The guidelines for patients’ eligibility for bariatric surgery have not changed since 1991, although recent data suggest there may be indications for broadening application of the surgery.
Advance directives, substituted judgment, and the best-interest standard all have limitations that constrain their usefulness in making medical decisions for patients who cannot choose for themselves.
In one study, nurses who called for ethics consultations experienced physician anger, strained relationships with other team members, and even threats to their continued employment.
Advance directives do not always resolve questions about the best care for patients who no longer have decision-making capacity; physicians and patient surrogates can take alternative approaches to arrive at the best care decision.
There are many elements and much coordination involved in the design and implementation of an effective resident training program in systems-based practice.