishes and living wills...ignore pt current requests
Wreen: honor present wishes and use substituted judgement |
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Euthanasia: 3 types
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voluntary: w/ pt wishes
non-voluntary: neither w/ or w/o pt wishes involuntary: against pt wishes |
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Robertson - "Involuntary Euthanasia of Defective Newborns"
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Issue: babies born with mental defects
Stance: in favor of non-voluntary euthanasia |