Informed Consent Flashcards
Hippocratic Oath
No reference to privacy or consent; establishes “passive consent”
Simple Consent
Presupposes advent of contractarian social philosophies- “truth telling” displaces the “noble lie” which was only to better the perception of the doctors. Does not clearly establish necessity of disclosure.
Nuremberg Code
Clearly establishes “voluntariness” and leads to concerns about overt threats, unfair inducements (person doesn’t have reasonable reason to refuse (e.g. when money is involved)), and manipulation.
Patient Standard
“Materiality standard”: info material to a decision; what does the reasonable patient want to know?
Professional concerns: “comprehension”
Professional Standard
Nature/Purpose of the treatment, potential risks and benefits, rights to refuse.
Kant - “The categorical imperative”
Consent is based on respect for persons understood seesing able to exercise rational choices.
Mill - Utilitarianism
Ethical Justification for obtaining consent is that disclosing info is generally a good practice since it supports social goods (trust) as consequences.
Beauchamp (There are circumstances in which a doctor may withhold information)
The harm principle: A person’s autonomy is justifiably restricted to prevent harm to others caused by that person’s actions (threatens utilitarian theory).
The principle of Paternalism: A person’s autonomy is justifiably restricted to prevent harm to one’s self caused by one’s own actions, irrespective of whether any harm is caused to others. An intentional overriding of one person’s own autonomous choices by the appeal to mitigating harm to the person whose choices are limited or overridden. Withholding Info prior to a second diagnostic procedure. Caring for patients who have received bad news. Patients in extraordinary circumstances. Staged disclosure measures while making sure that the info does not mislead or give misimpressions to the patients.
Eberl (There are NO circumstances in which a doctor may withhold information)
Therapeutic Privilege: the practice of informational guardianship. A physician and even a psychiatrist is NOT competent to render an accurate prognosis concerning how a patient will react upon learning they are terminally ill. Not disclosing all relevant info is to treat the rational, autonomous agent as an infant. Can lead to undesirable consequences such as confusion, false belief, and misinterpretation of info that is disclosed and make physicians guilty of discrimination by double standards because they are treating the patient in a way that they wouldn’t want to be treated if they were a patient. An open relationship can lead to “therapeutic alliance” that can help patients be at peace with their situation and they should be fully allowed to participate in their treatment.
Watson (Clinical Trials ARE inherently exploitative)
Traditional Western usage of exploitation suggests the use of one person by another for the latter’s benefit. Value transactions are conducted by subjective standards. Creating a situation where a subject can not reasonably refuse is wrongful exploitation if it constitutes the risk of losing something fundamental of value (life or health) called URLV. The ability to reasonably refuse a morally binding agreement entails the capacity to consent. Obtaining genuine informed consent constitutes a necessary condition for whether a subject stands a URLV. If a subject is not in a position to consent either by lack of physical or mental capacity because complete information is withheld or biased then by accepting admittance, the researchers are exploiting them. Cultural exposure may inhibit accurate assessment of procedure options or reduce a subject to unreasonable treatment options. The severity of the subject’s disease can put them at risk of an MWE. People are exploited because humans are not always motivated to act morally.
Arneson (Clinical Trials are NOT inherently Exploitative)
Voluntary informed consent is not a necessary condition for the moral acceptability of conducting medical research. There can be mutually beneficial exploitation where the victim voluntarily consents to the deal. Advocated the pareto norm which is where the research renders some significant change without making anyone worse off. The Act consequentialist is morally obligated to take advantage of international situations because it would bring the greatest good for the greatest amount of people.
