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Ethics
Rationing Healthcare or the Right to Die?
The ongoing debate on healthcare reform took an interesting turn over the past summer as focus shifted, at least for a short period of time, to the question of when to pull the plug on Grandma. The debate ended, at least for now, as politicians all ducked for cover claiming that government would never pull Grandma’s plug.
Of course, sooner or later, absent nature’s intervention, someone needs to pull the plug on Grandma. The question is who, when, and under what circumstances. Since this question first hit the courts, more than 30 years ago, our courts have consistently held that this
10 Ethical Principles in Geriatrics and Long-Term Care
1. Beneficence
• Do right (“good”) by the patient.
• The physician’s main concern is the welfare of the patient.
• Do what is medically helpful.
2. Non-Maleficence
• Avoiding harm.
• Implement effective non-hospital treatment when possible (due to complications that can arise during hospitalization of elderly patients).
• Withhold diagnostic work-up or treatment when intervention is unlikely to result in meaningful survival or patient well-being.
3. Futility of Treatment
• Treatment should be consistent with the patient’s(clinically r
10 Ethical Principles in Geriatrics and Long-Term Care
1. Beneficence
• Do right (“good”) by the patient.
• The physician’s main concern is the welfare of the patient.
• Do what is medically helpful.
2. Non-Maleficence
• Avoiding harm.
• Implement effective non-hospital treatment when possible (due to complications that can arise during hospitalization of elderly patients).
• Withhold diagnostic work-up or treatment when intervention is unlikely to result in meaningful survival or patient well-being.
3. Futility of Treatment
• Treatment should be consistent with the patient’s(clinically r
Medical Futility: Ethical, Legal, and Policy Issues
Introduction
Physicians often encounter situations in which they believe a particular treatment that they are being asked to provide may not confer any meaningful benefit to their patient. In these cases, a practitioner may decide to withdraw this treatment because he or she has judged it to be futile. However, futility is a morally and ethically freighted term, and physicians need to be knowledgeable about its definition and implications before unilaterally deciding to withdraw treatment.
The impact on the healthcare system of providing medically futile care is also uncert
10 Ethical Principles in Geriatrics and Long-Term Care
1. Beneficence
•Do right (“good”) by the patient.
•The physician’s main concern is the welfare of the patient.
•Do what is medically helpful.
2. Non-Maleficence
•Avoiding harm.
•Implement effective non-hospital treatment when possible (due to complications that can arise during hospitalization of elderly patients).
•Withhold diagnostic work-up or treatment when intervention is unlikely to result in meaningful survival or patient well-being.
3. Futility of Treatment
•Treatment should be consistent with the patient’s(clinically realistic) goals.
•Asses
Medical Malpractice and Long-Term Care; Part II: Risk Management
This is part II of a two-part article. Part I addressed litigation and appeared in the April issue of the Journal.
Introduction
There has been a significant increase in medical malpractice lawsuits in long-term care (LTC).1 Therefore, the facilities and the healthcare providers who work in them need to be aware of several important risk management strategies that can reduce their likelihood of being sued for medical malpractice. Good medical practice and medical malpractice risk reduction are congruent activities.2 There are, however, several areas of practice where a li
10 Ethical Principles in Geriatrics and Long-Term Care
1. BENEFICENCE
• Do right (“good”) by the patient.
• The physician’s main concern is the welfare of the patient.
• Do what is medically helpful.
2. NON-MALEFICENCE
• Avoiding harm.
• Implement effective non-hospital treatment when possible (due to complications that can arise during hospitalization of elderly patients).
• Withhold diagnostic work-up or treatment when intervention is unlikely to result in meaningful survival or patient well-being.
3. FUTILITY OF TREATMENT
• Treatment should be consistent with the patient’s (clinically
10 Ethical Principles in Geriatrics and Long-Term Care
1. Beneficence
• Do right (“good”) by the patient.
• The physician’s main concern is the welfare of the patient.
• Do what is medically helpful.
2. Non-Maleficence
• Avoiding harm.
• Implement effective non-hospital treatment when possible (due to complications that can arise during hospitalization of elderly patients).
• Withhold diagnostic work-up or treatment when intervention is unlikely to result in meaningful survival or patient well-being.
3. Futility of Treatment
• Treatment should be consistent with the patient’s (clinically realistic) goals.
10 Ethical Principles in Geriatrics and Long-Term Care
When reviewing an article about ethics, serving on an ethics committee, or caring for patients, it is important to keep the following ethical principles in mind. Practicing Geriatrics based upon sound ethical principles helps to ensure that the greatest good is being done. The reader should be mindful that ethical principles are not consistently in harmony with each other in all clinical situations. In fact, they may conflict and thereby create ethical dilemmas. Discussion of these principles with colleagues, the interdisciplinary team, the resident/proxy, and family members prior to their app
ALTC Blogs
Thomas T. Yoshikawa, MD
Springfield , Massachusetts
Anytown, Alabama
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