Doctor patient relationships, ethics and decision-making capacity

Doctor-patient relationships, ethics, and decision-making capacity:

Patients exercise autonomy by making informed decisions about their care. The physician’s responsibility is to explain all reasonable treatment options, including the option of no treatment. The patient’s decision is final.
Informed consent can be revoked at any time, including verbally. The patient must be able to understand and comprehend what they are consenting to. Exceptions to informed consent include emergency situations, a legally incompetent patient (e.g., severe dementia), therapeutic privilege, and situations in which the patient has waived the right to informed consent. Therapeutic privilege means a physician may withhold information about a patient’s diagnosis or treatment when disclosure would pose a serious psychological threat - so serious that disclosure would be medically contraindicated.
Parental consent should be obtained to treat minors (< 18 years of age). Exceptions include medical emergencies and issues related to drug abuse, contraception, pregnancy, and sexually transmitted diseases. Emancipated minors (those in the military, married, or financially self-sufficient) do not need parental consent.

Advance directives

Durable power of attorney / health care surrogate (power of attorney): Appoints an individual (or individuals) to make decisions on the patient’s behalf if the patient is incapacitated and unable to express their wishes for treatment.
Living will: Specifies the patient’s wishes regarding DNR (do not resuscitate), CPR, mechanical ventilation, feeding tubes, dialysis, etc. DNR means no cardiopulmonary resuscitation and intubation; it does not mean stopping all treatment.
The living will is used only if the individual is unable to give informed consent.
If a patient lacks decision-making capacity, has no advance directive, and no surrogate is available and willing to make decisions (or no surrogate can be identified), the attending physician should seek assistance from an ethics committee or another appropriate resource to determine the patient’s best interest.
An appropriate surrogate is someone who knows the patient well and can best predict the patient’s wishes. The typical hierarchy is: spouse → adult children → parents → siblings → other relatives.

Patient health records are private. Nobody, including a spouse or children, may access them unless the patient authorizes it.
Physicians may provide adequate analgesia, including opiates, to patients with terminal diagnoses if the patient desires it, even though it carries a risk of respiratory depression. Euthanasia and physician-assisted suicide are illegal.
If a family member asks that certain information (e.g., prognosis in stroke or malignancy) be withheld from the patient, the physician should ask the patient whether they prefer to be told everything or prefer their family to filter information. If a patient explicitly requests that health-related information be conveyed to family members or other loved ones instead of directly to the patient, it is appropriate to honor that request.
Romantic relationships with patients are unethical.
If a patient under your care tells you they plan to harm someone, you must inform the police and the intended victim.
If a patient is angry, acknowledge their feelings and apologize.
If an error was made, the patient must be notified, even if the error did not cause harm.
Child abuse and elder abuse must be reported to authorities. Most state laws require partner abuse to be reported to authorities.
Reportable diseases must be reported, even though doing so breaches patient confidentiality.
Treatment should not be continued if the patient is clinically dead, even if the family demands it. An ethics committee or the courts may intervene in such cases.

Doctor patient relationships, ethics and decision-making capacity

Doctor-patient relationships, ethics, and decision-making capacity:

Patients exercise autonomy by making informed decisions about their care. The physician’s responsibility is to explain all reasonable treatment options, including the option of no treatment. The patient’s decision is final.
Informed consent can be revoked at any time, including verbally. The patient must be able to understand and comprehend what they are consenting to. Exceptions to informed consent include emergency situations, a legally incompetent patient (e.g., severe dementia), therapeutic privilege, and situations in which the patient has waived the right to informed consent. Therapeutic privilege means a physician may withhold information about a patient’s diagnosis or treatment when disclosure would pose a serious psychological threat - so serious that disclosure would be medically contraindicated.
Parental consent should be obtained to treat minors (< 18 years of age). Exceptions include medical emergencies and issues related to drug abuse, contraception, pregnancy, and sexually transmitted diseases. Emancipated minors (those in the military, married, or financially self-sufficient) do not need parental consent.

Advance directives

Durable power of attorney / health care surrogate (power of attorney): Appoints an individual (or individuals) to make decisions on the patient’s behalf if the patient is incapacitated and unable to express their wishes for treatment.
Living will: Specifies the patient’s wishes regarding DNR (do not resuscitate), CPR, mechanical ventilation, feeding tubes, dialysis, etc. DNR means no cardiopulmonary resuscitation and intubation; it does not mean stopping all treatment.
The living will is used only if the individual is unable to give informed consent.
If a patient lacks decision-making capacity, has no advance directive, and no surrogate is available and willing to make decisions (or no surrogate can be identified), the attending physician should seek assistance from an ethics committee or another appropriate resource to determine the patient’s best interest.
An appropriate surrogate is someone who knows the patient well and can best predict the patient’s wishes. The typical hierarchy is: spouse → adult children → parents → siblings → other relatives.

Patient health records are private. Nobody, including a spouse or children, may access them unless the patient authorizes it.
Physicians may provide adequate analgesia, including opiates, to patients with terminal diagnoses if the patient desires it, even though it carries a risk of respiratory depression. Euthanasia and physician-assisted suicide are illegal.
If a family member asks that certain information (e.g., prognosis in stroke or malignancy) be withheld from the patient, the physician should ask the patient whether they prefer to be told everything or prefer their family to filter information. If a patient explicitly requests that health-related information be conveyed to family members or other loved ones instead of directly to the patient, it is appropriate to honor that request.
Romantic relationships with patients are unethical.
If a patient under your care tells you they plan to harm someone, you must inform the police and the intended victim.
If a patient is angry, acknowledge their feelings and apologize.
If an error was made, the patient must be notified, even if the error did not cause harm.
Child abuse and elder abuse must be reported to authorities. Most state laws require partner abuse to be reported to authorities.
Reportable diseases must be reported, even though doing so breaches patient confidentiality.
Treatment should not be continued if the patient is clinically dead, even if the family demands it. An ethics committee or the courts may intervene in such cases.