ICM: Test 2
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Set of techniques desigend to restore circulation and respiration in the emergent situation of acute cardiac or cardiopulmonary arrest.
Any medical treatment that serves to prolong life without reversing the underlying medical condition.
Guess that case:
22 yo in persistent vegetative state
No previous wishes about life support
Patient's father, appointing himself legal guardian, requiested rmoval of ventilator support
Physicians caring for her refused to remove ventilator support
"The nature, extent, and duration of care by societal standards is the responsibility of the physician."
Karen Ann Quinlan Case
"Medical procedures to provide nutrition and hydration are more similar to other medical procedures than t typical human ways of providing nutrtiona and hydration. Their benefits and burdens ought to be evaluated in the same manner as any other medical procedure."
Barber vs. Superior Court
"If the right of the patient to self-determination as to his ownmedical treatment is to have any meaning at all, it must be paramount to the interested of the patient's hospital and doctors. The right of a competent, ill patient to refuse medical tx is a constitutionally guaranteed right which must not be abridged."
Bartling vs. Superior Court
Bouvia vs. Superior Court
California State Court of Appeals overturned a lower court's decision and held that state policy does not require that " all and every life must be preserved against the will of the sufferer."
Landmark case in which Missouri Court required absolutely clear evidence of patient's previous desires. The Supreme Court of the US upheld the decision.
Hospital went to court to get guardianship over woman on PVS vent in ICU
Ultimate goal to withdraw life support.
Court declined to address the issue of futility and left her husband of 50 years as guardian
Conservatorship of Wanglie
- Anencephalic baby
- Determined that hospital had obligation to treat, but never addressed limitation based on futility
Only clear legal rule on futile treatment
Traditional malpractice test which measures the physicians actions aginst standards of medical care.
2 Major Misconceptions
- Life support will not cure the underlying disease.
- Survival after resuscitation is poor acutely and long term.
Withdrawal of life support is never a direct cause of death; it merely allows death to occur.
No moral difference exists between witholding and withdrawing life sustaining treatments.
Issues involved in organ transplantation (B JUSI)
- Societal Benefit
- Individual Benefit
What produces the greatest possible benefit with the least possible burdens for all persons affected by the action.
Marginal gains to individuals may threaten the welfare of the whole.
Despite legally executed donor cards, families sometimes over-rule an individual's donation choices; donor registries resolve this problem
"First Person" Consent
Organs automatically recovered unless "no" decision recorded before demise (legal in some countries)
Marginal donors/organs available for willing patients
Recipient Informed Consent
Consent is a ______ NOT a ______.
Consent is a Process NOT a QUESTION!
A 63 year-old male involved in a motor vehicle accident receives massive head trauma. Despite aggessive
resuscitation he progresses to brain death over 24 hours and is pronounced by the neurologist in the ICU. He has
a signed and legally executed donor card indicating his desire to donate"any needed organs and tissues" at the time of his death. His 40 year old daughter has recently read a book about organ stealing and is reluctant to
give consent for recovery of his organs. In Mississippi,
"First person consent" legisation honors the man's desire to donate and allows organ recovery without survivor consent
Matchingdonors.com is a web-site which:
Attempts to allow altruistic donors the opportunity to find a needy recipient
An "Ethically Acceptable Incentive":
Should convey gratitude for a gift
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