Concept Of Patient Autonomy Research Articles

Ethical Issues in Pediatric Consultation-Liaison

General principles of medical ethics are outlined as a basis for discussion of ethical issues in pediatric consultation-liaison psychiatry. Modern ethics is rooted in philosophical soils that extend across a wide intellectual terrain, from ideologic ethical systems such as rule utilitarianism and act utilitarianism to deontologic systems, exemplified by the categoric imperative. Differences between the conclusions pointed to by these systems give rise to the potential tensions among concepts of patient autonomy, physician beneficence, and distributive justice. The roles of the child psychiatrist consulting to pediatrics are reviewed. Using six clinical vignettes, several ethical issues and the child psychiatrist‘s response to them are explored. These are analyzed in relation to the underlying ethical theory.

Futile cardiopulmonary resuscitation and physician authority for unilateral do not resuscitate orders

There is an emerging consensus today that specific case profiles exist in which in-hospital cardiopulmonary resuscitation (CPR) would be futile care and in which a do not resuscitate (DNR) order is medically appropriate. The physician's affirmative decision to perform CPR usually is made without involvement of the patient or the patient's family. On the other hand, DNR orders seldom are issued without consent of the patient or the patient's family, even though the patient is not likely to survive CPR. The concept of patient autonomy, however, does not extend to the patient and/or family a legal, ethical, or social right to futile care, particularly CPR that is futile. As such, the treating physician is not required to obtain the patient's and/or family's informed consent prior to issuing a DNR order, but has the unilateral authority to enter such an order.

Refusal of Treatment

The decision regarding refusal of treatment ultimately rests with competent adult patients. When the elderly patients is an inadequate or incompetent decision-maker, in order to protect the interests of the patient, the physician should have some knowledge of the way decisions are and ought to be made, particularly when a decision to forgo life-sustaining treatment is being deliberated. In acquiring this knowledge, the physician needs to develop clear understanding about who has the authority and responsibility to speak for the patient and what standards are to guide the decision-making process involving the incompetent patient. This is not an easy task for any physician. In many instances, the process can become clouded by a host of complex ethical and legal issues that make any decision a questionable one. A beginning point might be the acceptance of the fact that every elderly patient possesses values and goals that are quite unique to him, even though they might seem identical to those held by many other patients. This fact, more than anything else, will help to remove many of the impediments that face the physician during the decision-making process.