The ethical appropriateness of using prognostic scoring systems in clinical management.
The four ethical principles of beneficence, nonmaleficence, autonomy, and social justice provide a framework for making medical decisions, including those that involve the administration of life-sustaining therapies. In recent years, a number of prognostic scoring systems, including the Acute Physiology Assessment and Chronic Health Evaluation (APACHE) system, have been developed to augment clinical judgment in determining which critically ill patients are likely to benefit from such therapies. Although these systems all have limitations, their use in decision making is as ethically appropriate as is the use of clinical judgment, which has its own limitations and has been used for years.
Luce
J M
JM
Department of Medicine, University of California at San Francisco.
Wachter
R M
RM
D017088:AIDS-Related Opportunistic Infections / Q000145:classification / Q000401:mortality / Q000628:therapy; D000328:Adult; D026686:Beneficence; D002983:Clinical Competence; D003422:Critical Care / Q000458:organization & administration; D003659:Decision Making, Organizational; D004992:Ethics, Medical; D005544:Forecasting; D006801:Humans; D007600:Judgment; D008297:Male; D017063:Outcome Assessment, Health Care / Q000458:organization & administration*; D010343:Patient Admission; D018579:Patient Selection; D026684:Personal Autonomy; D011020:Pneumonia, Pneumocystis / Q000145:classification / Q000401:mortality / Q000628:therapy; D011379:Prognosis; D040841:Resource Allocation; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012922:Social Change; D035501:Uncertainty; D028761:Withholding Treatment