Beneficence, |
Clinical assessment |
nonmaleficence |
Nature of illness (acute, chronic, reversible, terminal)? Goals of treatment? |
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Treatment options and probability of success for each option? |
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Adverse effects of treatment and does benefit outweigh harm? |
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Effects of no medical/surgical treatment? |
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If treated, plans for limiting treatment? Stopping treatment? |
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Respect for autonomy |
Patient rights and preferences |
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Information given to patient on benefits and risks of treatment? Patient understood the information and gave consent? |
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Patent mentally competent? If competent, what are his/her preferences? |
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If patient mentally incompetent, are patient's prior preferences known? If preferences unknown, who is the appropriate surrogate? |
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Beneficence, |
Quality of life (QOL) |
nonmaleficence, |
Expected QOL with and without treatment? |
respect for autonomy |
Deficits − physical, mental, social − may have after treatment? |
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Judging QOL of patient who cannot express himself/herself? Who is the judge? |
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Recognition of possible physician bias in judging QOL? |
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Rationale to forgo life-sustaining treatment(s)? |
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Distributive justice |
External forces and context |
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Conflicts of interests − does physician benefit financially, professionally by ordering tests, prescribing medications, seeking consultations? |
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Research or educational considerations that affect clinical decisions, physician orders? |
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Conflicts of interests based on religious beliefs? Legal issues? |
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Conflicts of interests between organizations (clinics, hospitals), 3rd party payers? |
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Public health and safety issues? |
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Problems in allocation of scarce resources? |