A patient and relative centred evaluation of treatment escalation plans: a replacement for the do-not-resuscitate process
David Bourget (Western Ontario)
David Chalmers (ANU, NYU)
Rafael De Clercq
Jack Alan Reynolds
Learn more about PhilPapers
Journal of Medical Ethics 36 (9):518-520 (2010)
The Treatment Escalation Plan (TEP) was introduced into our trust in an attempt to improve patient involvement and experience of their treatment in hospital and to embrace and clarify a wider remit of treatment options than the Do Not Resuscitate (DNR) order currently offers. Our experience suggests that the patient and family are rarely engaged in DNR discussions. This is acutely relevant considering that the Mental Capacity Act (MCA) now obliges these discussions to take place. The TEP is a form that the doctor completes, ideally with the competent patient or close relative, documenting what treatment options would be appropriate if that patient were to become acutely unwell. Ventilation of the lungs, cardiac resuscitation, renal replacement therapy, intravenous fluids and antibiotics are all discussed. The study evaluated patient and relative experiences with the TEP. 55 patients or their relatives were interviewed regarding their experience of the TEP and thoughts regarding the process. 96% of patients and relatives evaluated thought that the TEP was a good idea. Free text comments were all positive and only 34% of patients claimed to feel anxious when completing the form. Following this study, the TEP has been expanded hospital wide and into the community within our trust. Discussions are currently taking place in hospitals within our region to introduce the TEP form into other local trusts
|Keywords||No keywords specified (fix it)|
|Categories||categorize this paper)|
Setup an account with your affiliations in order to access resources via your University's proxy server
Configure custom proxy (use this if your affiliation does not provide a proxy)
|Through your library|
References found in this work BETA
No references found.
Citations of this work BETA
Suze Berkhout (2012). Relational Autonomy on the Cutting Edge. American Journal of Bioethics 12 (7):59 - 61.
Similar books and articles
Martin G. Leever, Kenneth Richter, Peg Nelson, Christopher J. Allman & Duncan Wyeth (2012). The Case of Do-Not-Resuscitate (DNR) Orders and the Intellectually Disabled Patient. HEC Forum 24 (2):83-90.
Christopher Mayes (2009). Pastoral Power and the Confessing Subject in Patient-Centred Communication. Journal of Bioethical Inquiry 6 (4):483-493.
Peter Fleming & Stelios C. Zyglidopoulos (2008). The Escalation of Deception in Organizations. Journal of Business Ethics 81 (4):837 - 850.
Richard E. Ashcroft (2000). Teaching for Patient-Centred Ethics. Medicine, Health Care and Philosophy 3 (3):285-293.
John Pollock (2004). Plans And Decisions. Theory and Decision 57 (2):79-107.
Jaklin Eliott & Ian Olver (2008). Choosing Between Life and Death: Patient and Family Perceptions of the Decision Not to Resuscitate the Terminally Ill Cancer Patient. Bioethics 22 (3):179–189.
Douglas O. Stewart & Joseph P. DeMarco (2005). An Economic Theory of Patient Decision-Making. Journal of Bioethical Inquiry 2 (3):153-164.
Tolga Guven & Gurkan Sert (2010). Advance Directives in Turkey's Cultural Context: Examining the Potential Benefits for the Implementation of Patient Rights. Bioethics 24 (3):127-133.
Matthew C. Lally & Scott A. Freeman (2005). Perspectives: The Struggle to Maintain Neutrality in the Treatment of a Patient with Pedophilia. Ethics and Behavior 15 (2):181 – 190.
David W. Hollar, John Hattie, Bert Goldman & James Lancaster (2000). Developing Assessment Procedures and Assessing Two Models of Escalation Behavior Among Community College Administrators. Theory and Decision 49 (1):1-24.
Roy Gilbar & Ora Gilbar (2009). The Medical Decision-Making Process and the Family: The Case of Breast Cancer Patients and Their Husbands. Bioethics 23 (3):183-192.
Carolyn Ells, Matthew R. Hunt & Jane Chambers-Evans (2011). Relational Autonomy as an Essential Component of Patient-Centered Care. International Journal of Feminist Approaches to Bioethics 4 (2):79-101.
David B. Resnik (2005). The Patient's Duty to Adhere to Prescribed Treatment: An Ethical Analysis. Journal of Medicine and Philosophy 30 (2):167 – 188.
David C. Thomasma (1986). Philosophical Reflections on a Rational Treatment Plan. Journal of Medicine and Philosophy 11 (2):157-165.
Added to index2010-09-13
Total downloads3 ( #294,221 of 1,101,564 )
Recent downloads (6 months)1 ( #292,059 of 1,101,564 )
How can I increase my downloads?