Jerry Menikoff, MD, JD Jerry Menikoff, MD, JD Associate Professor Associate Professor Department of History and Philosophy of Medicine Department of History and Philosophy of Medicine
Ethical Principles Ethical Principles Ethical Principles � Autonomy Autonomy � � Beneficence Beneficence � � Nonmaleficence Nonmaleficence � � Justice Justice �
Right to Refuse Care Right to Refuse Care � Karen Ann Quinlan (1975) Karen Ann Quinlan (1975) �
Persistent Vegetative State Higher Brain Lower Brain
Right to Refuse Care Right to Refuse Care � Karen Karen’ ’s Interest: Privacy s Interest: Privacy � � State Interests: State Interests: � � 1. preserving life 1. preserving life � � 2. protecting ethical standards of 2. protecting ethical standards of � medical profession medical profession
Right to Refuse Care Right to Refuse Care � Rejected distinctions Rejected distinctions � � 1. extraordinary v. ordinary care 1. extraordinary v. ordinary care � � 2. medical Rx v. artif. food/fluids 2. medical Rx v. artif. food/fluids � � 3. withholding v. withdrawing 3. withholding v. withdrawing �
Right to Refuse Care Right to Refuse Care � Elizabeth Bouvia (1986) Elizabeth Bouvia (1986) �
Right to Refuse Care Right to Refuse Care � Bouie's Interest: Privacy Bouie's Interest: Privacy � � State Interests: State Interests: � � 1. preserving life 1. preserving life � � 2. preventing suicide 2. preventing suicide � rd parties � 3. protecting innocent 3 3. protecting innocent 3 rd parties � � 4. protecting ethical standards of medical 4. protecting ethical standards of medical � profession profession
Decision- -Making Capacity Making Capacity Decision � Older Concept: Competence Older Concept: Competence � (global) (global) � Newer: Capacity to make specific Newer: Capacity to make specific � decision decision
Decision- -Making Capacity Making Capacity Decision � Patient must have ability to: Patient must have ability to: � � 1. 1. understand understand info about condition info about condition � � 2. 2. appreciate appreciate how info applies to them how info applies to them � � 3. 3. reason , using info to weigh options reason , using info to weigh options �
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