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Table of Contents
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
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59. Triage
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Patients pay the medical practitioner for their trouble; for the medical practitioner’s kindness, patients remain in debt.
~ Seneca
Triage Dilemma
Balancing Needs and Limited Resource
The emergency room was in chaos as paramedics rushed in with multiple casualties from a horrific car accident. Dr. Anna Lee, the lead physician on duty, quickly assessed the situation and began to triage the patients. She sorted them based on their injuries, with the most severe cases receiving immediate attention, while the less critical cases were tended to as resources allowed.
As the night wore on, more patients continued to arrive, and the hospital’s resources began to run thin. Dr. Lee was forced to make some difficult triage decisions, deciding which patients would receive treatment and which ones would have to wait. One patient in particular, an elderly man with a history of heart disease, required urgent attention, but the hospital’s only available bed was needed for a young woman who had been severely injured in a car crash.
Dr. Lee agonized over the decision, knowing that both patients needed immediate medical attention, but there was only one available bed. She consulted with her colleagues and the hospital’s triage policy, which prioritized patients based on the severity of their injuries and the likelihood of a successful outcome. After careful consideration, Dr. Lee decided to give the bed to the young woman, who had a higher chance of survival with prompt treatment.
The next morning, Dr. Lee was shocked to find out that the elderly man had passed away in the waiting area. His family was devastated, and they demanded answers. Dr. Lee explained her decision-making process, citing the hospital’s triage policy and the limited resources available. However, the family was not satisfied, and they filed a lawsuit against the hospital and Dr. Lee.
The case went to trial, and Dr. Lee was called to testify. She explained her triage decisions and the reasoning behind them, citing the principles of beneficence, nonmaleficence, and justice. She also explained that triage decisions were made by hospital policy, not by individual physicians, to prevent conflicts of interest and ensure fair allocation of resources. Despite her best efforts, the jury found Dr. Lee and the hospital liable for the elderly man’s death.
The case highlighted the importance of clear and transparent triage policies, and the need for healthcare providers to understand and follow these policies to prevent legal liability. It also emphasized the difficult decisions that medical practitioners must make in triage situations, balancing the needs of multiple patients with limited resources. Through education and training, healthcare providers can learn to navigate these complex situations and prioritize patient-centered healthcare.
Abstract
The concept of triage in medicine refers to the practice of sorting and prioritizing patients based on the severity of their medical conditions and available resources. The word “triage” originates from the French word “trier,” meaning to sort or select. In some instances, treatment has been provided to those who would recover quickly in order to get them back to their responsibilities, while in others, treatment has been given to patients in need of life-saving measures. However, the medical practitioner has a professional duty to prioritize their patient’s medical interests before any other individual, making it necessary for triage decisions to be socially determined by public policy, not the practitioner. The patient’s autonomous informed consent must align with the maximization of the patient’s best interests, while the practitioner must prioritize their patient’s best interests in accordance with the patient’s reasonable goals, values, and priorities. Triage decisions must be made by public policy to promote transparency, understanding, trust, and acceptance while ensuring justice and protecting vulnerable populations. The practitioner’s prime directive should always be patient-centered health care that promotes the patient’s best interests.
**
Think
[59:1] The word “triage” is etymologically from the French word “trier” which means to separate, sort, or select, and was implemented when the patient demand for medical facilities, treatment, medications, or equipment was greater than what was available. How triage has been implemented has varied widely.
[59:2] In war, it was not unusual to provide treatment first to those patients who would most quickly recover so that they could get back to fulfilling their responsibilities. At other times, treatment was given to patients most in need of life-saving treatment while more minor ailments would not be treated. However, treatment for those with a low probability of surviving would be curtailed or not provided in either scenarios.
[59:3] Triage or not, the medical practitioner has a professional duty to pursue their patient’s medical best interests before any other person with whom they do not have a patient-practitioner relationship. This is why triage decision-making policies need to be socially determined by federal, state, and institutional policy, not by the practitioner, as that would either violate fair and impartial resource allocation or violate the patient-practitioner relationship.
Assess
Patient: 1) Autonomy
[59:4] A patient’s autonomous informed consent is supposed to be coherent with the maximization of the patient’s best interests as determined by the patient’s reasonable goals, values, and priorities. The practitioner provides the patient with a diagnosis, prognosis, treatment options, risks, and benefits and answers questions. Then the patient chooses a treatment option and authorizes the practitioner to provide the treatment. However, sometimes the treatment will be limited because of an excess volume of patients, demand, or scarce availability.
Practitioner: 2) Beneficence & 3) Nonmaleficence
[59:5] The medical practitioner always has the obligation of maximizing the patient’s best interests in accordance with the patient’s reasonable goals, values, and priorities. This is based on the patient-practitioner relationship in which the patient trusts that the practitioner will always champion the patient’s best interests even when treatments are limited. This is why practitioners should not be involved in triage decision-making that involves their own patients, as doing so would oblige the practitioner to either choose their own patient to be treated at the expense of other practitioners patients or violate the patient-practitioner relationship and choose another practitioner’s patient to be treated before one’s own patient.
[59:6] For triage, there needs to be a clear separation between public policy and the patient-practitioner relationship to prevent either of those scenarios. This distinction makes it possible for the practitioner to honestly inform their patients that they will do everything humanly possible to get them the treatment they need within the parameters and resources available.
Public Policy: 4) Justice
[59:7] Triage decisions need to be established by federal, state, or institutional policies and by those who can make objective and fair allocation decisions independent of, but still respecting, the patient-practitioner relationship. Triage policies must be transparent and agreeable to the public, promoting understanding, trust, and acceptance while protecting vulnerable populations such as the elderly, the disabled, and the socially disadvantaged.
Conclude
[59:8] It is imperative that society can know and trust that the medical practitioner will always act and make decisions that will promote each patient’s best interests as determined by the patient’s reasonable goals, values, and priorities. Triage needs to be made by federal, state, or institutional policies to avoid practitioner violation of the patient-practitioner relationship. Patient-centered health care for the patient’s best interests should always be the practitioner’s prime directive in the practice of the art of medicine.
[59:9] In summary, triage decisions must be made by public policy to protect the patient-practitioner relationship and uphold the medical practitioner’s responsibility to prioritize their patient’s best interests. By separating public policy from the patient-practitioner relationship, practitioners can maintain their commitment to providing patient-centered healthcare within the constraints of available resources. Transparent and fair triage policies also promote understanding, trust, and acceptance while ensuring the protection of vulnerable populations. Medical practitioners must always strive to act in the best interests of their patients, guided by their patients’ reasonable goals, values, and priorities.
**
59. Review Questions
1. Triage or not, the practitioner has a professional duty to be fair and impartial when distributing medical resources, even if that means providing treatment for another practitioner’s patient before one’s own patient.
2. Triage decision-making policies need to be socially determined by federal, state, and institutional policy, not by the patient’s practitioner, as that would either violate fair and impartial resource allocation or violate the patient-practitioner relationship.
3. Practitioners should not be involved in triage decision-making that involves their own patients, as doing so would oblige the practitioner to either choose their own patient to be treated at the expense of other practitioners patients or violate the patient-practitioner relationship and choose another practitioner’s patient to be treated before one’s own patient.
4. Triage decision-making needs to be established by federal, state, or institutional policies and by those who can make objective and fair allocation decisions independent of, but still respecting, the patient-practitioner relationship.
5. [59:6] Triage policies must be transparent and agreeable to the public, promoting understanding, trust, and acceptance while protecting vulnerable populations such as the elderly, the disabled, and the socially disadvantaged.
**
Wrong 😕
[59:2] Triage or not, the practitioner has a professional duty to pursue their patient’s medical best interests before any other person with whom they do not have a patient-practitioner relationship. This is why triage decision-making policies need to be socially determined by federal, state, and institutional policy, not by the patient’s practitioner, as that would either violate fair and impartial resource allocation or violate the patient-practitioner relationship.
CORRECT! 🙂
[59:2] Triage or not, the practitioner has a professional duty to pursue their patient’s medical best interests before any other person with whom they do not have a patient-practitioner relationship. This is why triage decision-making policies need to be socially determined by federal, state, and institutional policy, not by the patient’s practitioner, as that would either violate fair and impartial resource allocation or violate the patient-practitioner relationship.
Wrong 😕
[59:2] Triage or not, the practitioner has a professional duty to pursue their patient’s medical best interests before any other person with whom they do not have a patient-practitioner relationship. This is why triage decision-making policies need to be socially determined by federal, state, and institutional policy, not by the patient’s practitioner, as that would either violate fair and impartial resource allocation or violate the patient-practitioner relationship.
CORRECT! 🙂
[59:2] Triage or not, the practitioner has a professional duty to pursue their patient’s medical best interests before any other person with whom they do not have a patient-practitioner relationship. This is why triage decision-making policies need to be socially determined by federal, state, and institutional policy, not by the patient’s practitioner, as that would either violate fair and impartial resource allocation or violate the patient-practitioner relationship.
CORRECT! 🙂
[59:5] The medical practitioner always has the obligation of maximizing the patient’s best interests in accordance with the patient’s reasonable goals, values, and priorities. This is based on the patient-practitioner relationship in which the patient trusts that the practitioner will always champion the patient’s best interests even when treatments are limited. This is why practitioners should not be involved in triage decision-making that involves their own patients, as doing so would oblige the practitioner to either choose their own patient to be treated at the expense of other practitioners patients or violate the patient-practitioner relationship and choose another practitioner’s patient to be treated before one’s own patient.
Wrong 😕
[59:5] The medical practitioner always has the obligation of maximizing the patient’s best interests in accordance with the patient’s reasonable goals, values, and priorities. This is based on the patient-practitioner relationship in which the patient trusts that the practitioner will always champion the patient’s best interests even when treatments are limited. This is why practitioners should not be involved in triage decision-making that involves their own patients, as doing so would oblige the practitioner to either choose their own patient to be treated at the expense of other practitioners patients or violate the patient-practitioner relationship and choose another practitioner’s patient to be treated before one’s own patient.
Wrong 😕
[59:6] Triage decisions need to be established by federal, state, or institutional policies and by those who can make objective and fair allocation decisions independent of, but still respecting, the patient-practitioner relationship. Triage policies must be transparent and agreeable to the public, promoting understanding, trust, and acceptance while protecting vulnerable populations such as the elderly, the disabled, and the socially disadvantaged.
CORRECT! 🙂
[59:6] Triage decisions need to be established by federal, state, or institutional policies and by those who can make objective and fair allocation decisions independent of, but still respecting, the patient-practitioner relationship. Triage policies must be transparent and agreeable to the public, promoting understanding, trust, and acceptance while protecting vulnerable populations such as the elderly, the disabled, and the socially disadvantaged.
CORRECT! 🙂
[59:6] Triage decisions need to be established by federal, state, or institutional policies and by those who can make objective and fair allocation decisions independent of, but still respecting, the patient-practitioner relationship. Triage policies must be transparent and agreeable to the public, promoting understanding, trust, and acceptance while protecting vulnerable populations such as the elderly, the disabled, and the socially disadvantaged.
Wrong 😕
[59:6] Triage decisions need to be established by federal, state, or institutional policies and by those who can make objective and fair allocation decisions independent of, but still respecting, the patient-practitioner relationship. Triage policies must be transparent and agreeable to the public, promoting understanding, trust, and acceptance while protecting vulnerable populations such as the elderly, the disabled, and the socially disadvantaged.
59. Clinical Vignettes
1. Ms. Michelle Cook is a 35-year-old teacher who presents to the emergency department with a severe headache and loss of vision in her right eye. The medical team suspects that she may have a brain tumor and orders a computed tomography (CT) scan to confirm the diagnosis. However, there are only two CT scanners in the hospital, and there are multiple critical patients waiting for the same test. Which of the following triage options is most ethical?
2. Mr. Michael Russell is a 50-year-old construction worker who presents to the emergency department with severe lower back pain and difficulty walking. The medical team suspects that he may have a herniated disc and orders a magnetic resonance imaging (MRI) scan to confirm the diagnosis. However, there is only one MRI machine in the hospital, and there are multiple patients waiting for the same test. Which of the following triage options is most ethical?
3. Ms. Karen Smith is a 65-year-old retiree who is brought to the emergency department with symptoms of a heart attack. She is taken to the triage area and assessed by the medical staff. The medical team determines that Ms. Smith is in need of immediate treatment and that she should be taken to the cardiac catheterization lab for urgent intervention. However, the hospital is currently experiencing a shortage of beds and resources due to an outbreak of a highly contagious virus. The triage team has to make a difficult decision on which patients will receive the limited resources available. They determine that Ms. Smith's condition is severe, but not immediately life-threatening, and that other patients with more severe conditions should receive the limited resources first. The medical team informs Ms. Smith of the situation and advises her that there may be a delay in receiving treatment. Ms. Smith expresses her concerns about the delay and the potential consequences of waiting for treatment. The medical team explains the situation to her and reassures her that they will do everything possible to provide her with the necessary treatment as soon as possible. How should the medical team balance Ms. Smith's urgent medical needs with the limited resources available in the hospital during an outbreak?
4. Mr. Wesley James is a 55-year-old man with a history of heart disease, hypertension, and diabetes. He presents to the emergency department with symptoms of chest pain and shortness of breath. After initial evaluation, it is determined that he requires urgent cardiac catheterization to assess for possible coronary artery disease. However, the hospital's catheterization lab is currently at capacity and there are two other patients who also require urgent catheterizations. Upon further evaluation, it is discovered that Mr. James is a prominent local politician and community leader, and there is public pressure from his supporters to prioritize his care. Additionally, the hospital's administration is concerned about negative publicity if Mr. James is not given priority. What should be the triage decision in this case?
5. Ms. Lily Chen is a 45-year-old teacher who has been diagnosed with COVID-19 and admitted to a hospital. Despite her worsening condition, she insists on being transferred to a private hospital that offers better amenities and services than the public hospital where she is currently receiving treatment. The private hospital is known to have better medical resources and a higher success rate in treating COVID-19 patients. However, the hospital has limited beds and is currently only accepting patients with severe COVID-19 cases. What ethical principle should guide the hospital's triage decision-making in this scenario?
CORRECT! 🙂
Explanation: The most ethical position is to adhere to institutional policies for triage, while promoting your patient’s best interests [59:3-4]. Following institutional policies for triage and allocating resources based on medical urgency aligns with the principles of fairness and impartiality. The other options are not correct, because ordering a CT scan for Ms. Cook immediately without considering institutional policies would violate the principle of fair and impartial resource allocation, because placing Ms. Cook on a waiting list could lead to her condition deteriorating and causing preventable harm, because prioritizing Ms. Cook's CT scan over institutional policies would violate the principle of fair and impartial resource allocation [59:3-4]. In summary, following institutional policies for triage and allocating resources based on medical urgency promotes fair and impartial resource allocation and aligns with socially determined triage policies.
Wrong 😕
Explanation: The most ethical position is to adhere to institutional policies for triage, while promoting your patient’s best interests [59:3-4]. Following institutional policies for triage and allocating resources based on medical urgency aligns with the principles of fairness and impartiality. The other options are not correct, because ordering a CT scan for Ms. Cook immediately without considering institutional policies would violate the principle of fair and impartial resource allocation, because placing Ms. Cook on a waiting list could lead to her condition deteriorating and causing preventable harm, because prioritizing Ms. Cook's CT scan over institutional policies would violate the principle of fair and impartial resource allocation [59:3-4]. In summary, following institutional policies for triage and allocating resources based on medical urgency promotes fair and impartial resource allocation and aligns with socially determined triage policies.
CORRECT! 🙂
Explanation: The most ethical option is to follow institutional policies for triage and allocate resources based on medical urgency, taking into account the severity of Mr. Russell's condition [59:3]. This approach aligns with the principles of fairness and impartiality [59:4] and ensures that resources are allocated to those who need them the most based on medical urgency. While Mr. Russell's condition may be potentially life-altering, ordering an MRI scan for him immediately without considering institutional policies would violate the principle of fair and impartial resource allocation [59:3]. Placing Mr. Russell on a waiting list may not be the best option, as his condition could worsen and cause preventable harm. Prioritizing the MRI scan for patients who are younger may not be the best option, as age should not be a determining factor in triage decisions [59:4]. The most ethical option is to follow institutional policies for triage and allocate resources based on medical urgency, taking into account the severity of Mr. Russell's condition [59:3].
Wrong 😕
Explanation: The most ethical option is to follow institutional policies for triage and allocate resources based on medical urgency, taking into account the severity of Mr. Russell's condition [59:3]. This approach aligns with the principles of fairness and impartiality [59:4] and ensures that resources are allocated to those who need them the most based on medical urgency. While Mr. Russell's condition may be potentially life-altering, ordering an MRI scan for him immediately without considering institutional policies would violate the principle of fair and impartial resource allocation [59:3]. Placing Mr. Russell on a waiting list may not be the best option, as his condition could worsen and cause preventable harm. Prioritizing the MRI scan for patients who are younger may not be the best option, as age should not be a determining factor in triage decisions [59:4]. The most ethical option is to follow institutional policies for triage and allocate resources based on medical urgency, taking into account the severity of Mr. Russell's condition [59:3].
CORRECT! 🙂
Explanation: In situations where there are limited resources available, triage protocols are established to ensure that the resources are allocated fairly and impartially based on the severity of the patient's medical condition [59:1]. The medical team must follow these protocols to ensure that the allocation of resources is fair and just, and that the needs of all patients are met. In this case, Ms. Smith's condition is severe, but not immediately life-threatening, and other patients with more severe conditions require immediate treatment. The medical team must follow the established triage protocol to ensure that the limited resources are allocated fairly and impartially [59:3]. Consultation with Ms. Smith's family and loved ones is not necessary as it is the responsibility of the medical team to make medical decisions based on the patient's medical condition. Discharging Ms. Smith and advising her to seek medical attention elsewhere is not ethical as it may put her at risk and may not provide her with the necessary care she requires [59:5].
Wrong 😕
Explanation: In situations where there are limited resources available, triage protocols are established to ensure that the resources are allocated fairly and impartially based on the severity of the patient's medical condition [59:1]. The medical team must follow these protocols to ensure that the allocation of resources is fair and just, and that the needs of all patients are met. In this case, Ms. Smith's condition is severe, but not immediately life-threatening, and other patients with more severe conditions require immediate treatment. The medical team must follow the established triage protocol to ensure that the limited resources are allocated fairly and impartially [59:3]. Consultation with Ms. Smith's family and loved ones is not necessary as it is the responsibility of the medical team to make medical decisions based on the patient's medical condition. Discharging Ms. Smith and advising her to seek medical attention elsewhere is not ethical as it may put her at risk and may not provide her with the necessary care she requires [59:5].
CORRECT! 🙂
Explanation: The ethical principle of justice requires that triage decisions be based on medical need rather than social status [59:7]. While Mr. James may be a prominent figure in the community, his status should not be a factor in the triage decision. The hospital's triage protocol should be followed, and patients should be prioritized based on medical need, regardless of social status or other external factors [59:3]. Delaying the procedure for all three patients or transferring Mr. James to another hospital are not optimal solutions, as these actions may result in harm to the patients and may not address the underlying issue of resource allocation. It is essential that the hospital's administration prioritize patient care based on medical need and ensure that resource allocation is fair and equitable.
Wrong 😕
Explanation: The ethical principle of justice requires that triage decisions be based on medical need rather than social status [59:7]. While Mr. James may be a prominent figure in the community, his status should not be a factor in the triage decision. The hospital's triage protocol should be followed, and patients should be prioritized based on medical need, regardless of social status or other external factors [59:3]. Delaying the procedure for all three patients or transferring Mr. James to another hospital are not optimal solutions, as these actions may result in harm to the patients and may not address the underlying issue of resource allocation. It is essential that the hospital's administration prioritize patient care based on medical need and ensure that resource allocation is fair and equitable.
CORRECT! 🙂
Explanation: In this scenario, the principle of justice in resource allocation should guide the hospital's triage decision-making [59:1]. Triage decisions must prioritize the allocation of limited resources to those with the greatest need and likelihood of survival [59:7]. Although Ms. Chen has the autonomy to choose where she receives treatment [59:4], the hospital's resources must be distributed equitably to all patients. Similarly, while the principle of beneficence requires healthcare providers to act in the best interests of their patients, the limited availability of resources means that difficult choices must be made [59:5]. Finally, while non-maleficence obliges healthcare providers to do no harm to their patients, in this case, the harm to Ms. Chen is due to the limitations of resources and not a result of any intentional or negligent action on the part of the healthcare provider [59:6]. The principle of justice in resource allocation must guide triage decision-making to ensure that resources are distributed fairly and equitably to all patients. Hospitals must establish transparent and agreed-upon triage policies that prioritize the allocation of limited resources to those with the greatest need and likelihood of survival while also protecting vulnerable populations [59:7]. In this scenario, the hospital must weigh Ms. Chen's desire to be transferred to a private hospital against the need to allocate the limited resources available to other patients with more severe cases of COVID-19.
Wrong 😕
Explanation: In this scenario, the principle of justice in resource allocation should guide the hospital's triage decision-making [59:1]. Triage decisions must prioritize the allocation of limited resources to those with the greatest need and likelihood of survival [59:7]. Although Ms. Chen has the autonomy to choose where she receives treatment [59:4], the hospital's resources must be distributed equitably to all patients. Similarly, while the principle of beneficence requires healthcare providers to act in the best interests of their patients, the limited availability of resources means that difficult choices must be made [59:5]. Finally, while non-maleficence obliges healthcare providers to do no harm to their patients, in this case, the harm to Ms. Chen is due to the limitations of resources and not a result of any intentional or negligent action on the part of the healthcare provider [59:6]. The principle of justice in resource allocation must guide triage decision-making to ensure that resources are distributed fairly and equitably to all patients. Hospitals must establish transparent and agreed-upon triage policies that prioritize the allocation of limited resources to those with the greatest need and likelihood of survival while also protecting vulnerable populations [59:7]. In this scenario, the hospital must weigh Ms. Chen's desire to be transferred to a private hospital against the need to allocate the limited resources available to other patients with more severe cases of COVID-19.
**
59. Reflection Vignettes
1. Two patients with COVID 19 need the only available extracorporeal membrane oxygenation (ECMO) machine. Both patients came in at the same time and are essentially equal in allocation determinants. The only difference is that patient A is unvaccinated, and patient B is vaccinated. It is not possible to share the ECMO machine.
In the given scenario, the practitioner is faced with a difficult decision regarding the allocation of a scarce resource, the ECMO machine, between two patients with COVID-19. One patient is unvaccinated, and the other is vaccinated. However, the practitioner should not be making decisions regarding the allocation of resources as it should be determined by institutional and public policy. The practitioner's professional duty is to prioritize their patient's medical best interests, which means that they should not be involved in triage decision-making that involves their own patients, as this would violate the patient-practitioner relationship. Triage decisions should be transparent and agreeable to the public, promoting understanding, trust, and acceptance while ensuring justice and protecting vulnerable populations. In conclusion, the practitioner should not be making allocation decisions, and triage should be made by federal, state, or institutional policies. The practitioner's prime directive should always be patient-centered health care that promotes the patient's best interests.
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
**
2. A practitioner has a patient A with COVID 19 and requires the only extracorporeal membrane oxygenation (ECMO) machine. Patient B has been transferred over from another hospital, which also needs the ECMO machine. The only difference between the two is that patient A is unvaccinated, and patient B is vaccinated. It is not possible to share the ECMO machine, and there are no federal, state, or institutional triage policies in place, so the practitioner must be the one who determines which patient gets the ECMO machine.
In a situation where there are no federal, state, or institutional triage policies in place, the practitioner should consider several ethical principles in determining which patient gets the ECMO machine. These principles include beneficence, nonmaleficence, justice, and respect for patient autonomy. The practitioner must evaluate each patient's medical condition, prognosis, and overall chances of recovery, and then make a decision based on the best interests of each patient. It is important to note that the decision should not be based on the vaccination status of the patients alone, but on a thorough evaluation of all relevant factors.
**
59c*
COVID 19 - Quality of Life
[C59:1]
A patient with quadriplegia is admitted with COVID. The patient requires admission to the ICU, but the attending practitioner says that the quality of the patient’s life does not warrant aggressive treatment. The patient’s family disagrees. What should be done?
[C59:2]
- A. Do not admit the patient to the ICU because the practitioner has the authority to determine who gets admitted into the ICU and who does not.
- B. Do not admit the patient to the ICU because the quality of life is more important than quantity of life.
- C. Let the courts decide.
- D. Admit the patient to the ICU because the practitioner has the professional obligation to promote the quantity of life.
- E. Admit the patient to the ICU because the patient’s family has the decision-making authority.
- F. The practitioner needs to get informed consent from the patient.
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
***
