#94 Treatment Over Objection Part 1: At the Bedside Segment

Core IM | Internal Medicine Podcast

Core IM Team

Mental Health, Education, Health & Fitness, Medicine

4.8 • 1K Ratings

🗓️ 8 December 2021

⏱️ 25 minutes

🔗️ Recording | iTunes | RSS

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Summary

Get a very useful framework to help you weigh the risks and benefits of treatment over objection!Show notes, Transcript and References: https://www.coreimpodcast.com/2021/12/08/treatment-over-objection/ (https://www.coreimpodcast.com/2021/12/08/treatment-over-objection/)Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im (https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im%C2%A0)Time stamps* 03:02 Ethical and emotional challenges* 10:08 Case 1* 18:55 Study of the 7 Questions* 22:46 Conclusion Tags: IM Core, CoreIM, autonomy, capacity, human dignity, non-maleficence, ethics, medical humanties Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840 Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

Transcript

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0:00.0	Hi everyone, this Coriam episode will count for CME Credit with the American College of Physicians.
0:05.6	We'll link the exact URL in the show notes, so click on the link, answer three questions, and get
0:10.0	CME Credit. And with that, let's dive into this thought-provoking topic.
0:15.0	She was lethargic but recoiled every time she was touched, pulling away from the nurses,
0:20.0	pushing the bipat mask off her face.
0:23.0	She was in florid kidney failure.
0:25.0	Her lungs were full of fluid and her potassium was so high it could stop her heart,
0:29.0	but the delirium we wanted to fix with dialysis
0:32.0	was making her fight everything we were doing to save her.
0:35.2	The sun stood at her bedside, shaken but resolute.
0:39.2	Please, he said, you've got to bring her back.
0:46.0	This was my first case of treatment over objection. I wish I could say these cases got easier with time,
0:49.0	but there is nothing easy about forcing a patient to do something against their will.
0:54.6	If a patient lacks decisional capacity, if they can't understand the intervention being offered,
0:59.7	appreciate the consequences, reason through the risks and benefits, and communicate a choice,
1:05.1	then we have to make hard decisions about what to do if the patient says no.
1:09.7	Welcome back to At The Bedside, I'm Margot.
1:12.0	I'm Tamar. And I'm Joffer. Our goal today is to help you
1:15.2	navigate cases of treatment over objection and our guest is Dr. Kenneth Praker.
1:19.4	I'm a pulmonologist and I'm director of clinical ethics and chairman of the Medical
1:25.3	Ethics Committee at Columbia University Medical Center. I've been doing ethics
1:29.3	consultations for nearly 30 years since our ethics program began actually and one thing that appeared quite
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