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  #1  
Old 03-27-2012
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Medicolegal and Ethics Family cannot reach consensus about the patient!

An 84 yr old women with severe Alzheimers disease is admitted in your hospital. She has lost her ability to communicate, is bed bound. She did not appoint a proxy and there is no clear written or verbal advance directive of what she wanted for herself. Multiple family members routinely visit her and you are unable to achieve a clear consensus amongst the family of what the patients wishes were

What would you do in terms of her case?

A. Follow the wishes of the eldest child
B. Follow what you think is best
C. Ask another attending physicians opinion
D. Ask the hospital administrator for consent
E. Pursue an ethics committee evaluation
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  #2  
Old 03-27-2012
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A) Follow the wishes of the eldest child
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  #3  
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nop...how can the physician decide that the eldest child is the best well wisher
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Originally Posted by usmlemydream View Post
nop...how can the physician decide that the eldest child is the best well wisher
Wouldn't the decision fall on the next of kin ? ... assuming the patients husband is not present anymore.
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the following order should be followed when surrogates make decisions
1.subjective standard(Advance directed)
2.substitutional judgement
3.best interest standard

cant be 1 coz patient did not leave any written or verbal orders
cant be 2 coz we dont know who best represents the patients wishes
then it has to be 3 we decide in the best interest of patient

so i chose the answer as B. follow what you think is best...and to my utmost despair again wrong
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In that case I would've chosen B as well
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Old 03-27-2012
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Its B
you dont follow the wishes of the next of kin, unless he tells you what the patient wished or might have wished

so if the eldest son says he wants to pursue a particular course coz thats HIS wish, it has no value. but if he says that he thinks the patient would want to do so, or that he heard the patient say such things, then that would matter
in absence of any indication of what the patient would want, its the duty of the doctor to act in the best interest of the patient
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but the answer given was E
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Originally Posted by usmlemydream View Post
but the answer given was E
Is there an explanation for it ?!

Thanks for posting all these ethics questions. A lot of the times I get so busy doing other subjects that I tend of miss out on Behavioral! So thank you
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ya there is...it says that if there is no family available then the ethics committe
and physicians make the decisions based on the judgement of what wud have been in the best interest of the patient

in the options it mentions both the ethics committe and the physician
how do i know which to choose when i heard the videos Dr Daughtery said that the physician decides you cannot wait for the ethics committe to sit and then decide so this is confusing me who do i believe

whats the right answer????
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  #11  
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Yep... I'm asking the same thing... If this is the answer, when do we call (what are the guidelines) the ethics committee then?
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as long as the step1 is concerned, u NEVER refer your patient to anyone, NEVER ask a senior, NEVER in any way transfer your duty to anyone else
option E is obviously wrong, atleast for the step1
in real life, things may be different
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  #13  
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E
Not A - because you don't know if the eldest child is deciding according to her interest.
Not B - Because what you think is the best can be biased. You can decide something based on your knowledge/experience and not the patient's wish.
Not C, D - Just doesn't make sense...
E - Although you might not have the time to.. If there is no one else to make the decision then you will have to get the ethics committee evaluation. Atleast according to Step 1. (That's what I rmr from Conrad's cases).
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its ethics committee..nd if it fails even there go to court..yup sukar..conrad fischer's 100 casesit rocks
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Old 03-28-2012
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i am not convinced...i know 100 cases gives the answer as E but we were taught by Dr.Daughtery(videos) that we as physicians are the not less than anybody to decide...no where does he mention to go to ethics committee
this question still confuses me
if any of you are going for kaplan live lectures please confirm this answer
you must be having the email id of the person who taught behavioral can anybody please take the pain to mail and confirm this answer
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