USMLE an important question on behavioural science

[SeahawksFan]

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so this is a question i heard from a friend of a friend..

An old woman..basically having no scope of much survival... 96 years..severe dementia..some grave prognosis kinda disease 10 kg wt loss in 2 months.. etc.. has 4 kids..no living will..
to keep her alive u need a gastostomy tube..
the kids..4 of em.. meet and come to u and say..
Doc i just want u to take the decision for us as we cant decide.. do whats best for her and tell us..
the doctor does so.. what ethical principal did he use..

rationing of resoures
truth telling
Paternalism

etc

please help..high yield..

 

[AZ7]

The "Best Interest Standard" i.e weigh the burdens vs benefits and reach a decision that is most likely what a rationally thinking competent patient would conclude upon and not what you as a doctor would prefer.

 

[Transposony]

If you cannot talk directly with the patient, use one of the three principles below in this order:

1. Subjective standard: Advance directive including what the patient said to someone.
2. Substituted judgment: Someone who knows the patient offers a best guess about what the patient would have wanted.
3. Best-interest standard: What would most patients in this situation want?

Dr Dougherty's 20 or so principles really helps to answer any behavioral science questions.

 

[illinichief89]

sounds like paternalism