Explore the complex issue of medical decision-making for incapacitated patients without healthcare surrogates in this comprehensive lecture by Thaddeus M. Pope, JD, PhD, Director of the Health Law Institute at Mitchell Hamline School of Law. Delve into the definition of decision-making capacity, assessment methods, and the challenges faced when patients lack capacity. Examine the growing problem of "unbefriended" patients and the various approaches to making medical decisions on their behalf. Analyze different consent mechanisms, including interdisciplinary teams, solo physician decisions, and the use of expert neutrals. Gain insights into the ethical considerations and legal frameworks surrounding this critical healthcare issue, and understand the importance of developing appropriate protocols for managing the care of incapacitated patients without surrogates.
Better Medical Decision Making for Incapacitated Patients - UCLA Health Ethics Center
University of California, Los Angeles via YouTube
Overview
Syllabus
Unbefriended and Unrepresented: Better Medical Decision Making for Incapacitated Patients without Healthcare Surrogates
Biographical sketch 2. Experiences 1933 to 1939 3. Events during the war 4. Fate - how died or survived
Decision making capacity
What is "capacity"
significant benefits, risks and alternatives to proposed health care
Able to make a decision
That's the definition
When/How to Assess
Assess capacity carefully
Patients often lack capacity
Obstacle 2
Reasonable expectation of recovery
1 page form front & back
Recap
rd choice - After agent & surrogate
Ask court to appoint SDM
Last resort
Advance directive POLST
Increasingly common situation
Big problem
deaths
Growing problem
key factors
Nobody to authorize treatment
Treat aggressively
to appropriate setting
Need a consent mechanism
Who decides?
Interdisciplinary team
1. Physician 2. Registered professional nurse with responsibility for the resident 3. Other staff in disciplines as determined by resident's needs 4. Where practicable, a patient
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patterned on IDT
Variability
Solo physician
Most common approach
causes angst for the greater ethics community
Having a single health professional make unilateral decisions ...
Second physician consent
Attending physician Nurse familiar with patient Social worker familiar with patient Chair or vice-chair of HEC Non-medical (community) member of HEC
Expert Neutral
Quick Convenient
Taught by
UCLA Health
