M1 reading objectives Flashcards
ancient v contemporary oath
suicide/ abortion, swearing to deities, sex with patients, surgery on patients, teaching others, new focuses on equality across race/ gender
fundamental shift in the oath
key fundamental of keeping the patient’s best interests in mind is still there, but new means of accomplishing this= race equality, more open to procedures, privacy, do not practice outside bounds of knowledge
3 core elements of medical professionalism
1- moral commitment to ethic of medical service= devotion to medicine (drives improvement- fiduciary role)
2-public profession of values (psychological motivation, accountable to public, policing other MDs)
3-negotiation on social values (how to pay/ what treatment; vaccines, education; PMS, homosexuality)
stages of activism
1- routine advocacy- advocating for patient values first= daily
2-internal dissent- internal to group/ institution
3-public dissent-organize community support, op-ed, follow rules, but make clear you do not approve
4-direct disobedience- break rules directly
5-indirect disobedience- call attn to wrong= change dress code
6-principled exit from practice
competence
competence to decide is relative to the decision; personality may be a factor, as well as divergent two party interests
judgement issues
competence judgements= gate keeper in health care
-may lead professionals to override patient decisions; physicians do have de facto power to override
autonomy
absence of constraints (liberty) and capacity for intentional action (agency) required for autonomous decisions
- kant= due to inherent worth of each person
- mill= society should let freedom as long as it doesn’t infringe upon freedom of others
informed consent
one must be 1-competent to act, 2-receive disclosure, 3- comprehend the disclosure, 4-act voluntarily, 5-consent to the intervention
disclosure
transfer of info from phys to patient
influence
1- coercion= threat of force; 2- persuasion= comes to believe through reasoning of prof.; 3- manipulation= combo of 1 and 2
substituted judgement standard
used only for once-competent patients and only if another can “don the mental mantle” and make a judgement they would’ve made =respects all previously made autonomous choices
best interests standard
surrogate determines highest net benefit= quality of life
-criterion= well being; can override previous documents in rare cases (present situation could be different that expectation)
=focus on value of life for the person LIVING it, not the value of their life to others (worth/ enhancement to others)
pure autonomy standard
eliminates dubious autonomy; applies to formerly autonomous, now-incompetent who expressed relevant, autonomous treatment preferences in the past= “precedent autonomy”- look at previous pattern of decisions and use to decide
-problem= surrogates could skew decisions considered
3 standards related in practice
objective is to protect autonomy in a clear and coherent framework
- runs from 1-autonomously executed advanced directives, to 2-substituted judgement, to best interests with 1>2>3
- if previous competent left no traces of preference or directive, then best interests std is used