Quadrant model of ethical decision making
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School
Emory University *
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Course
328
Subject
Medicine
Date
Apr 3, 2024
Type
docx
Pages
1
Uploaded by GrandSalmon4394
MEDICAL INDICATIONS PATIENT PREFERENCES Beneficence and Nonmaleficence * What is the patient’s medical problem? History? Diagnosis? Prognosis? ® Is the problem acute? Chronic? Critical? Emergent? Reversible? What are the goals of treatment? What are the probabilities of success? What are the plans in case of therapeutic failure? In sum, how can this patient be benefited by medical and nursing care, and how can harm be avoided? Respect for Patient Autonomy ¢ Is the patient mentally capable and legally competent? Is there evidence of capacity? ® If competent, what is the patient stating about preferences for treatment? ® Has the patient been informed of benefits and risks, understood this information, and given consent? If incapacitated, who is the appropriate surrogate? Is the surrogate using appropriate standards for decision making? * Has the patient expressed prior preferences (eg, advance directives)? Is the patient unwilling or unable to cooperate with medical treatment? If so, why? ® In sum, is the patient’s right to choose being respected to the extent possible in ethics and law? QUALITY OF LIFE CONTEXTUAL FEATURES Beneficence, Nonmaleficence, and Respect for Patient Autonomy * What are the prospects, with or without treatment, for a return to normal life? * What physical, mental, and social deficits is the patient likely to experience if treatment succeeds? ® Are there biases that might prejudice the provider's evalu- ation of the patient’s quality of life? ® Is the patient’s present or future condition such that his or her continued life might be judged as undesirable? ® Is there any plan and rationale to forgo treatment? ® Are there plans for comfort and palliative care? Loyalty and Fairness ® Are there family issues that might influence treatment decisions? ® Are there provider (physician, nurse) issues that might influence treatment decisions? Are there financial and economic factors? Are there religious or cultural factors? Are there limits on confidentiality? Are there problems of allocation of resources? How does the law affect treatment decisions? Is clinical research or teaching involved? Is there any conflict of interest on the part of the providers or the institution?
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