How surrogate decision-making differs from routine decision-making

Read the scenario and answer questions.

A middle-aged, homeless woman who was brought to the emergency room after suffering a massive intracranial hemorrhage. She was profoundly lethargic, possessed medication for schizophrenia, and showed signs of a previous stroke. The clinicians who evaluated her believed that medical interventions could preserve her life, but that it was very unlikely that she would recover much, if any, functional or communicative capacity. Faced with the decision of whether to operate or institute palliative care, the medical team tried in vain to locate family members. Members of the team believed surgical intervention was not in the best interest of the patient, but they decided to perform the procedure anyway because their knowledge of public opinion data (invoked as a proxy surrogate) suggested that most families of patients in similar clinical scenarios would choose medical intervention. After an emergency craniotomy was performed, the patient’s son and daughter were located, and both reported that their mother would not have chosen to undergo the operation had she been able to express her wishes. The patient never regained consciousness and died five months later of complications.

Please answer the following questions. Each question must be a minimum of two paragraphs.  You should incorporate topics learned during the course such as, law, ethics, bioethics, liability, malpractice, consent and end of life issues.

  1. Discuss how surrogate decision-making differs from routine decision-making. Should physicians give equal weight to an individual’s decisions for herself/himself compared to a surrogate’s decisions for the individual? Give an example.”
  2. Explain how informed consent differs between patients with and without capacity. Describe how consent was obtained for this patient. Why?
  3. Discuss the role of advance directives in end of life planning.
  4. What role should the ethics committee play in this scenario?
  5. Discuss the clinicians’ duty, if any to the patient and or family. Was that duty breached? Describe.

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