Autonomy Flashcards
What is the moral basis of the principle of patient autonomy or self-rule?
-The Principle of Respect; have right to make their own choices and develop their own life plan -‘You shall not treat a patient without the informed consent of the patient or his or her lawful surrogate, except in narrowly defined exceptions’ -to discuss treatment preferences with patients and to document them
What are the requirements for informed consent?
-patient or surrogate must: be competent, be free from influence -health care provider must: understandable necessary information, reflective conversation, must recommend
What is required for a person to be competent?
presume that adult patients are competent, able to understand effects of options, no easy way to determine incompetence (except that the health care provider spend time), patient has values different from the health care provider does not by itself prove the patient incompetentence, Standards for competence may be set higher in cases where the consequences have more meaning
What should one do in case a patient is incompetent?
medical practitioner must consult the patient’s living will, medical practitioner must consult a surrogate decision maker
What principles should govern decision-making once a patient is no longer competent?
a hierarchy of approaches: -Evidence of known prior preferences of patient -surrogate for health care decision-making may make a substituted judgment and determine what the patient would prefer -physician or surrogate must decide based on his or her judgment about what would be in the best interest of the patient -meeting should be called in which all such parties have a chance to exchange information and views -consult the institutional ethics committee -courts can be consulted to order treatment or appoint a conservator
How much disclosure is required in order to satisfy the demand for informed consent?
standards for full disclosure: -prudent person rule: patient understands diagnosis,purpose of treatment, risks, failure rates, expected benefits, alternative treatments, prognosis, costs -subjective substantial disclosure rule: health care provider describe to the patient everything material/ important
Are there exceptions to the requirement to seek explicit informed consent?
-Implied consent: consent is suggested and procedures are not risky -Therapeutic privilege: adverse effect on the patient’s health information may be withheld but health care providers misestimate so therapeutic privilege is almost never justified -Emergencies: advance wishes are not known and there is danger to life the obligation to seek informed consent is lost -irreversible state, the health care provider may be justified in postponing treatment even if the patient wants it, based on an appeal to beneficence
When is violating informed consent clearly unjustified?
-Non-emergencies with incompetent patients: no surrogate available and no living will, courts used -form of manipulation when the health care provider wishes to influence a decision by withholding information
When is overriding a patient’s autonomous preference, or medical paternalism, justified?
-Medical paternalism: acting without consent in order to benefit the patient -Strong paternalism: the overriding of a competent patent’s explicit wishes, is generally rejected since it violates autonomy -Weak paternalism: acting for the benefit of an incompetent patient, is justified in some cases in order to restore that person’s competence
What is the role of the Ethics Committee in protecting a patient’s autonomy?
The Ethics Committee should act primarily as a guardian of patient’s rights
