What May We Do? Ethical Permissibility in Medical

Transcript:What May We Do? Ethical Permissibility in Medical:
What May We Do? Ethical Permissibility in Medical Decision-Making Michael McDuffie, Ph.D. Department of Philosophy California State University San Marcos (No financial conflicts of interest to report.) Objectives of this workshop Examine the idea of ethical permissibility as an operative concept in medical decision-making; Propose the concept of permissibility mapping as the discursive process by which shared decision makers locate and coordinate care and treatment options that are ethically and legally available; Consider fictionalized cases that illustrate the need for such mapping, when patients and family face ethical confusion and uncertainty. Discuss the health care chaplain’s role in such discussions. Can vs. May Medical Decision Making (MDM) involves questions of what can be done and what may be done. What can be done for the patient? Clinical judgment: medicine, nursing, social work, chaplaincy, etc. (Jonsen and Siegler, 2015) Goal: propose beneficial treatment and care options Draw from clinical experience and multiple stocks of knowledge, research, data, testing, etc. What may be done for the patient? Legal, ethical, and moral judgment Goal: Propose permissible treatment and care options Draw from law, ethics, morality: different concepts, categories, and measures of permissible action Medical Decision Making Should correlate what can be done (as determined by clinicians) and what may be done (as determined by shared-decision-makers) (“Boxes” one and two: Jonsen and Siegler, 2010) Challenge: What may be done, ethically and legally speaking, in general terms, is often unknown to those who face serious medical decisions, as patients and as surrogates. Case Number One David Carson was 28 years old, single, working in sales, and enjoying his business success through a life rich in travel, sporting activities, lively friendships, and the security of a strong extended family. Unfortunately, Mr. Carson suffered a skiing accident that left him with a traumatic brain injury and a cervical spine injury. After he was rescued, placed on a ventilator, and stabilized, it was determined that Mr. Carson would remain quadriplegic and ventilator-dependent. He suffered significant anoxic brain damage in the time after his accident. After a few days, Mr. Carson emerged from coma, but he demonstrated no awareness, and was determined to be in a persistent vegetative state. Mr. Carson’s parents and doctors waited and watched for over two weeks, but he showed no neurological progress. At this point, Mr. Carson’s physicians met with his parents to discuss goals of care, long-term prospects, and step-down treatment plans. Mr.