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1.

“You could try the new medication or stay with the one you’re on now”

iv.

Discussion of benefits/risks pros/cons

1.

“The new medication is more expensive, but only need to take it once a day”

v.

Uncertainties

1.

“Most patients respond well, but not all”

vi.

Understanding

1.

“Are you with me so far”

vii.

Elicitation of the patient’s preference

1.

“How does that sound, what do you think”

d.

Transparency in Physician’s Explanation

i.

Disclosing dr’s reasoning

ii.

Discussion why proposed treatment is recommended over alternatives

iii.

Process of mutual exchange about goals/values

iv.

“thinking aloud” in language the patient understands

V.

Emancipated Minor

a.

Same capacity as adult to consent for treatment if married or parent of a child

b.

Same capacity to consent to certain treatments/advice relating to:

i.

Drug abuse/alcoholism

ii.

STDs

iii.

Pregnancy

iv.

Contraception

v.

Physical exam for rape/sexual offence

vi.

Screening and exam if admitted to detention center

VI.

Surrogate Decision Making

a.

Hierarchy of Surrogate Decision Making

i.

Health care agent or proxy designated by advance directive

ii.

Court approved guardian

iii.

Spouse

iv.

Adult child

v.

Parent

vi.

Sibling

vii.

Other relative

viii.

Close friend

b.

Concerns

i.

Difference between legal and moral surrogate

ii.

Limitations:

1.

Withdrawal of life sustaining treatment

2.

Termination of pregnancy or sterilization

3.

ECT/involuntary psychiatric hospitalization

iii.

Conflicts of interest

iv.

Legal vs moral surrogate

VII.

Advanced Care Planning

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