Consent and Patient Autonomy

The contrast between patient decisions and emergency decisions made on patients’ behalf develops into a question of who has the right to define care.

increasingBearing stren­gth in each eventdecreasing

The Modern Consent Principle

The Modern Consent Principle A Right to Decide Informed consent requires disclosure of a treatment’s nature, risks, benefits, and alternatives. It protects patients from decisions imposed without their participation. Historical Purpose The principle arose in response to abuses in medicine. It recognizes that a clinician’s judgment does not erase the patient’s authority over their own body.

Advance Directives

Advance Directives Refusing Treatment Court decisions affirmed that patients could refuse life-sustaining treatment through their own wishes or a surrogate. Living wills and advance directives gave people a way to express those preferences in advance. The Danger of Substitution A directive can be misunderstood when circumstances change. It should not become a license to infer that a person does not want rescue or other care.

DNR Misread as Destiny

DNR Misread as Destiny A Narrow Order Expanded At Memorial, DNR status influenced evacuation priority even though the order addressed resuscitation rather than transfer. Families had not consented to that broader meaning. Autonomy Under Pressure The emergency made it difficult to reach patients and proxies, but absence of consultation did not make their wishes irrelevant. The use of DNR status revealed how quickly autonomy could be displaced by institutional convenience.

Families Ask to Be Heard

Families Ask to Be Heard A Proxy’s Knowledge Angela McManus and other relatives tried to clarify their family members’ wishes and challenge evacuation decisions. Their knowledge was practical and intimate, grounded in daily care. Exclusion Has a Cost Families were ordered away or lacked access to doctors who could change an order. Their exclusion deprived clinicians of valuable information and left relatives with lasting distress.

Transparency as an Ethical Duty

Transparency as an Ethical Duty Decisions Must Be Explainable Later disaster-planning recommendations emphasized transparency, consistency, proportionality, and accountability. These principles make decisions more reviewable and help preserve trust. A Public Question The book asks whether people affected by rationing should participate in shaping its rules. Autonomy is not only an individual bedside principle; it is also a community interest in how emergency care is governed.

1950s onward

1975–1990

August 30–31, 2005

September 1, 2005

After Katrina