Search PubMed⌕ Search

Biomedical subjects

D J Doukas

Publications and source records attributed to D J Doukas.

35 records · Page 2Linked to original sources
PubMed1992

The design and use of the bioethics consultation form.

The emergence of the ethics consultation as a means to resolve moral crises in clinical medicine has revealed the need for a worksheet that would facilitate intake and analysis. The author developed the "Bioethics Consultation Form" as an attempt to remedy this need. The form is arranged in an outline format and is a useful asset to ethics committee discussions and record keeping. The first section covers basic intake data concerning the patient's medical and personal information, advance directives, and values, as well as the values of the physician and family. After the intake section is completed with the above data, the ethics consultant then turns to the analysis section. This second section allows for (1) the discussion of conflicting values, (2) the identification of priorities, and (3) the elucidation of ethical norms relevant to the case. The Bioethics Consultation Form was adopted by the Patient Care Advisory committee of the Franklin Square Hospital Center in Baltimore, Maryland in 1986. The methodology in the use of the form will be discussed. Further, the potential spectrum of consultative cases that can be analyzed using the form will be highlighted.

Bioethics↗
PubMed1991

The do-not-resuscitate order: a comparison of physician and patient preferences and decision-making.

PURPOSE: The purpose of this study was to compare the decision-making and preferences regarding do-not-resuscitate (DNR) orders of a group of family physicians with a group of out-patients from a family practice center. Complete results of the outpatient questionnaire were published in a previous study by the authors. SUBJECTS AND METHODS: A random sample of 202 members of the Michigan Academy of Family Practice and all 32 members of the University of Michigan Department of Family Practice were surveyed by a mailed questionnaire. The questionnaire was divided into five parts: demographics, past experiences with DNR orders, who should be involved in DNR decision-making, values clarification, and a series of scenarios matched by a variety of biomedical and non-biomedical factors. RESULTS: After eliminating physicians who had left no forwarding address or who had retired or died, the overall response rate was 61.8%. Most physicians (97%) had at some time written a DNR order for one of their patients; discussions most commonly took place in the hospital room. Physicians, like patients, thought that in addition to the patient, DNR decisions should involve the spouse, the physician, and the patient's children, respectively. Value clarification revealed that both groups most highly value "being able to think clearly" and "being treated with dignity." The presence of a number of quality-of-life issues (age, drug or alcohol use, wheelchair use, dementia, and severe pain) in a series of scenarios negatively affected the decision of both family physicians and patients to resuscitate. CONCLUSION: There are significant similarities and differences in the way physicians and patients make DNR decisions. It is important that physicians and their patients communicate in a timely manner about prognosis, values, and quality-of-life issues in order to make effective DNR decisions.

Adult↗
PubMed1991

The living will: a national survey.

This national survey examined the knowledge and use of the living will among 494 family physicians of the American Academy of Family Physicians in 39 jurisdictions with living will statutes. The findings revealed a positive relationship between physician knowledge of the living will and its clinical use. Additionally, a positive relationship between physician knowledge and willingness to initiate discussions on the document with patients was found. The implications of these findings, as related to disclosure of the living will in the informed consent process, is discussed.

Adult↗
PubMed1991

The values history. The evaluation of the patient's values and advance directives.

Autonomous decision making by patients can be enhanced by a variety of advance directives. These directives, the living will and the durable power of attorney, have an ethical and legal basis on which the patient can prospectively make decisions about life-sustaining therapies. The strength of these directives can be enhanced by the use of the Values History, serving as an adjunct to them. The Values History can also be used as a clinical tool to elicit the values of the patient as they pertain to chronic as well as critical medical care. Documentation of the patient's values will give the health care team a fuller understanding of the patient's preferences and directions.

Advance Directives↗
PubMedDate not supplied

A preventive ethics approach to counseling patients about clinical futility in the primary care setting.

Given the current themes of futility and managed care in medicine and bioethics, the primary care setting needs to account for how to address futility. We argue for applying the concept of clinical futility to primary care medicine. A preventive ethics approach directs the primary care physician to explain and counsel against futile interventions, with a negotiation strategy for circumstances of disagreement. These efforts will require primary care physicians to concentrate their efforts on education, negotiation, and enhanced trust in their patient relationships. Using a preventive ethics approach in these circumstances, the physician can better protect the interests of the patient by avoiding nonbeneficial interventions, especially those that also are potentially harmful.

Advance Care Planning↗
PubMedDate not supplied

After the Cruzan case: the primary care physician and the use of advance directives.

In the case of Nancy Cruzan, involving an incompetent patient's right to have artificial feeding withdrawn, the Supreme Court of the United States upheld the State of Missouri's right to set evidenciary standards prior to the discontinuation of care. The "clear and convincing" standard of the Cruzan ruling highlights the primary care physician's importance in proactively addressing advance directives with patients in the outpatient setting. Primary care physicians need to familiarize themselves with and discuss with patients such advance directives as the living will and the durable power of attorney. Physicians also need to understand the legal requirements of advance directives, as well as the implications of the clear and convincing standard in their own state.

Adult↗