Also known as ‘expert systems’, these are computer software systems intended to help doctors make clinical decisions. Primary care medicine is especially noted for its uncertainty by virtue of being most patients’ ?rst point of contact with health care, confronting the clinician with many ‘undi?erentiated’ health problems. So far, these systems have not been as e?ective as expected because of a failure to ana-lyse the needs of primary care. Simple procedures to prompt the delivery of treatment to patients with chronic conditions have improved care quality, but work needs to be done on their cost-e?ectiveness. The aim of more complex computerised support systems will be to forecast likely future events and the possible e?ectiveness of proposed interventions, based on available information about the patient and an understanding of the risks and e?cacy of interventions by doctors and other experts.
One example, called ISABEL, can be accessed by paediatricians to check on their diagnosis and management of many childhood disorders.... computerised decision-support systems
An approach to decision-making that involves modelling the sequences or pathways of multiple possible strategies (e.g. of diagnosis and treatment for a particular clinical problem) to determine which is optimal. It is based upon available estimates (drawn from the literature or from experts) of the probabilities that certain events and outcomes will occur and the values of the outcomes that would result from each strategy.... decision analysis
In a policy context, evidence-based decision-making is the application of the best available scientific evidence to policy decisions about specific treatments or care, as well as changes in the delivery system.... evidence-based decision-making
A term applied in medicine to a substance used as a substitute for another. The term is also applied to a woman who agrees to become pregnant and give birth to a child on the understanding that she will give up the child to the parents who have contracted with her for the surrogacy arrangement. When in vitro fertilisation (IVF – see under ASSISTED CONCEPTION) proved successful, it became possible to transfer a fertilised egg to a ‘uterus of choice’. Arti?cial insemination of the potential surrogate mother using sperm from the putative ‘father’ is also practised. Surrogacy has thrown up a host of ethical and legal problems which have yet to be satisfactorily resolved.... surrogate
(in England and Wales under the Mental Capacity Act 2005) a legally recognized decision or statement by an adult with *capacity identifying any specific or general treatment the patient does not want in the event that he or she loses capacity. An advance directive or decision (formerly often called a living will) should be informed, made voluntarily, and must be valid and applicable to the medical situation that arises; at the extreme it can constitute an advance refusal of potentially life-saving treatment. It cannot, however, be used to demand future treatment and does not apply as long as the person retains capacity. An advance statement is a more general and less legally binding expression of the person’s values and views on the sort of treatment he or she may or may not wish to undergo. Directives and statements can raise ethical questions: for example, should life-saving treatment refused in advance nevertheless be given if it could restore the patient to a quality of life with which he or she was content before losing capacity.... advance directive, decision, or statement
(surrogate decision) a decision made with or on behalf of a person who lacks full legal capacity to *consent to or refuse medical treatment. See best interests; Gillick competence; parental responsibility; power of attorney; substituted judgment.... proxy decision
a woman who becomes pregnant (by artificial insemination or embryo insertion) following an arrangement made with another party (usually a couple unable themselves to have children) in which she agrees to give the child she carries to that party when it is born. Surrogacy arrangements are made on the understanding that no payment is involved between either parties although reasonable expenses can be paid. See also section 30 order.
Details of surrogacy at the Human Fertilisation and Embryology Authority website... surrogate mother
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