Healthcare Ethics

ASSESSMENT DEPARTMENT WESTERN GOVERNORS UNIVERSITY

QUESTIONS DERIVED FROM THE UNIVERSITY OF WASHINGTON PARADIGM

Course of Action One – 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

1. non-maleficence

1. 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

1. non-maleficence

1. 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

1. non-maleficence

1. 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

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022016