A Consensus-Based Approach to Providing Palliative Care to Patients Who Lack Decision-Making Capacity
Karlawish, Jason H.T.
Meier, Diane E.
Annals of Internal Medicine. 1999 May 18; 130(10): 835-840.
Making palliative care decisions for a patient who lacks decision-making capacity presents several challenges. Other people, such as family and caregivers, must choose for the patient. The goals and values of these decision makers may conflict with those of each other and with those of the patient, who now lacks the capacity to participate in the decision. This paper presents a case study of a patient with severe Alzheimer disease who has two common clinical problems: neurogenic dysphagia and aspiration pneumonia. The case study describes a consensus-based decision-making strategy that keeps what is known about the patient's wishes and values in the foreground but also expects guidance from the physician and elicits input from family members and other people who care for and have knowledge about the patient. The steps of this process, including key clinical prompts and potential transition statements, are outlined and described. The overall goal of the case commentary is to demonstrate that physicians can guide a highly emotional and personal process in a structured manner that has meaning for the patient, family, physician, and other caregivers.
Advance Care Planning; Aged; Allowing to Die; Alzheimer Disease; Artificial Feeding; Caregivers; Case Studies; Communication; Consensus; Counseling; Consent; Decision Making; Dementia; Disease; Drugs; Family Members; Food; Goals; Institutionalized Persons; Knowledge; Life; Nursing Homes; Palliative Care; Patient Care; Patient Care Team; Patients; Physician's Role; Physicians; Quality of Life; Terminal Care; Terminally Ill; Third Party Consent; Values; Withholding Treatment;
Showing items related by title, author, creator and subject.
A Consensus-Based Approach to Providing Palliative Care to Patients Who Lack Decision-Making Capacity Karlawish, Jason H.T.; Quill, Timothy; Meier, Diane E. (American College of Physicians-American Society of Internal Medicine [ACP-ASIM]. End-of-Life Care Consensus Panel, 1999-05-18)
Decisions to Limit Life-Sustaining Treatment for Critically Ill Patients Who Lack Both Decision-Making Capacity and Surrogate Decision-Makers White, Douglas B.; Curtis, J. Randall; Lo, Bernard; Luce, John M. (2006-08)
Advance Care Planning by Proxy for Residents of Long-Term Care Facilities Who Lack Decision-Making Capacity Volicer, Ladislav; Cantor, Michael D.; Derse, Arthur R.; Edwards, Denise Murray; Prudhomme, Angela M.; Gregory, Dorothy C. Rasinski; Reagan, James E.; Tulsky, James A.; Fox, Ellen (2002-04)