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Denise_Dudzinski_ Lecture Slides

A psychiatrist determines that she has decision

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A psychiatrist determines that she has decision-making capacity. Her son feels that whatever his mother wants is okay with him. The MD’s believe that she has a life-threatening condition, though it cannot at this moment be judged an emergency, however a state of emergency could arise suddenly and the woman lives 200 miles from the hospital.
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The physician has a relationship with Mrs. J developed over several years and thinks that admitting her to the hospital against her wishes may seriously impair the quality of that relationship. He feels torn about what to do. You are an ethics consultant and he cals you while Mrs. J is in the hospital. He asks your advice.
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1. Construct and fill in the four boxes 2. Identify several important ethical issues 3. What options do we have? 4. What will you recommend and why?
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Medical Indications Sepsis Low BP 58yo woman Has DMC Hx of infx, treated w/ po abx Urgent but not yet emergent Potential serious harm if strays too far from hospital Recommend admit to ICU (pressors, abx, etc.) – fear septic shock - IV fluids, abx, vasoconstrictors to increase bp to vital organs PMH – in ICU in past
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Patient Preferences No hospital or ICU (came only b/c of son) Wants to take po meds at home Wants to go home Does she want to live? No underlying terminal illness noted Believes she knows what’s wrong Has she given IC? Disclosure/understanding
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Quality of Life Septic shock may lead to multiple organ failure, short/long-term disability, death Living independently, ambulatory, speaks her mind, knows what she wants Dislikes being in the hospital
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Contextual Features Son worried about her, brought her to hospital. He’s willing to assent to what she wants. Lives far from hospital Personal relationship w/ MD – trust Professional responsibility to keep pt safe, must be sure she understands risks if leaves AMA
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Thank you
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A psychiatrist determines that she has decision making...

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