Friday, June 17, 2011

course on bioethics

  • Decision-Making Capacity, Surrogates, and Advance (health) Directives.  6 months after the event that paralyzed accident victims, 90% feel their quality of life is good -- ironically the ones who require ventilation (mechanical assistance to breathe) felt better than those who could breathe on their own.
  • In working through a scenario to resolve conflict among parties, must keep in mind the patient's interest is foremost consideration, family's is second.   Whatever the suggested options to be described as "ethical", there must be a clear rationale based on some fundamental concept of ethics and justice, whether it is "truth-telling",  individual person (patient)'s autonomy and right to decide the fate of their own body (and life), benefit (to community; e.g. utilitarianism, or intrinsically, or according to the consequences of those options.
  • What are your goals ?  Go home?  Back to life as it was before?  Life regardless of comfort or dignity?  or comfort and dignity potentially at the cost of length of life ?  Question is sometimes framed as "why?"  - what's the rationale of the patient's desires?    Discovery of whether patient's decisions were made based on incorrect information, can only be accomplished by direct contact and conversation / investigation with patient, much of important background cannot be found in the paper trail.
  • Power, Trust, Money, Hope, Integrity -- all candidates for components that constitute medical futility after the obvious medical diagnosis.
"Hope is a state of mind independent of the state of the world.  If your heart's full of hope, you can be persistent when you can't be optimistic.  You can keep the faith, despite the evidence, knowing that only in so doing does the evidence have any chance of changing.  So, while I'm not optimistic, I'm always very hopeful."    -- Reverend William Sloane Coffin.