Miscomprehension of substituted judgement

[moneduloides]

---

Members don't see this ad.

Students did not appear to internalize or correctly apply the substituted judgment standard, even though they could describe it accurately. This suggests the substituted judgment standard may run counter to students' moral intuitions, making it harder to apply in clinical practice.

Heavy stuff.

[Article]

 

[Depakote]

I got to the point when I realized that they were judging the students based on papers written for a M1 ethics class.

 

[masterofmonkeys]

Interesting, but unsurprising (for me at least). The average medical student (or anyone for that matter) has devoted appallingly little time specifically to the study of philosophy and more generally to the simple pursuit of clear, discrete, and concrete reasoning.

What's more interesting to me is how patient/family values somehow continually fall by the wayside in end of life care. It's been consistently shown that terminally ill patients and often their families would prefer them to die at home, comfortably, with no heroic measures. Which is the opposite of what ends up happening.

There are legal issues, healthcare proxy, etc etc etc. But at the end of the day the underlying reason for the discrepancy seems to be the fact that physicians value medical intervention to prolong the beating of the heart and the intermittent expansion and contraction of the chest cavity more than they do other considerations.

And of course, the other problem in cases where the patient themself has left behind no concrete evidence as to their views one way or another, is whose substituted judgment do we follow?

The son, the daughter, the wife, the husband, the father, the mother? There's the sensationalized Peterson case, but we see similar differences of opinion in proxy judgment between individuals equally close to the patient day in and day out.

 

[gatoradedrinker]

New York and Missouri don't even use substituted judgment... instead, physicians require "clear and convincing evidence" to withdraw/withhold treatment. That's the law.

Any medical ethicist will tell you that there are significant differences between the two clauses. CCE is obviously more restricting and often times impossible to provide... it's unfortunate because without it, extreme life prolonging measures must be taken (according to law, anyway) despite the family's sentiments and interpretation of prior conversations with brother Johnny.

 

[Scaredshizzles]

Interesting, but unsurprising (for me at least). The average medical student (or anyone for that matter) has devoted appallingly little time specifically to the study of philosophy and more generally to the simple pursuit of clear, discrete, and concrete reasoning.

What's more interesting to me is how patient/family values somehow continually fall by the wayside in end of life care. It's been consistently shown that terminally ill patients and often their families would prefer them to die at home, comfortably, with no heroic measures. Which is the opposite of what ends up happening.

There are legal issues, healthcare proxy, etc etc etc. But at the end of the day the underlying reason for the discrepancy seems to be the fact that physicians value medical intervention to prolong the beating of the heart and the intermittent expansion and contraction of the chest cavity more than they do other considerations.

And of course, the other problem in cases where the patient themself has left behind no concrete evidence as to their views one way or another, is whose substituted judgment do we follow?

The son, the daughter, the wife, the husband, the father, the mother? There's the sensationalized Peterson case, but we see similar differences of opinion in proxy judgment between individuals equally close to the patient day in and day out.

This reminds me of the Scrubs episode when JD wonders what making dying as comfortable as possible means anyway. For a lot of people managing a dying relative at home is difficult in many ways, regardless of having appropriate at home nursing support. And in some cases suffering is inevitable, and in other cases the patient is so out of it that it is hard to argue that further interventions are making the patient uncomfortable.. The implication that an ethicist can come up with a correct answer that everyone can agree upon is stupid imo and unbecoming of a profession full of intelligent people (I mean doctors, not ethicists.) As long as a physician cares enough to try to make the right decision then that usually works out pretty well---but there will always be some people upset with whatever decisions you make.