Exam #2 Flashcards
Treatment that is pointless or ineffective, it can’t cure or benefit the patient
Medical futility
Illness is rooted in disease, experienced in the form of symptoms, and reported in various ways.
(What is wrong with the person)
Arthur Kleinmanns meanings of illness for individuals:
•Biological meaning
What are the goals of healthcare?
- Prolongation of Life
- Alleviation of Pain and suffering
- Promotion of Health and prevention of disease
Non-normative definition of health
Uses factual evidence in regards to functioning, rather than added value terms.
Judgement and claims based off of value.
Normative definition of disease and health.
Arthur Kleinmanns meanings of illness for individuals:
•Biological meaning
Illness is rooted in disease, experienced in the form of symptoms, and reported in various ways.
(What is wrong with the person)
Arthur Kleinmanns meanings of illness for individuals:
•Cultural meaning
Predominant values in your culture. What is highly valued.
The effect illness has on the patient’s family, friends, and coworkers, as they deal with the management of his or her illness.
Arthur Kleinmanns meanings of illness for individuals:
•Social meaning
Arthur Kleinmanns meanings of illness for individuals:
•Moral
Illness teaches us about life’s lessons
What physical and psychological factors can hinder a patients autonomy?
Physical:
•Being locked up
•Physical restraints
Psychological:
•Being overcome by fear or other emotions
•Making a decision based on false info
•Coercing or manipulating a person to do what we want them to do
Respect for patient autonomy
The ability to choose and make decisions for oneself
Overriding a persons actions or decision making, or known preferences, for the persons own good.
Paternalism
Paternalism
Overriding a persons actions or decision making, or known preferences, for the persons own good.
Weak paternalism
Overriding known preferences of a person thought to be incompetent to decide
Arthur Kleinmanns meanings of illness for individuals:
•Personal meaning
How it affects the person in his or her life, what it means to have a disease for the person
What are the following?
- Prolongation of Life
- Alleviation of Pain and suffering
- Promotion of Health and prevention of disease
Goals of Healthcare
Strong paternalism
Overriding the preferences of a competent person
Uses factual evidence in regards to functioning, rather than added value terms.
Non-normative definition of health
Normative definition of health and disease
Judgement and claims based off of value.
Overriding the preferences of a competent person
Strong paternalism
Meaning of illness for individuals:
Illness teaches us about life’s lessons
Arthur Kleinmanns meanings of illness for individuals:
•Moral
When is paternalism thought to be justified?
- When freedom of choice is impaired, be it Alzheimer’s, ignorance of facts, limited cognitive abilities, etc.
- When dealing with children
Medical futility
Treatment that is pointless or ineffective, it can’t cure or benefit the patient
Arthur Kleinmanns meanings of illness for individuals:
•Social meaning
The effect illness has on the patient’s family, friends, and coworkers, as they deal with the management of his or her illness.
Overriding known preferences of a person thought to be incompetent to decide
Weak paternalism
What are some of the issues that make futility a difficult issue for physicians and patients?
- Patients may reject the label of futility and insist everything be done that can be done
- Physicians and patients often have different ideas about what constitutes as futility
Advance directive and it’s 2 parts?
•Expresses what the patient would want doctors to do or not to do should he or she become incompetent
~2 parts ~
•Designates an individual to make decisions about treatment for the individual (living will)
•Extends autonomy to times when the patient is no longer competent to make decisions for himself or herself (power of attorney)
•Expresses what the patient would want doctors to do or not to do should he or she become incompetent
~2 Parts~
•Designates an individual to make decisions about treatment for the individual (living will)
•Extends autonomy to times when the patient is no longer competent to make decisions for himself or herself (Power of attorney)
Advance directive and it’s 2 parts
Issues with advance directives
- Documents can be missed placed or unnoticed
- Surrogates not given copies, therefore on aware of patient’s wishes
- When hope trumps documentation the patients instructions can be overridden
- Vague or outmoded language
How does act utilitarianism apply to paternalism?
Some acts of paternalism may be justified if it maximizes the good.
How does rule utilitarianism apply to paternalism?
I’m the long run, lies do more harm than good, it harms people in the long run to have their wishes ignored.
What would a Kantian say about patient refusal of treatment?
Means to an end:
Requires physicians to honor a patients decision to refuse treatment even when they believe the treatment is life saving.
What would a Kantian say on futile treatment? (Medical futility)
If a physician believes a treatment is pointless and that giving it would be unethical, then withdrawing the treatment is morally permissible. Forcing the physician to do what he thinks is wrong would be a violation of her autonomy.
What is Mill’s Harm Principle?
No one should interfere with a persons liberty except to prevent harm to others.
What are the main arguments for lying to patients?
Truth telling can evoke in patients feelings of panic, hopelessness, fear, and depression. These can all worsen a patients condition, sap their will to live, or even tempt them to suicide.
What are the main arguments against lying to patients?
- Informed patients are better patients, they comply with treatment.
- Not knowing the truth robs a patient of informed life decisions.
Consequentialist arguments regarding confidentiality
- Without confidentiality, physicians would be pressed to obtain info from patients that could help in treatment, and trust would break down.
- Disclosure of confidential medical information could expose patients to discrimination, disrupt their personal relationships, and subject them to shame or public ridicule
Non-consequentialist arguments regarding confidentiality
They appeal to the concept of autonomy
•Autonomous persons have a right to determine what may or may not be done to their bodies and private lives.
•They have a right to privacy and to control who may possess and use information about themselves
Question of whether confidentiality is absolute?
Any breach of absolute confidentiality undermines trust between physicians and patients, and amounts to impermissible deception.
Question of whether confidentiality is prima facie?
Exceptions are sometimes justified when confidentiality must be weighed against other duties, such as the duty to prevent serious harm to the patient and others
HIPAA
Health Insurance Portability and Accountability Act of 1996
Designed to provide privacy standards to protect patients medical records, and other health information. Sets boundaries on the use and release of health records
Using severe harm or threat to control another’s actions
Coercion
What are the components of informed consent?
- Physician disclosure
- Patient Competence
- Patient Understanding
- Voluntariness
- Consent to treatment
3 standards of adequate disclosure
- Physician or professional based standard
- Patient or reasonable person based standard
- Subjective standard
Competence
The ability to render decisions about medical information.
The ability to render decisions about medical information.
Competence
Sliding scale of competence
The greater the level of risk in refusing a treatment, the higher the level of competence should be for the patient to make the decision.
The greater the level of risk in refusing a treatment, the higher the level of competence should be for the patient to make the decision.
Sliding scale of competence
What is meant by understanding of medical information for the purposes of informed consent?
The patient has to understand the information presented. Disclosure should be put in terms a patient can understand, given his or her intellectual level.
What barriers can interfere with informed consent?
Language issues, if a patient has trouble hearing or seeing
Consent
A person must have decision making capacity and be 18 in order to make an autonomous decision. Decisions can be made for incompetent person by proxy, through expressed wishes, a living will, or substituted judgment.
A person must have decision making capacity and be 18 in order to make an autonomous decision. Decisions can be made for incompetent person by proxy, through expressed wishes, a living will, or substituted judgment.
Consent
What is the distinction between curing and healing?
Curing targets a disease as the enemy and encourages the patient to follow healthcare professionals orders. Healing focuses on the restoration of balance and harmony within the patient and promps the patient to assume some responsibility for getting better.
Tarasoff v. Regents
Prosenjit Poddar confided to a psychotherapist that he intended to kill Tatiana Tarasoff. Police were notified, but not Tatiana or her parents. Police considered him a non threat and released him, but he ended up killing her as he said. Her parents sued the university for not warning them and won. The court recognized the importance of confidentiality and right to privacy, but ruled the psychotherapist had a duty to breech it in order to warn 3rd party of serious risk or harm.
Physician or professional based standard of disclosure explanation and problem.
How much information and what kind of information patients need is determined by physicians or medical community, and it is based on what is in a patient’s best interest
•Problem: Ignores the patients needs for information relevant to her own personal decisions and assumes physicians know what is in the patient’s best interest
Patient or reasonable person based standard explanation and problem
Adequate disclosure is whatever a hypothetically reasonable person would want to know. Respecting the patient autonomy a right to self-determination is important
•Problem: it is difficult to determine who is a reasonable person in any given case, it may not meet the information needs of a particular individual
Subjective standard exclamation and problem
Disclosure is tailored to the information needs of particular patients. Information should be put in terms of patient understand, taking into consideration cultural differences, language barriers, etc.
•Problem: naively assumes that patients can always decide for themselves what facts they do and do not need to evaluate treatment options.
Voluntary choices
They are informed and free of controlling constraints such as physical constraints, coercion, manipulation.
Coercion
Using severe harm or threat to control another’s actions
Conveying info in a way that makes the person do something he or she might not want to do otherwise
Manipulation
Manipulation
Conveying info in a way that makes the person do something he or she might not want to do otherwise
Asserts that the rightness of actions depends solely on their consequences
Consequentialism
Consequentialism
Asserts that the rightness of actions depends solely on their consequences
- Act according to the maxim that it would be become a universal law.
•so if everyone stopped and fed the homeless would this result in good everywhere? Yes. - Act so that you always treat others as an end, never as a means to an end.
•so if I feel obliged to feed the homeless man and do so, I’m not thinking about the consequences or benefits to myself. I treat the person as an end. If I feel inclined to do so because I’ll feel good about myself afterwards, I treat the homeless person as a means to an end.
First and second formulation of CI
First and second formulation of CI
- Act according to the maxim that it would be become a universal law.
•so if everyone stopped and fed the homeless would this result in good everywhere? Yes. - Act so that you always treat others as an end, never as a means to an end.
•so if I feel obliged to feed the homeless man and do so, I’m not thinking about the consequences or benefits to myself. I treat the person as an end. If I feel inclined to do so because I’ll feel good about myself afterwards, I treat the homeless person as a means to an end.
