QUESTIONS DERIVED FROM THE UNIVERSITY OF WASHINGTON PARADIGM
Course of Action One – Follow Bashir’s Wishes
MEDICAL INDICATIONS
The Principles of
... [Show More] Beneficence and Non-maleficence
• What is the patient’s medical problem? Is the problem acute? Chronic? Critical? Reversible? Emergent? Terminal?
• Using this course of action, describe, in full sentences, necessary considerations via
1. beneficence
2. non-maleficence
3. autonomy
• In what circumstances are medical treatments not indicated?
• What are the probabilities of success of various treatment options?
• In sum, how can this patient be benefited by medical and nursing care, and how can harm be avoided?
PATIENT PREFERENCES
The Principle of Respect for Autonomy
• Has the patient been informed of benefits and risks, understood this information, and given consent?
• Is the patient mentally capable and legally competent, and is there evidence of incapacity?
• If mentally capable, what preferences about treatment is the patient stating?
• If incapacitated, has the patient expressed prior preferences?
• Who is the appropriate surrogate to make decisions for the incapacitated patient?
• Is the patient unwilling or unable to cooperate with medical treatment? If so, why?
QUALITY OF LIFE
The Principles of Beneficence, Non-maleficence, and Respect for Autonomy
• What are the prospects, with or without treatment, for a return to normal life, and what physical, mental, and social deficits might the patient experience even if treatment succeeds?
• On what grounds can anyone judge that some quality of life would be undesirable for a patient who cannot make or express such a judgment?
• Are there biases that might prejudice the provider’s evaluation of the patient’s quality of life?
• What ethical issues arise concerning improving or enhancing a patient’s quality of life?
• Do quality-of-life assessments raise any questions regarding changes in treatment plans, such as forgoing life-sustaining treatment?
• What are plans and rationale to forgo life-sustaining treatment?
• What is the legal and ethical status of suicide?
CONTEXTUAL FEATURES
The Principles of Justice and Fairness
• Are there professional, interprofessional, or business interests that might create conflicts of interest in the clinical treatment of patients?
• Are there parties other than clinicians and patients, such as family members, who have an interest in clinical decisions?
• What are the limits imposed on patient confidentiality by the legitimate interests of third parties?
• Are there financial factors that create conflicts of interest in clinical decisions?
• Are there problems of allocation of scarce health resources that might affect clinical decisions?
• Are there religious issues that might affect clinical decisions?
• What are the legal issues that might affect clinical decisions?
• Are there considerations of clinical research and education that might affect clinical decisions?
• Are there issues of public health and safety that affect clinical decisions?
• Are there conflicts of interest within institutions or organizations (e.g. hospitals) that may affect clinical decisions and patient welfare?
Course of Action Two - Refuse to Follow Bashir’s Wishes
MEDICAL INDICATIONS
The Principles of Beneficence and Non-maleficence
• What is the patient’s medical problem? Is the problem acute? Chronic? Critical? Reversible? Emergent? Terminal?
• Using this course of action, describe, in full sentences, necessary considerations via
1. beneficence
2. non-maleficence
3. autonomy
• In what circumstances are medical treatments not indicated?
• In sum, how can this patient be benefited by medical and nursing care, and how can harm be avoided?
PATIENT PREFERENCES
The Principle of Respect for Autonomy
• Has the patient been informed of benefits and risks, understood this information, and given consent?
• Is the patient mentally capable and legally competent, and is there evidence of incapacity?
• If mentally capable, what preferences about treatment is the patient stating?
• If incapacitated, has the patient expressed prior preferences?
• Who is the appropriate surrogate to make decisions for the incapacitated patient?
• Is the patient unwilling or unable to cooperate with medical treatment? If so, why?
QUALITY OF LIFE
The Principles of Beneficence, Non-maleficence, and Respect for Autonomy
• What are the prospects, with or without treatment, for a return to normal life, and what physical, mental, and social deficits might the patient experience even if treatment succeeds?
• On what grounds can anyone judge that some quality of life would be undesirable for a patient who cannot make or express such a judgment?
• Are there biases that might prejudice the provider’s evaluation of the patient’s quality of life?
• What ethical issues arise concerning improving or enhancing a patient’s quality of life?
• Do quality-of-life assessments raise any questions regarding changes in treatment plans, such as forgoing life-sustaining treatment?
• What are plans and rationale to forgo life-sustaining treatment?
• What is the legal and ethical status of suicide?
CONTEXTUAL FEATURES
The Principles of Justice and Fairness
• Are there professional, interprofessional, or business interests that might create conflicts of interest in the clinical treatment of patients?
• Are there parties other than clinicians and patients, such as family members, who have an interest in clinical decisions?
• What are the limits imposed on patient confidentiality by the legitimate interests of third parties?
• Are there financial factors that create conflicts of interest in clinical decisions?
• Are there problems of allocation of scarce health resources that might affect clinical decisions?
• Are there religious issues that might affect clinical decisions?
• What are the legal issues that might affect clinical decisions?
• Are there considerations of clinical research and education that might affect clinical decisions?
• Are there issues of public health and safety that affect clinical decisions?
• Are there conflicts of interest within institutions or organizations (e.g. hospitals) that may affect clinical decisions and patient welfare?
Course of Action Three- Delay Treatment
MEDICAL INDICATIONS
The Principles of Beneficence and Non-maleficence
• What is the patient’s medical problem? Is the problem acute? Chronic? Critical? Reversible? Emergent? Terminal?
• Using this course of action, describe, in full sentences, necessary considerations via
1. beneficence
2. non-maleficence
3. autonomy
• In what circumstances are medical treatments not indicated?
• In sum, how can this patient be benefited by medical and nursing care, and how can harm be avoided?
PATIENT PREFERENCES
The Principle of Respect for Autonomy
• Has the patient been informed of benefits and risks, understood this information, and given consent?
• Is the patient mentally capable and legally competent, and is there evidence of incapacity?
• If mentally capable, what preferences about treatment is the patient stating?
• If incapacitated, has the patient expressed prior preferences?
• Who is the appropriate surrogate to make decisions for the incapacitated patient?
• Is the patient unwilling or unable to cooperate with medical treatment? If so, why?
QUALITY OF LIFE
The Principles of Beneficence, Non-maleficence, and Respect for Autonomy
• What are the prospects, with or without treatment, for a return to normal life, and what physical, mental, and social deficits might the patient experience even if treatment succeeds?
• On what grounds can anyone judge that some quality of life would be undesirable for a patient who cannot make or express such a judgment?
• Are there biases that might prejudice the provider’s evaluation of the patient’s quality of life?
• What ethical issues arise concerning improving or enhancing a patient’s quality of life?
• Do quality-of-life assessments raise any questions regarding changes in treatment plans, such as forgoing life-sustaining treatment?
• What are plans and rationale to forgo life-sustaining treatment?
• What is the legal and ethical status of suicide?
CONTEXTUAL FEATURES
The Principles of Justice and Fairness
• Are there professional, interprofessional, or business interests that might create conflicts of interest in the clinical treatment of patients?
• Are there parties other than clinicians and patients, such as family members, who have an interest in clinical decisions?
• What are the limits imposed on patient confidentiality by the legitimate interests of third parties?
• Are there financial factors that create conflicts of interest in clinical decisions?
• Are there problems of allocation of scarce health resources that might affect clinical decisions?
• Are there religious issues that might affect clinical decisions?
• What are the legal issues that might affect clinical decisions?
• Are there considerations of clinical research and education that might affect clinical decisions?
• Are there issues of public health and safety that affect clinical decisions?
• Are there conflicts of interest within institutions or organizations (e.g. hospitals) that may affect clinical decisions and patient welfare [Show Less]