Category Archives: Autonomy

The Problem with POLST – Physician Orders for Life-Sustaining Treatment Standard

The Problem with POLST Over the years, informed consent has been given short shrift. There is, however, a growing understanding of the importance of obtaining an actual and legitimate consent before  having a patient accept or reject medical treatment. Autonomy, transparency, respect, dignity, and other similarly recognized human rights are increasingly recognized as legal and ethical requirements. “POLST” (Physician Orders for Life-Sustaining Treatment) however, makes it easy and even inviting to avoid these requirements with the stroke of a pen on a conclusionary form. POLST only makes sense in cases of patients with terminal illnesses, in end stage disease with no…

Waiting for medical records “after discharge” is of no help for decision making Standard

Medical records: Waiting for medical records “after discharge” is of no help.  Reviewing medical records  in the hospital allows the patient and/or a surrogate decision maker to obtain the greatest amount of information possible over the cross section of medical specialties providing care.  It provides a clear picture of the condition of the patient with respect to cognition, pain and prognosis. Review of reports of CT scans, x-rays, and MRI’s can bring a clear picture of improvement and deterioration in the patient’s condition. All of this will ensure that consent is based upon complete information and make it easier for…

FCC adopts rules for Medcial Body Area Networks Standard

The FCC adopted rules for Medical Body Area Networks (MBANs), with multiple body-worn sensors “MBAN” that monitor blood glucose, pressure monitoring, electrocardiogram readings, and even neonatal monitoring systems. The monitors can be used in the hospital setting, nursing facilities to identify life-threatening symptoms before they reach critical levels. Under Part 95 of Medical Device “MedRadio” Service no application will be required to use body area networks According to a study by the Institute for Healthcare Improvement, a monitored hospital patient has a 48% chance of surviving a cardiac arrest—this number plummets as low as 6% without monitoring.   The challenge…

Same Sex Domestic Partners and Medical Decision Makers Standard

The Senate Judiciary and Public Affairs committee in New Mexico passed (5 to 4) the Domestic Partnership Bill – 800 pages long that gives unmarried same-sex and opposite-sex couples the legal protections and benefits of married couples on issues including medical decision-making. It is anticipated that republicans will oppose.   It must be made clear that patients are not restricted in nomination who ever they want to act as their surrogate decision makers. It is the person who best knows the patients wishes and values that should act as the surrogate decision maker in all instances.   Some states provide…

Death Panels and Advanced Care Planning Standard

A recent article in the Journal of the American Medical Association, JAMA, discusses the need for effective public health announcements to encourage people to explain their end of life wishes and their values, goals and preferences. It has been well established that physicians are reluctant to discuss end of life choices with their patients and the norm has been to put it off until the patient is in advanced terminal disease when it is, indeed, more difficult to discuss. Studies have also shown that the majority of patients said they would choose to forego futile care but few are presented…

Doctor’s Mothers and Autonomous Choices Standard

Physicians continue to tell patients what they would do if it were their mother. This is just another form of paternalism and disregard for autonomous decision making. Physicians remain exceedingly reluctant to confront the difficult subject of end of life care. The New York times, on January 11, 2009 published an article, by Denise Grady, – “Facing End-of-Life Talks, Doctors Choose to Wait.” Discussing a survey of 4,074 doctors who took care of cancer patients, who had only four to six months left, but was still feeling well. 65 percent said they would talk about the prognosis, but wait to…

The Proper Role of Bioethics Standard

In Bioethics we learn that the patient has a right to make autonomous decisions. There has, however, been a bias built into to applicable legislation in many states, which interprets “autonomy” as the dignity to refuse treatment and avoid what is termed a protracted death. This slant on autonomy and the right to refuse treatment can cause some patients to be fearful of having an advanced directive, or, cause death due to withholding of artificial life support when not intended or requested by the patient. It is not, the job of Bioethicists to emphasize the right to refuse treatment, but instead the…

Kidney Transplants and Informed Consent Standard

At the 42d meeting of the American Society of Nephrology in San Diego this week, entitled “Renal Week,” Elisa J. Gordon, PhD, MPH, of Northwestern University presented a study on informed consent, that found that  “kidney transplant consent forms are written at considerably higher reading levels than they should be.” She is of the view that consent forms should be written at a 5th to 8th grade reading to ensure that transplant candidates are well informed about transplantation processes, understand the material, and can provide informed consent. My concern is that many physicians see forms as a satisfactory replacement for…

Hospital Ethics Committee Failure Standard

Being right does not make a decision morally correct. The patient, a 98 year old man was suffering from a dissecting aortic aneurysm of 7.5 cm. He was unresponsive and near death. He previously, and with unquestioned capacity, executed an advance health directive indicating that he refused surgery. He also had previously told his physician that he would rather die than to face the probable mental and physical damage and quality of life deterioration that would accompany such damage.  Without question, principles of clinical bioethics would demand respect for the patient’s wishes and directives. In this instance, the patient’s spouse…

Autonomy: The Patient is the Patient – the family isn’t Standard

    Many patients facing illness or disease that places their lives at risk do not generally ask why their life is at an end. Instead they often ask, “Why did I live at all?”  “What difference did my life make? It is remarkable how disempowered one feels when seriously ill. Dr Paulina Taboada, describes it:      “Indeed, perhaps the most devastating aspect of despair is the inability to find meaning.”      When we become weak, confused and exhausted we often enter into a void where our thoughts and decisions are distanced from us. As football coach Vince Lombardi said,…