What are the five aspects of practical wisdom in medicine
- Pursuit of worthwhile ends
- Accurate perception of concrete circumstances
- Committment to moral principles
- Deliberation that integrates moral principles and virtues
- Motivation to act
What are the four goals of medicine?
- Preventing disease and injury, and promoting health
- Relieving pain
- Caring and curing
- Avoid premature death, and pursuing a peaceful death
When should goals be discussed?
Prior to the intervention
What are the seven goals of care toward the end of life?
- Be cured
- Live longer
- improve or maintain function/quality of life
- Be comfortable
- Achieve life goals
- Provide support for family/caregiver
- Clarify diagnosis or prognosis
(CLFCLF)
What are the challenges with goals?
- May have to be prioritized
- Shift over time
- Disagreements
What are the two additional dimensions to treatment decisions?
Probability of outcome
Willingness to endure suffering
What are the aspects of clinical judgement?
Transform data into a differential diagnosis, which is shifted to the most likely diagnosis, and justify an approach to its treatment
When are tests helpful?
When the probability of two outcomes are near 50/50, or when it will change the management
What are the five steps of clinical ethical reasoning?
- State problem plainly
- Gather and organize date
- Ask if problem is ethical
- Ask if more info needed
- Determine best course of action
What are the three types of moral reasoning?
judgement based on:
- principles
- consequences
- virtues
What are the two features of virtues?
Motivation to act, as well as to think
What are the three obligations in medicine?
- to pts
- to self
- to society
What is the difference between a principle and a virtue?
Virtues are the ability to act on the principle
What are the three kinds of moral reasoning outlined in lecture?
- Moral obligations
- Consequences
- Virtues
What are the four reasons that a treatment may be medically futile?
- Pt’s condition
- Will not produce physiologic effects
- Cannot expect to produce benefit sought
- Anticipated effects will be outweighted by burdens, harms, costs
