For each of the following patient encounters, identify the specific ethical doctrine or decision-making standard that appropriately justifies the clinical action taken.
- An adult child declines a feeding tube for their comatose father, citing the father's previous casual statements that he would 'never want to be kept alive by tubes if there was no hope of waking up.'Substituted judgment standard
- A state-appointed guardian authorizes an urgent cholecystectomy for a nonverbal adult ward who has had profound, lifelong cognitive impairment.Best interests standard
- A patient facing a high-risk bypass graft explicitly asks the cardiovascular surgeon not to explain the potential complications, requesting that all details be discussed only with their spouse.Waiver of informed consent
- An attending physician temporarily delays disclosing a terminal diagnosis to a hospitalized patient who is currently being physically stabilized following a severe, acute suicide attempt.Therapeutic privilege
Answer
The scenarios match to their respective ethical standards as follows: the adult child acting on previous statements illustrates the substituted judgment standard; the guardian acting for a lifelong impaired patient illustrates the best interests standard; the patient declining information illustrates a waiver of informed consent; and delaying disclosure due to immediate self-harm risk illustrates therapeutic privilege.
Each scenario illustrates a distinct doctrine in medical ethics. Substituted judgment applies when a surrogate uses the known values of a formerly capable patient. Best interests applies when the patient's values are unknown or they never possessed capacity. A waiver occurs when a patient explicitly asks not to be informed. Therapeutic privilege allows a physician to withhold information if disclosure would cause severe, immediate psychological harm.
Step-by-Step Solution
Key Concept
Standards of surrogate decision-making and exceptions to informed consent