Concepts Leadership AERO 310
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This 16 page Class Notes was uploaded by Lamont MacGyver IV on Thursday October 29, 2015. The Class Notes belongs to AERO 310 at University of Michigan taught by Jonathan Liscombe in Fall. Since its upload, it has received 11 views. For similar materials see /class/231633/aero-310-university-of-michigan in Aviation Sciences at University of Michigan.
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Date Created: 10/29/15
Types of ethical problems Informed consent Miss Shurouq Qadous 2032011 Informed consent is the process by which a fully informed patient can participate in choices about his health care It originates from the legal and ethical right the patient has to direct what happens to his body and from the ethical duty of the physician to involve the patient in her health care The ma orta39nt a1 ofinfi ormegd consent that the M A w w quot x snow m um Knampnzlh mm mm GENERAL ccwssm mamamam mu comm mm anger Imporsmlu mm a W may versequot to m mummy nxmmum rumugnnw mcdL IX momma my Pnbtm pmqum vaccnnmus mu mmw m ummam n ca calsun 9 mu m a mummy Inlazmmhn 1m quotmmquot mmquot a m y mam mango quotanmmuxm and Mimeup needs Signamm a pmquot we Complete informed consent includes the following elements The nature of the decisionprocedure Reasonable alternatives to the proposed intervention The relevant risks benefits and uncertainties related to each alternative Assessment of patient understanding The acceptance of the intervention by the patient In most cases it is clear Whether or not patients are competent to make their own decisions Occasionally it is not so clear Patients are under an unusual amount of stress during illness and can experience anxiety fear and depression The stress associated with illness should not necessarily preclude one from participating in one39s own care However precautions should be taken to ensure the patient does have the capacity to make good decisions There are several different standards of decision making capacity Generally assess the patient39s ability to understand his or her situation understand the risks associated with the decision at handand communicate a decision based on that understanding If the patient is determined to be incompetent to make health care decisions a surrogate decision maker must speak for her If no appropriate surrogate decision maker is available the physicians are expected to act in the best interest of the patient until a surrogate is found or appointed Brody 1988 outlined general criteria of competency these criteria include The ability to receive information from the surroundings The capacity to remember the information received The ability to make a decision and give a reason for it The ability to use the relevant information in making the decision The ability to appropriately assess the relevant information Case 1 A 64yearold woman with MS is hospitalized The team feels she may need to be placed on a feeding tube soon to assure adequate nourishment They ask the patient about this in the morning and she agrees However in the evening before the tube has been placed the patient becomes disoriented and seems confused about her decision to have the feeding tube placed She tells the team she doesn39t want it in They revisit the question in the morning when the patient is again lucid Unable to recall her state of mind from the previous evening the patient again agrees to the procedure Is this patient competent to decide Which preference should be honored Discussion This patient39s underlying disease is impairing her decision making capacity If her wishes are consistent during her lucid periods this choice may be considered her real preference and followed accordingly However as her decision making capacity is questionable getting a surrogate decision maker involved can help determine what her real wishes are Case 2 A 55yearold man has a 3month history of chest pain and fainting spells You feel his symptoms merit cardiac catheterization You explain the risks and potential bene ts to him and include your assessment of his likely prognosis Without the intervention He is able to demonstrate that he understands all of this but refuses the intervention Can he do that legally Should you leave it at that Discussion This patient understands what is at stake with his treatment refusal As he is competent to make this decision you have a duty to respect his choice However you should also be sure to explore his reasons for refusing treatment and continue to discuss your recommendations A treatment refusal should be honored but it should also not be treated as the end of a discussion
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