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Renal 18 Ethics

Ryan: Ethics

Court appointed guardians Have legal priority over other surrogates Happens when pt is incompetent Sought as a last resort
Surrogates selected by Pt Set up by living wills Allows the pt to have autonomy
Family members Most people want family members to serve as surrogates Often know what the Pt would want Many times, decisions are made as a group
WV selection hierarchy 1.Court appointed guardian 2.Spouse 3.Adult children 4.Parent 5.Adult sibling 6.Adult grandchildren 7. Close friend
If pt selects someone, but hasn't completed a living will... Should be respected as the pt chose them
Medical Power of Attorney Person chosen by pt to make medical decisions Representative's name should be written on MPOA form, witnessed by 2 people and notarized
Healthcare surrogates Chosen by physician/adv. nurse to make decisions for pt who did not name a MPOA Generally the person "best qualified"
Healthcare Surrogates Criteria -Better able to make decisions according to the pt wishes -Person's regular contact with pt -Demonstrated care and concern -Visit pt during illness -engage in face-to-face contact
Problems with decision making If surrogate's decision conflicts with previous statements or best interests Emotional barriers Decisions inconsistent with pt values
Problems with decision making (cont) Conflicts of interest -don't be overly suspicious -respecting close relationships is important Disagreements among potential surrogates
Improving surrogate decision making After sufficient discussions, surrogates agree in decisions Discuss decision-making process Decisions should be made on the pt's preferences
Improving surrogate decision making (cont) Give a recommendation -based on what is known about the pt -important when families are overwhelmed with grief -can be a valuable tool
Created by: bcriss