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Historically, “incapacity” was considered primarily a clinical finding, and “incompetency” was considered a legal finding. That distinction, at least in terminology, is no longer firmly recognized; most state laws now use “incapacity” rather than “incompetency,” although the terms are frequently used interchangeably (1).
- Confidentiality and HIPAA
Traditionally, ethical health care has always included the...
- Consent and Surrogate Decision Making
In most states, children below the age of 18 years do not...
- Medical Malpractice
This approach, referred to as defensive medicine, exposes...
- Informed Consent
Consent of the patient is a prerequisite for any medical...
- Advance Directives
They are called advance directives because they communicate...
- Capacity to Make Health Care Decisions
Clinical incapacity to make health care decisions is the...
- Confidentiality and HIPAA
- Case
- Commentary
- Documentation
- Disclosure
- Rectifying An Error
- Conclusion
An 82-year-old man is brought to the emergency department with altered mental status, fever, and cough after being found on the street. He cannot be identified and is presumed to be homeless. He is admitted to the intensive care unit (ICU) for severe pneumonia with developing acute respiratory distress syndrome, and he requires intubation. After hi...
Respect for patient autonomy is a core value in medical ethics and forms the cornerstone of the modern patient-physician relationship.3 At its heart lies the right of patients to make decisions concerning their own medical treatment, even to the detriment of their own health. This principle requires patients to provide informed consent for any trea...
An important purpose of documenting an error is facilitating identification of areas of improvement for both the practitioners directly involved and the hospital system as a whole.8 It is for this reason that latent errors (less obvious failures of an organization or system that contribute to human errors or to accidents waiting to happen) and “nea...
In contrast to documentation, a process largely independent of patient or surrogate involvement, error disclosure can be complicated by a lack of persons to whom the physician could otherwise express contrition and sympathy. During a disclosure process, a physician could inform the patient or—if he or she lacks decision-making capacity—an available...
What constitutes adequate rectification of an error can be an ongoing source of ethical and clinical consideration, but, for purposes of discussion here, rectification can be construed as a restorative process related to either a harmed patient (by minimizing his or her discomfort) or, in the case of a patient’s death, memories of that patient. Unf...
In cases in which an error is made in the care of an unrepresented patient, the absence of a surrogate does not preclude the clinician’s ethical responsibilitiesto document, disclose, and, insofar as possible, rectify the mistake. As suggested here, the obligations of physicians and their organizations to an unrepresented patient are not all that d...
- Ryan G. Chiu
- 2019
Clinical incapacity to make health care decisions is the medical judgment of a qualified doctor or other health care professional who determines a person is unable to do the following: Understand his or her medical condition or the significant benefits and harms of proposed treatment and its alternatives
- Thaddeus Mason Pope
When a patient lacks decision-making capacity, the physician has an ethical responsibility to: Identify an appropriate surrogate to make decisions on the patient’s behalf: the person the patient designated as surrogate through a durable power of attorney for health care or other mechanism;
If there is not adequate evidence of the incapacitated or incompetent patient’s preferences and values, the decision should be based on the best interests of the patient (what outcome would most likely promote the patient’s well-being).
- Danielle Hahn Chaet
- 2016
One of the most difficult situations facing physicians involves decision making by substitute decision makers for patients who have never been competent. This paper begins with a brief examination of the ethics of substitute decision making for ...
Jun 30, 2014 · Today, doctors in the United States are ethically required to report an incompetent colleague. Iatrogenic injury—injury caused unintentionally by medical treatment—breaks the oldest and most famous rule of medical ethics: primum non nocere , or above all, do no harm.
