An Introduction to Bioethics by Thomas A. Shannon;Nicholas J. Kockler

Author:Thomas A. Shannon;Nicholas J. Kockler
Language: eng
Format: epub
Published: 2011-07-16T03:44:00+00:00

Medical Dimensions

Regardless of whether the patient was once competent or was never competent, one should consider the medical dimensions of the patient's situation in formulating a treatment decision. For the once-competent adult patient, several clinical factors function in decision making. First, one must know the patient's diagnoses. This includes more than what the patient's main complaint was or why the doctor admitted the patient to the hospital; this requires consideration of the various other conditions the patient may have and their combined effect. Second, one must know the patient's overall prognosis. In light of several different diagnoses as well as the process of consulting with physicians who are different specialists, the patient's overall prognosis may become clouded or miscommunicated. Third, one must also consider the resources and technology available to address those conditions. In fact, what is medically feasible informs one's overall prognosis. These factors require further reflection: in order to make the best decision, one needs to evaluate these factors in terms of the patient's values and preferences. Often, health care providers will appraise decisions differently than surrogates or patients because they may not know the patient's values or preferences. A physician's medical decision or recommendation is related to but distinct from a patient's personal health care decision.

For the never-competent newborn patient, two clinical factors play a role in decision making. The first is prenatal diagnosis in its various forms. While we covered some of this in chapter 7, it is important to note here that clinicians can diagnose many hundreds of genetic diseases as well as other anomalies before birth. What this means practically is that frequently the decisionmaking process begins well before birth occurs. The second factor is the neonatal intensive care unit (NICU); this is the place where health care professionals take premature infants as well as other newborns with various problems as soon as possible after birth. Developments in this area have occurred more rapidly than one could have imagined, and a variety of interventions and therapies are available that were not even imaginable thirty years ago. Decision making is becoming more complex as the technical and medical possibilities increase. Health care today has greater capacities to help newborns overcome their medical conditions and to push back the threshold of when a fetus is viable outside of the womb to an earlier time in the pregnancy. It is important to note, however, that despite all of the powers of modern medicine, there are still limits. Sometimes a decision to forgo or withdraw treatment in the NICU is the morally right decision.

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