Lecture 6-autonomy Flashcards
Informed consent requires disclosure
Disclosure involves providing the relevant treatment information to patients
Informed consent requires disclosure
-Acceptable exceptions?
- Emergency
- Waiver
- Incompetency
- Therapeutic privilege (Very limited)
Informed consent requires disclosure
-Exceptions-emergency example?
Mass casualty
Informed consent requires disclosure
-Exceptions-Waiver example?
Patient tells you what to do in advance
Informed consent requires disclosure
-Exceptions-Incompetency example?
Unconscious patient
Informed consent requires disclosure
-Exceptions-Therapeutic privilege?
- Very limited
- If necessary for decision making, must present serious harm
Informed consent requires voluntariness
-What can constrain voluntariness?
- Voluntariness involves the right a patient has to make treatment decisions free from undue influence
- Internal and external factors constrain voluntariness
Informed consent requires voluntariness
-External factors include?
- Force
- Coercion
Informed consent requires voluntariness
- External factors include
- Force?
-Physical restraint/sedation
Informed consent requires voluntariness
- External factors include
- Coercion?
- Implicit/explicit threat
- Manipulation
- deliberate distortion of information to influence patient decision making-violates both the ‘informed’ and ‘consent’ aspects of informed consent
3 ways autonomy can get messed up?
- Autonomy and actions
- Autonomy and options
- Autonomy and decision making
Autonomy and actions
- Cases in which?
- Example?
- Cases in which we are influenced by physical force or coercion (institutionalization)
- Example-patient is restrained legally or patients in nursing care facilities
Autonomy and options
- Autonomy requires?
- Example?
- Autonomy requires that we have genuine options to decide between (access to care, awareness of alternatives)
- Example-patient who does not have adequate healthcare to receive a particular treatment
Autonomy and decision making
- Autonomy requires?
- Example?
- Autonomy requires that our relevant options be made known to us (disclosure)
- Example-physician does not tell patient about all potential options intentionally
Truth telling and medicine
-Exposes the?
Exposes the pressure point between autonomy and paternalism
Reasonable restrictions on autonomy?
- Harm principle
- Principle of paternalism
- Principle of legal moralism
- Welfare principle
Reasonable restrictions on autonomy
-Harm principle?
Prevention of harm to others
Reasonable restrictions on autonomy
-Principle of paternalism?
Prevention of harm the individual themselves
Reasonable restrictions on autonomy
-Principle of legal moralism?
- The prevention of law breaking including for the punishment of law breaking
- Acceptable to restrict someone’s autonomy when they are breaking a law and when they are in jail their autonomy is highly restricted
- Assumption: the function of law is to enforce morality
Reasonable restrictions on autonomy
-Welfare principle
- Benefit to others
- Small restriction of autonomy of one person provides maximum benefit for others
- Example of this would be taxation-restrict income to provide services for everybody
- Assumption-We’d have to give up a negligible amount of autonomy to provide extreme benefit for others
Truth telling and medicine
-When might we want to protect the patient from the truth?
When a patient is extremely emotional
When might a patient want us to protect them from the truth?
Patient says not to tell them the results of a test before they have had a chance to talk to their family
Protective deception does not equal?
- preference for ignorance
- rather, protective deception involves considering whether the disclosure itself would cause suffering (either physical or emotional)
Protective deception does not equal preference for ignorance
-In severe enough cases?
In severe enough cases, such suffering may require the exercise of “therapeutic privilege”
Therapeutic privilege
An uncommon situation whereby a physician may be excused from revealing information to a patient when disclosing the information to the patient would pose a serious psychological threat, so serious a threat as to be medically contraindicated
What circumstances evoke “therapeutic privilege”?
?
Informed consent requires what 3 things?
Informed consent requires disclosure, voluntariness, and capacity
