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Kestigian A, London AJ. A Dilemma for Respecting Autonomy: Bridge Technologies and the Hazards of Sequential Decision-Making. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2022; 47:293-310. [PMID: 35452092 DOI: 10.1093/jmp/jhab050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Respect for patient autonomy can apply at two levels: ensuring that patient care reflects their considered values and wishes and honoring patient preferences about how to make momentous decisions. Caregivers who seek to respect patient autonomy in the context of some end-of-life decisions face a dilemma. Because these decisions are fraught, patients may prefer to approach them sequentially, only making decisions at the time they arise. However, respecting patients' preferences for a sequential approach can increase the likelihood that surrogates and care teams wind up in situations in which they lack information needed to ensure patients receive care that conforms to their considered values after they are no longer competent to make decisions for themselves. Sequential decision-making can thus conflict with the goal of ensuring care reflects the wishes of patients. After illustrating how this dilemma can arise in the use of life-sustaining "bridge" technologies, we argue that care teams may be warranted in requiring patients to articulate their wishes in an advance care plan before treatment begins. In some cases, care teams may even be permitted to refuse to undertake certain courses of care, unless patients articulate their wishes in an advance care plan.
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Affiliation(s)
- Aidan Kestigian
- Wheaton College, Norton, Massachusetts, USA.,ThinkerAnalytix, Cambridge, Massachusetts, USA
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Nakagawa S, Ando M, Takayama H, Takeda K, Garan AR, Yuill L, Rosen A, Topkara VK, Yuzefpolskaya M, Colombo PC, Naka Y, Blinderman CD. Withdrawal of Left Ventricular Assist Devices: A Retrospective Analysis from a Single Institution. J Palliat Med 2020; 23:368-374. [DOI: 10.1089/jpm.2019.0322] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Shunichi Nakagawa
- Adult Palliative Care, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Masahiko Ando
- Division of Cardiothoracic Surgery, Department of Surgery, Tokyo University, Tokyo, Japan
| | - Hiroo Takayama
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, New York
| | - Koji Takeda
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, New York
| | - Arthur R. Garan
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Lauren Yuill
- Adult Palliative Care, Department of Care Coordination and Social Work, NewYork Presbyterian Hospital, New York, New York
| | - Amanda Rosen
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - Veli K. Topkara
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Melana Yuzefpolskaya
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Paolo C. Colombo
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Yoshifumi Naka
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, New York
| | - Craig D. Blinderman
- Adult Palliative Care, Department of Medicine, Columbia University Medical Center, New York, New York
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Pullman D, Hodgkinson K. On the Curious Range of Responses to Our Curious Case: Response to Open Peer Commentaries on "The Curious Case of the De-ICD: Negotiating the Dynamics of Autonomy and Paternalism in Complex Clinical Relationships". THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2016; 16:W4-W6. [PMID: 27471946 DOI: 10.1080/15265161.2016.1196762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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