Virtual Mentor. May 2014, Volume 16, Number 5: 357-358.
The Code Says
The AMA Code of Medical Ethics’ Opinions on End-of-Life Decision Making
The AMA Code of Medical Ethics‘ opinions on end-of-life decision making.
Opinion 2.191 - Advance Care Planning
The process of advance care planning is widely recognized as a way to support patient self-determination, facilitate decision making, and promote better care at the end of life. Although often thought of primarily for terminally ill patients or those with chronic medical conditions, advance care planning is valuable for everyone, regardless of age or current health status. Planning in advance for decisions about care in the event of a life-threatening illness or injury gives individuals the opportunity to reflect on and express the values they want to have govern their care, to articulate the factors that are important to them for quality of life, and to make clear any preferences they have with respect to specific interventions. Importantly, these discussions also give individuals the opportunity to identify who they would want to make decisions for them should they not have decision-making capacity.
Proactively discussing with patients what they would or would not want if recovery from illness or injury is improbable also gives physicians opportunity to address patients’ concerns and expectations and clarify misunderstandings individuals may have about specific medical conditions or interventions. Encouraging patients to share their views with their families or other intimates and record them in advance directives, and to name a surrogate decision maker, helps to ensure that patients’ own values, goals, and preferences will inform care decisions even when they cannot speak for themselves.
Physicians should routinely engage their patients in advance care planning in keeping with the following guidelines:
Issued June 2011 based on the report “Advance Care Planning,” adopted November 2010.
Opinion 2.17 - Quality of Life
In the making of decisions for the treatment of seriously disabled newborns or of other persons who are severely disabled by injury or illness, the primary consideration should be what is best for the individual patient and not the avoidance of a burden to the family or to society. Quality of life, as defined by the patient’s interests and values, is a factor to be considered in determining what is best for the individual. It is permissible to consider quality of life when deciding about life-sustaining treatment in accordance with Opinions 2.20 Withholding or Withdrawing Life-Sustaining Medical Treatment, 2.215 Treatment Decisions for Seriously Ill Newborns, and 2.22 Do-Not-Resuscitate Orders.
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