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Medical Ethics

Medical Ethics. Fall 2011 Philosophy 2440 Prof. Robert N. Johnson Friday, August 8, 2014. MIDTERM NEXT THURSDAY (11/13) IN YOUR DISCUSSION LAB DESCRIPTION AND ESSAY QUESTIONS: http:// web.missouri.edu /~ johnsonrn /midtermFS11.htm. Advanced Directives. HELGA WANGLIE.

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Medical Ethics

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  1. Medical Ethics Fall 2011 Philosophy 2440 Prof. Robert N. Johnson Friday, August 8, 2014

  2. MIDTERM NEXT THURSDAY (11/13) IN YOUR DISCUSSION LAB DESCRIPTION AND ESSAY QUESTIONS: http://web.missouri.edu/~johnsonrn/midtermFS11.htm

  3. Advanced Directives

  4. HELGA WANGLIE • Advance directives are normally attempts to limit, withdraw, or withholdtreatment. • Wanglie (86 yrs) became dependent on a ventilator, then suffered cardiac arrest and severe brain damage while hospitalized. Physicians: not in her best interest to be kept alive. • Family insisted she be kept alive, based on verbal directives. • A judge agreed with the family. • $800,000 for 2 yrs., Medicare + insurer • Should physicians be required to provide treatment which is futile, or no medical benefit?

  5. Grounds for Advance Directives • Right to refuse treatment • Honors individual autonomy • Promotes individual decision making • Reduces family conflict

  6. The Push for Advance Directives Fear of final days of life • with a loss of dignity and bound to medical technology • spent in unrelieved pain and discomfort • reducing personal and family resources

  7. Problems with Advance Directives Difficulties in determining: • Incompetence • A "reasonable time" for determining terminal condition • A "terminal condition • “Irreversible” condition Generally, vague and imprecise language

  8. Problems with Advance Directives • Restricts physicians' clinical judgment • Support study (“Reconceptualizing Advance Care Planning From the Patient's Perspective”, JAMA, 1998) shows that advance directives are often ignored The bottom line: advance directives are attempts to limit treatment, however imprecise they may be. Err on the side of doing less rather than doing more

  9. SENSES OF “FUTILE” MEDICAL TREATMENT • Of no benefit to the patient, i.e. it is not likely to improve the patient's condition. • The quality of outcome of the treatment is extremely poor • It will not be felt, recognized, or known by the patient • Puts an undesirable burden on the patient (e.g. continues suffering) • Is inhumane, undignified; continues an existence that is not meaningful

  10. FUTILE MEDICAL TREATMENT • Can a treatment be futile (in whatever sense) for the patient but beneficial for others, e.g. family, friends, caregivers? • Can a treatment be futile because it costs too much? Is futility appropriately measured, not just in medical benefits, but in costs/benefits? • The assumption: Physicians need not provide, and patients should not ask for, futile treatment

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