Autonomy for Burned Patients When Survival Is Unprecedented

Abstract

Altered states of consciousness often exclude the seriously burned patient from decision making in his own case. During the first few hours of hospitalization, however, even the most severely burned patient is usually alert and mentally competent. When burns are so severe that survival is unprecedented, we use an aggressive approach to decision making to preserve patient autonomy. While still lucid, and with sufficient information, the patient is asked if he wishes to choose between a full therapeutic regimen or ordinary care, reassured that with either choice, the burn team will provide the constant presence of human caring and full use of its professional skills. This approach has not changed the mortality rate of such patients, but has increased both the self-determination that they exercise and the empathy that they receive.

Coping with a Community Stressor: The Threat of a Hazardous Waste Facility

“…Much research has been conducted on the manner in which people cope during a particularly stressful event such as severe burn (Hamburg et al, 1953;Imbus and Zawacki, 1977), bereavement (Glock et al, 1974;Vachon et al, 1977), surgery (Cohen and Lazarus, 1973;Janis, 1958), and doctoral examinations (Mechanic, 1962). Recently, attention has been paid to how members of the general population cope with the stressors of everyday life, such * Direct all correspondence to: Kenneth M. Bachrach, School of Public Health, University of California, Los Angeles, CA 90024.…”

Patient Autonomy and Medical Paternity: can nurses help doctors to listen to patients?

“…Following this general assumption, many contributors to the futility literature have suggested that patients are in the foremost position to decide on therapeutic goals and to determine whether or not they are worth achieving. [17][18][19][20][21][22] Correspondingly, they are in a prime position to evaluate, interpret and contemplate available medical information and to make evaluative judgements about whether a particular treatment modality is appropriate and worth trying. 10 This is generally accepted as true because only patients know how much risk they are willing to take and can judge particular benefits.…”

The Use of Intensive Care: New Research Initiatives and Their Implications for National Health Policy

“…Of 24 severely burned patients who were given the opportunity to choose between aggressive or supportive care, 21 chose only pain relief. All 24 died (Imbus and Zawacki 1977).…”