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,…

Capacity: What do we need know about patients before we can do what they tell us to do? Standard

A person may lack capacity to decide certain things and have capacity to do others. A person may be lack the capacity to decide sophisticated financial affairs, but have the capacity  to make medical decisions for themselves. The magnitude of the risk involved and the medical intervention contemplated is central to assessments of capacity. A decision to install a PICC line has a different level of risk than extubating (withdrawal of care) in a patient who clearly requires assistance in breathing. So, we can accept a  consent to a PICC line but not  necessarily to extubate. Levels of capacity vary…