An introduction to the crucial decisions in life

Often times, we go through life oblivious to what thoughts we are thinking and what actions we are taking. Every single decision we make in our days shapes our current reality. It shapes who we are as a person because we habitually follow through with the decisions we make without even realizing it.

An introduction to the crucial decisions in life

Decisions about the use of life-sustaining treatment when a person is seriously ill and likely to be near the end of life have profound consequences for that person, for his or her family and other loved ones, and often for health care providers.

These decisions also have an inevitable social dimension. They compel us, as a society, to examine our common ethical priorities concerning the relief of suffering, what it means to live and to die, the rights of individuals, and the ultimate goals of medicine.

They confront us with issues of justice, equity, and the economic constraints on the An introduction to the crucial decisions in life of health care resources.

The social dimensions of treatment decision-making near the end of life also include the cultural values, whether associated with religion, ethnicity, profession, or other identities and affiliations, which may inform how professionals present treatment options and how patients and surrogates make decisions.

Ethical challenges arise when the ethically appropriate course of action or range of choices is unclear, or when there are competing ethical claims that may not be reconcilable. Discussions about whether to use or forgo life-sustaining treatment frequently raise ethical concerns for health care professionals.

These discussions and the resulting decisions should be informed by ethical norms and legal rights and protections concerning the health and welfare of some of the most vulnerable members of society; by health care goals that follow from these norms, rights, and protections; and by analysis based on the history of careful thinking, publication, and policy on end-of-life care.

Our society must be confident that the decision-making processes used in health care institutions and by individual health care professionals are ethically sound, as well as equitable in the claims they allow any individual to make on shared health care resources.

These Guidelines are written for physicians, nurses, and other clinicians who care for patients facing decisions about life-sustaining treatment and patients nearing the end of life. These Guidelines are also intended to be useful to those responsible for the education of these clinicians, professionals who make institutional policy on care near the end of life, and public policy-makers working to improve end-of-life care.

Patients, loved ones, and surrogate decision-makers may also find the Guidelines helpful. The Function and Sources of These Ethics Guidelines Ethics guidelines are different from clinical practice guidelines and from law, although they are related to both of these.

Ethics guidelines for end-of-life care are grounded in the moral traditions of medicine and nursing and are consistent with the moral traditions of other health care professions such as clinical social work and clinical psychology. They reflect broad ethical, religious, and legal traditions of American society as well as decades of research, deliberation, and consensus-building among professionals, policy-makers, and patients and loved ones.

Their claim to serious attention derives from the informed and reasoned positions they present and from the widely acknowledged standards of ethically responsible clinical practice on which they are based. These Guidelines do not provide a formula or algorithm for making correct decisions.

They aim to guide reflection, judgment, and action in providing good care near the end of life and, in particular, to provide an ethical framework for making decisions under conditions that are challenging and sometimes psychologically distressing.

An introduction to the crucial decisions in life

They clarify the rights and responsibilities of each participant in the decision-making process. They can help ensure that these decisions are made with the appropriate deliberation, transparency, and fair process, as well as safeguards for vulnerable patients.

These Guidelines can help protect patients against both undertreatment, such as failing to provide medically appropriate interventions desired by the patient, and overtreatment, in the form of interventions that are unwanted by the patient or are unduly burdensome to that patient.

In formulating these Guidelines, we have been attentive to the state of the law.

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However, these Guidelines do not constitute legal advice. Users of this document should determine how the law in their jurisdiction bears on these ethical recommendations.

An introduction to the crucial decisions in life

Although these Guidelines differ from law in their status and authority, they can help policy-makers, legislators, regulators, and judges identify where more explicit legal direction is needed and where existing law impedes ethical decision-making, either directly or by creating uncertainty.

These Guidelines may also offer model formulations that can be translated into the language of statutes, regulations, and judicial rulings. However, not all ethics standards need to be or should be written into law. Health care professionals in the United States worry about lawsuits and even about the possibility of criminal prosecution.

Although the law serves a legitimate function in setting limits to behavior, it is a mistake to allow health care, which exists to care for the sick and to relieve suffering, to be driven primarily by liability concerns. Legal counsel to hospitals and other health care institutions, and legal advisors to individual health care providers, have a responsibility, as lawyers with expertise in health law, to help ensure that health care is driven by patient-centered goals and that health care professionals are not preoccupied by legal concerns.

These Guidelines thus offer guidance to health lawyers and to health care risk managers concerning their role in institutional policy-making to support good care near the end of life. Rights, Protections, and Key Philosophical Distinctions The right of patients to forgo life-sustaining treatment has been recognized by law in the United States starting in the mids.

This right is reflected in landmark cases such as Quinlan producing the first state supreme court decision on end-of-life decision-making, in and Cruzan producing the first U. Supreme Court decision on this issue, inin a large number of legal cases decided since Quinlan, and in federal and state statutes.

Federal and state law recognize and authorize the use of advance directives, such as durable powers of attorney for health care decision-making also known as proxy directives and treatment directives such as living wills.

These allow patients to state in advance what treatments they do or do not want under different clinical circumstances, and who should act as their surrogate decision-maker, if they lose decision-making capacity. As the legal rules have been clarified, a parallel ethical consensus has developed.

A broad ethical and legal consensus on much of end-of-life care is now in place.Decision-Making Framework; Introduction to Problem Solving; Identifying and Structuring Problems; right up to life-changing decisions like where and what to study, and who to marry.

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Decision-making - Wikipedia

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Most people don’t know the profound effects of making decisions. Often times, we go through life oblivious to what thoughts we are thinking and what actions we are taking.


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Decision-making - Wikipedia