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14 Cards in this Set

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Brody - "Physicians Role in Determining Futility"
Admits: futility contains value component
Maintains: sometimes it is OK for physician to write DNR w/o consulting patient's values
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
Wreen vs Brody
1- The principles don't account for wrongess of examples
2- neither princlile supports the claim that DNR orders are strictly physicans decision
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
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.
Brock - "Incompetent Patients"

What is an advanced directive?
directions recieved in advance for incompetent adults (aka living will, power of attorney)
Determining Incompetency (criteria)
a) capacity for understanding (rationale)
b) capcity for reasoning
c) capacity to apply set of values

**incompetency is a lapse of any of these
Tests for Capacity
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
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 $)
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)
Mappes - 2 issues
Living wills - too restrictive (requirement of previous diagnois of terminal)

Ist it ever OK to ignore AD? YES
Mappes argument: written instructions weren't applied in correct manner
Wreen's reply: wrong reasoning, wasn't mis-written, pt just didn't consider every consequence
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
Euthanasia: 3 types
voluntary: w/ pt wishes
non-voluntary: neither w/ or w/o pt wishes
involuntary: against pt wishes
Robertson - "Involuntary Euthanasia of Defective Newborns"
Issue: babies born with mental defects

Stance: in favor of non-voluntary euthanasia