Dr. Shirley

This quarter we had the privilege of having Dr. Shirley give a lecture on ethics. Dr. Shirley is currently a memeber of the ethics committee at UW medical center and has consulted on countless real-life cases where an ethics committee was needed to help guide a apteint's medical treatment. During her lecture she presented the class with two scenarios that were based on real-life cases in which we broke down the facts and the discussed in detail. This page is dedicated to answering the following prompts.

1. Summarize the main points of Dr. Shirley's lecture/discussion

2. Ask at least one question and record what you asked and how Dr. Shirley responded

   1. If you thought about the same question(s) that your classmates answered, record who asked that question(s) and how Dr. Shirley responded

3. What were the "a-ha" moments and/or any new learning/perspectives that occurred to you during this discussion with Dr. Shirley?

Meg Blake-

1. Summary: Dr. Shirley is an experienced nurse who currently sits on the Ethics committe at UW medical center. During her lecture she presented 2 case studies which were broken down and evalauted using the Jonsen model, the goal of this is to present only the facts. During the first case there was the coinflict of whether the patient has mental capaticity or not to make his own decision. We also listed the order of surrogcy in Washington state and had the conversation of who would be the patient's surrogacy if shown to not have capacity. The second case study was not discussed as in depth, this case was in regards to 2 parents and their sick child. This brought up good points such as amutual lack of mistrust between medical professionals and those of african american heritage.  This brought up another good point of how parents are most often not able to make decisions without thinking about the effects on themselve and their families and how doctors are to act as adovcates for children in light of this. 

2. Question: I asked several questions thorughout class. one of the main ones was "who gets the final say?" in regards to making the medical decisions. Dr. Shirely's response was that most of time there is a mutual decision made between healthcare providers and patient's/families after presenting facts and  allowing for time to pass.

3. Learning perspectives: 

   1. Capacity is specific to the situation and are to reassess capactiy at every step.

   2. Always ask, "what if we don't do anything?"

   3. Substitued judgement = What would the patient do if they had capacity?

   4. Lack oif disagreement = agreement

Beverly Sumanti

1. Summarize the main points of Dr. Shirley’s lecture. In Dr. In Shirley's lecture she presented 2 case studies in which presented ethical dilemmas. She used the Jonsen model  to break down the story into facts using the four ethical principles. She explained the purpose was to avoid any biases from the person telling the story. We then reconstructed the story based on the facts in the Jonsen model using the 5 different models of ethics to tell the story. Dr. Shirley explained the situation of a patient  not having the mental capacity to make their own health care decisions. She then explained the process of using a surrogate decision maker who will use a substituted judgment. Dr. Shirley then explained the difference in the capacity and consent in adults and the dependency of children  on their parents or guardians in making healthcare decisions She also explained the harm threshold. She described the ethic consultants' role in bringing everyone together and assisting them in coming to a consensus on a healthcare decision. 

2. Ask a question. How did she respond? I was not physically in class to ask a question. A question that I would have asked is what is the difference between capacity and competency in making decisions about healthcare? She explained that the difference was that in capacity it is yes or no. In capacity there are varied degrees that an individual may have. She describes that a person may have cognitive impairment, however they may consistently express a strong opinion about an aspect of their healthcare that should be taken into consideration when decisions are made about their healthcare. This allows a person who may not have an intact mental capacity to maintain some autonomy with their healthcare.

3. New learning perspectives that occurred during this day. During this lecture by Dr. Shirley I was able to understand the Jonsen model at a deeper level using the five different ethic models. I also learned the difference regarding medical consent for adults and  dependency of pediatric patients in the varied age groups with different degrees of autonomy. 

Sherwin Afable

1. Summarize the main points of Dr. Shirley’s lecture. 

• The Jonson Model is an ethical decision making framework that places emphasis on four factors: medical indications for interventions, the patient's personal preferences, the quality of life that will result according to what decisions are made, and contextual features.

• The patient's or decision makers decision capacity should be assesed at each junction of decision making.

• Capacity is specific to the question being asked

• Surrogate decision making follows a large top down order from state appointed guardians, family ties, then friends. 

2. Ask a question. 

State appointed medical guardianship is designed to protect the vulnerable ill from exploitation from those who would not have the patient’s best interest. Most of the time, these patients requiring guardianship have no other family, friends, or contacts that would be able to    make decisions for them, but I’ve also seen patients in the hospital who do have family or friends involved in the care yet guardianship is still being sought for this patient. While every patients case has unique contextual features, at what point is it decided that it would be best for a patient to have a state appointed guardian as opposed to a family member becoming a DPOA?

3. New learning perspectives that occurred during this day.

For me, an impactful insight from Dr. Shirley’s lecture is that decision making capacity is specific to the question being asked. Ethical cases are nuanced, requiring us to be thorough in our considerations for patient capacity. This calls for us as nurses to spend time with our patients to best understand where they’re coming from. What may seem like an ill-informed decision made by our patients may actually come from a place of legitimate reasoning that we need to respect.