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Ethical issues
Ethical
Ethical issues bearing upon the rights or
wrongs of human behaviour arise when the
answers proposed to any given question are
uncertain or conflicting.
Ethics
-1990
(Consequentialism) : An action is
morally judged in terms of the
consequences it brings about.
:(Jermy Bentham, ,
1748-1832)
(Utilitarianism):
(the happiness promoted)
(the
greatest happiness for the greatest
number)
(Deontology)
()
()
/(Guidelines)
(
)
(PAS)
2008
(medical futility
(medical uncertainty)
(decision-making)
(Advance Directives)
(assessment of decision
making capacity)
2008
Beauchamp and Childress (1983)
Autonomy
Non-maleficence (doing no harm)
vs.
1. The legal test
2. Gut-feeling test
3. The front-page test
(/ )
4. Role-Model test
- 102008
IDP: Issue, Discussion,
Discussion Plan
Patient preferences
Quality of life
Contextual features
Quality of life
Contextual features
Contextual features
In medical ethics
Beneficence
Nonmaleficence
Benefit-risk ratio
ratio
1
? ? ??
2
3
4
5
Indicated or non-indicated
indicated
Jonsen, Siegler,Winslade. Clinical EthicsA Practicall
Approach to Ethical Decisions in Clinical Medicine. 7th
ed.;2010
Indicated or non-indicated
nonindicated:
1.
2.
Non-indicated
3.
4.
indicated
4415MS
12
MS
urosepsis
indicated for
(adying patient)
(terminally ill patient)
(an incurable patient)
non-indicated.
Dying
(dis-integrating),
actively dying or
imminently dying
ICU
ICU
sepsis
(futility)
Recommendation
Mr. Care
indicated
Physicological futility
Terminal
Medicare, Medicaid
terminal
Terminal
(
)
all daily activity
Confused and disoriented, ER
ERunresponsive, high fever,
callpersonal physician,
ER
ICU?
AMIangioplasty
and stening?
procedures
not indicated ?
Comment
Mr. Care
fibrinolytic therapy or
angioplasty plus stenting
.
Comment (contd)
(support of
compromised function and prolongation of
life)
a)
(unresponsive)
(preference)
[]
b)(prognostic criteria)
functional status
Acute
Acute Physiology and Chronic Health
Evaluation(APACHE):
Evaluation(APACHE) to estimate a patients
risk of dying during an ICU admission.
Modified
Modified Organ Dysfunction Score(MODS):
Score(MODS)
record how many organ systems are
dysfunctional and for how many days
pneumonia, ARDS, AMI => ICU
(extremely low)
(probability)
(certainty)(
)
c)(the
principle of beneficence)
[][
]
d)[
]
[
]
Medical Futility
Futility
Futility
Futility
3
4
5?
6
2
()
6?
7?
1
?
2
3
4?
5?
6?
7?
8?
9?
10()
?
(
)
(PAS)
2008
,,
()()
1.
2.
3.
()
()
6
5
3
7
2
2
(
)
(PAS)
2008
() vs ()
()(CPR)
(ACLS)
()
()
(ECMO)
()
()
(time-limited trials)
1-2
(
)
(PAS)
2008
(double effect)
(best interest)
1.
2.
3.
4.
(
)
(PAS)
2008
vs
(Euthanasia)
(mercy killing)
()
!!!
vs
(natural death)
()
!!!
1. /
2.
3.
1.
2.
3.
Responds to patients
Reassuring response
Aggressive response
Judgmental response
Factual response
Empathic response
Questions, Silence
I
II
III
IV
V
()/
(45)
/()
/()
()
(active
dying process)
?
?
?
?
1.
?
: information
2. ?
3. ?
(
)
()
()
()
XXX(
)
/
XXX
Any Question ?