3.10 Ethics of Medical Futility

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  1. What are common factors that can lead to misunderstanding of the dx/ prognosis?
    • Doesn't understand or is even aware of dx
    • Too much jargon
    • Different or conflicting information
    • Previous optimistic prognosis
    • Stressful environment
    • Sleep deprivation
    • Emotional distress
    • Psychologically unprepared
    • Inadequate cognitive ability
  2. How do you communicate and negotiate to resolve misunderstanding and conflict directly?
    • Choose a 1° communicator, but provide access to all team members
    • Give info in small pieces, multiple formats
    • Use understandable language and avoid medical jargon
    • Frequent repetition may be required
    • Assess understanding frequently
    • Do not hedge to "provide hope"
    • Encourage writing down questions
    • Provide support
    • Involve other health care professionals as soon as possible - ie. social worker, chaplain, etc.
  3. What is the due process approach to futility?
    • Earnest attempts in advance - talk to pts before they undergo tx
    • Joint decision making
    • Negotiation of disagreements
    • Involvement of an institutional committee
    • Transfer to another physician
    • Transfer to another facility
  4. In futility conflicts, what are there disagreements over?
    • Goals
    • Benefits
  5. In futility conflicts, what are the differences in values of?
    • Religion
    • Miracles
    • Value of life
  6. Whatever the conflict is, it is important to what?
    Reaffirm the values and desirers of the patient
  7. What are Younger's 4 Criteria?
    (Used to support a claim that tx is futile)
    • That the pt will have a poor quality of life
    • That the tx is physiologically ineffective
    • That although partially effective, the tx cannot cure the underlying illness and will only postpone death
    • That the tx has an extremely low probability of being successful
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3.10 Ethics of Medical Futility
2014-01-27 18:50:20
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