6. Ethical Issues Flashcards
is the written assent of a patient to receive a proposed treatment.
Informed consent
It is the most common concert in all the
imaging modalities
Informed consent
Health Care Providers, however, should
be able to provide patients with a process that renders them truly
knowledgeable about the procedures and
their alternatives
Informed consent
is the concept that patients are to be treated as individuals and informed about procedures to facilitate appropriate decisions.
Autonomy
means that one human person, precisely as a human person, dares not have the authority and should not have power over another human person. In a medical sense, a patient will not be treated without informed consent of his or her lawful surrogates, except in narrowly defined emergencies.
Autonomy
is important in considerations of autonomy
The patient’s right to information
Specific treatments such as surgery, invasive procedures, or experimental treatments may require specific consent, called _______, which confirms in writing what is planned and the patient is agreeing to as part of that plan.
informed consent
CRUCIAL ELEMENTS IN PATIENT AUTONOMY AND INFORMED CONSENT
- Maintenance of patients’ rights
- Provision of education to facilitate
consent - Promotion of human dignity
- Determination of incompetence
- Advocacy of surrogates
- Elimination of attitudes of paternalism
- Clarification of unclear communication
involving therapeutic privilege - Strategies for dealing with emergency
situations - Use of compatible parameters for
consent in specific health care facilities - Education regarding the ethical theories
involved in patient autonomy and
informed consent
Established a patient care partnership document, which is to be given to hospitalized patients to help them understand the expectations, rights, and responsibilities regarding their health care
American Hospital Association
EXPECTATION SHOULD INCLUDE:
-High Quality hospital care delivered
with skill
-Compassion, and Respect
PCP
Patient Care Partnership
The following FIVE POTENTIALLY CONFLICTING RULES may guide the Physician or the health care provider in explaining information to patients (INFORMATION DELIVERY):
- Patient preference rule
- Professional custom rule
- Prudent person rule
- Subjective substantial disclosure rule
- Institutional Rules Regarding Informed Consent
requires health care professionals to tell patients what they want to know.
Patient preference rule
states that the health care professional should give the patient the information normally given to patients in similar situations
Professional custom rule
measures the physician’s disclosure to the patient based on the patient’s need for information to make decisions regarding treatment.
Prudent person rule
Prudent person rule AKA
reasonable patient standard
encourages the physician to disseminate all information important to the individual patient.
Subjective substantial disclosure rule
addresses many of
the important elements of informed
consent
Prudent person rule
A combination of the \_\_\_\_\_\_ and the \_\_\_\_\_\_, which requires the physician to communicate meaningfully with the patient, provides the information the patient needs to make an informed decision.
prudent person rule,
subjective substantial disclosure rule
Imaging professionals must consider
institutional rules concerning a variety of
ethical issues, including informed consent
Provides information
patients want to know
Patient preference rule
Provides the
information normally
given to patients
Professional custom rule
Provides the
information patients
need to know to consent
to or refuse treatment
Prudent person rule
Provides patients with
all information
Subjective substantial disclosure rule
Provides information
without overburdening
the patient
Combination of rules
Helps ensure patient autonomy
The Patients Self Determination Act of 1991
Means that imaging professionals
should respect a patient’s choice to
refuse treatments
The Patients Self Determination Act of 1991
The Patients Self Determination Act of 1991 Became effective
December 1, 1991
requires all health care institutions receiving Medicare or Medicaid funds to inform patients that they have the right to refuse medical and surgical care and the right to initiate a written advance directive
The Patients Self Determination Act of 1991
Formally legislated the basic human
rights of all patients to refuse treatment
Omnibus Budget Reconciliation Act of 1990
is the ability to make choices.
Competence
may be a parent, an individual named by the patient while competent, or a person or persons appointed by the courts.
Surrogate
Undue influences that may restrict the patient’s choices are a hindrance to autonomy:
- A lack of time can influence the completeness of the informed consent process.
- Lack of communication on the part of the patient or professional may interfere with the informed consent process.
provide seven points to enable the health care professional to maintain respect for autonomy.
Jonsen, Siegler, and Winslade
a narrowly construed prerogative invoked when health care providers withhold information from patients because they believe the information would have adverse effects on the patients’ conditions or health.
Therapeutic privilege
Can influence the completeness of the
informed consent process
Lack of time
the informed consent process may have to be abandoned to save the patient’s life.
Emergency Situations
According to the laws of many states, three conditions must be present for the omission of informed consent to be justified:
- The patient is incapable of giving consent, and no lawful surrogate is available.
- Danger to life or risk of a serious impairment to health is apparent.
- Immediate treatment is necessary to avert these dangers
are not always possible in emergency situations.
Informed consent and autonomy
Jonsen, Siegler, and Winslade provide seven points to enable the health care professional to maintain respect for autonomy. They have been modified below for imaging professionals:
- Is the patient mentally capable and legally competent? Is there any evidence of incapacity that would affect the imaging procedure?
- If competent, has the imaging patient expressed any preferences for the imaging procedure?
- Does the imaging patient understand the benefits and the risks, and has he or she given consent?
- If the patient is in need of a surrogate, is the surrogate using the appropriate standards for decision making?
- Has the imaging patient expressed prior preferences (e.g., advance directives)?
- If the imaging patient is unable or unwilling to cooperate with the imaging procedure, is there a specific reason?
- After a consideration of the first six points, is the patient’s right to choose being respected to the extent possible both ethically and legally?
is a predetermined (usually written) choice made to inform others of the ways in which the patient wishes to be treated while incompetent
Advance Directive
requires the greatest good to be done for the greatest number.
Theory of consequentialism (utilitarianism)
holds that the motives for an action are the most important considerations.
Deontology
invokes practical wisdom and right reason
Virtue ethics
is not very relevant in considerations of autonomy and consent because it is generally applied to large numbers of persons.
Utilitarianism
with its emphasis on motives instead of consequences, is difficult to apply in considerations of the maintenance of a patient’s autonomy because in this situation the consequences are crucial.
deontologic viewpoint
relies on virtues, practical wisdom, and an appreciation of the consequences of actions.
Virtue ethics
This theory is the most adaptable for dealing with the difficulties of patient autonomy because it promotes the dignity of patients and their freedom of choice
Virtue ethics
means that imaging professionals should respect a
patient’s choice to refuse treatments
principle of autonomy
a written or oral statement by which a competent person makes known his or her treatment
preferences and/or designates a surrogate decision maker in the event he or she should become
unable to make medical decisions on his or her own behalf
advance directive
is a necessary element in informed consent
Competence
entails the ability to make appropriate choices and consider their consequences.
Competence
is essential for the patient to give truly informed consent.
adequate information
