The value of taking an ‘ethics history’

Gwen M Sayers, David Barratt, Catherine Gothard, Clive Onnie, Sunimalee Perera and Daniel Schulman

Northwick Park Hospital, London

Objectives—To study the value of taking an ethics history as a means of assessing patients' preferences for decision making and for their relatives' involvement.

Design—Questionnaire administered by six junior doctors to 56 mentally competent patients, admitted into general and geriatric medical beds.

Setting—A large district general hospital in the United Kingdom.

Main measures—To establish whether patients were adequately informed about their illness and whether they minded the information being communicated to their relatives. To establish their preference regarding truthful disclosure and participation in decision making with risk attached. To establish whether they wished to be involved in CPR decision making, and if not, who should make the decision. To establish whether they knew of living wills and whether they had any advance directives.

Results—Twenty-four (43%) were inadequately informed of their illness.Forty-six (82%) said they would want to know were something serious to be found. Twenty-eight (50%) wanted to make their own decision if requiring risky treatment and 11 (20%) wanted family members involved. Thirty-one (55%) wanted to make a cardiopulmonary resuscitation (CPR) decision and five of these decisions differed from those made by the doctors. Twenty-five (45%) preferred the doctors to decide. Eleven (20%) of the patients had heard of living wills but only one had executed such a will. Seven (13%) of the patients wished to provide advance directives. Three (5%) did not find the history taking helpful but none were discomforted.

Conclusion—Taking an ethics history is a simple means of obtaining useful information about patients' preferences.

Key Words: Autonomy • confidentiality • CPR decision-making • advance directives

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