Group items tagged

>"...Offering a default option of opting in, rather than opting out (as many have suggested with organ donations as well) doesn't take away choice but guides us to make better ones, according to Richard H. Thaler, an economics professor at the University of Chicago, and Cass R. Sunstein, a professor at Chicago's law school, authors of "Nudge: Improving Decisions About Health, Wealth and Happiness". Making choices can be most difficult in the area of health. While we don't want to go back to the days when doctors unilaterally determined what was best, there may be ways of changing policy so that families are not forced to make unbearable choices. >Professor Iyengar and some colleagues compared how American and French families coped after making the heart-wrenching decision to withdraw life-sustaining treatment from an infant. In the United States, parents must make the decision to end the treatment, while in France, the doctors decide, unless explicitly challenged by the parents. >French families weren't as angry or confused about what had happened, and focused much less on how things might have been or should have been than the American parents.

'...the Cochrane Collaboration reported last year that patients who used tools to guide their decisions had a better grasp of their choices and risks. They were also more likely to select less intense or invasive treatment when considering major elective surgery, though results were mixed for other decisions. The influence of decision aids on adherence to medication or overall costs was "inconclusive," according to the report. 'But that uncertainty does not reduce the ethical obligation to better inform patients, or lessen the promise of tools that help patients understand their options and identify their values, some doctors say. "It is the right thing to do," said Dr. Victor Montori, associate director of the Health Care Delivery Research Program at the Mayo Clinic Center for the Science of Health Care Delivery....'

Autonomy has limits - pts want docs to exercise expertise.

Most readers favor palliative sedation if its primary intent is to allay intolerable suffering even if it may accelerate dying - as opposed to allowing the suffering because its treatment may lead to an earlier death.

Discussion of palliative sedation at end of life (Franklin Hospital Hospice Unit, NSLIJHealth System & Hospice Care Network of L.I.)