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| - | ==Medical ethics==
| + | I0Qt8e Thanks a lot for the post.Really looking forward to read more. Really Great. |
| - | *All the hospitals have adult and peds ethics boards.
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| - | ===Case 1: 48yo F===
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| - | *Advance directive law is specific state to state, so it is important to know how the laws work in the state where you are practicing.
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| - | ===Ages of medicine===
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| - | *The age of the physician:
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| - | **400 BC to 1960
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| - | *The age of the patient:
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| - | **1960 to Oct 1 1983
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| - | ***DRG = disease related groupings
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| - | ***These categorize payment
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| - | ***An attempt to reign in healthcare costs
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| - | ***Blue Cross Blue Shield also started in 1960
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| - | *The age of the payor
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| - | ===4 box method===
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| - | *Also called georgetown mantra = 4 box method
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| - | *A two by two
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| - | *First box is the medical indications and beneficence
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| - | **This is what the dr. brings to the table.
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| - | *Second box: Patient preference and autonomy
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| - | **This is what we want to get from the patient (through their rational decision making)
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| - | **Diff between capacity and competence: competence is a legal term (only a judge or lawyer can call someone competent through assessment by a psychiatrist or psychologist).
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| - | **Out of autonomy comes informed consent:
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| - | ***Must disclose risks, benefits, costs, outcomes, other options.
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| - | ***Must ascertain that they have the capacity to decide.
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| - | ***Must be sure it is voluntary.
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| - | ****People who may not make it straight forward voluntary: third party payors, healthcare providers, researchers, family members
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| - | *Third box: Quality of life and burdens / benefits
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| - | **Murky area because it is hard to determine what level of quality of life is worth living for.
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| - | **Burdens and benefits are patient focused, not about money or the healthcare or anything else.
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| - | *Fourth box: socioeconomic factors and justice
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| - | ===Confidentiality===
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| - | *The exceptions are harm to self or others.
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| - | **Not just an allowance but a perogative (duty to report).
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| - | ===Moral theories===
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| - | ===Kidder's dilemma paradigms===
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| - | *Reporter for Christian Science Monitor found that people in extroidinary situations were deciding between four major decisions:
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| - | **"How Good People Make Tough Choices"
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| - | **Justice vs. Mercy
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| - | **Truth vs. Loyalty
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| - | **Individual vs. Community
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| - | **Short term vs. Long Term
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| - | ===Standards for decision making for incompetent patients===
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| - | *There are three types of standards against which decisions can be made for a pt.
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| - | *Subjective standard
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| - | *Substituted judgement
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| - | **Asking someone who knows the pt to make a decision for the pt.
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| - | *Objective standard - "Best interests"
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| - | ===Kruzann family case===
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| - | *Supreme court determined:
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| - | **Nutrition and fluids are therapy that can be denied.
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| - | **States decide how things work.
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| - | ===PSDA===
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| - | *Patient self-determination act
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| - | *stopped here on 01/24/11 on 2PM.
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