Ethical Decision Making
Discuss the basic principles of bioethics as they apply to the practice of medicine.
Summarize the principles of ethical decision making in the clinical setting.
Apply principles of informed consent in decision making.
Review the process of withholding and withdrawing life support and its impact on families.
List the criteria and limitations for determining brain death.
Medical decision making is often influenced by competing interests of patients, families, the care setting, the payor, society, and the law; these issues are of special relevance to pulmonary and critical care medicine physicians who deal every day with patients at the end of life. Discussions of medical ethics can be framed in terms of the principles of autonomy, beneficence, nonmaleficence, and justice. Autonomy is limited in that decisions must be legal and that the patient must have capacity to make decisions; it depends on informed consent, where the risks, benefits, and alternatives are explained honestly. Critically ill patients usually lack capacity, and psychiatry consultation is usually not necessary except in cases in which the clinician believes that the patient is making an irrational decision, when there is associated mental illness, or in other situations that pose uncertainty.