PVB bits Flashcards
approaches to child decisions
child paternalistic approach
child liberationist approach
what are the types of best interests for children
basic interests - physical/emotional wellbeing
developmental interests - promote child development/emotional maturity/education/confidence/socialisation
autonomy interests - respecting and promoting autonomy
when do basic and developmental interests take precedence in children
if the autonomous decision will result in death or serious harm
should 18 be a cut off for legal protection from bad decisions?
- development continues after 18
- values and beliefs change as an adult
+ if we value autonomy, yes
+ practically there must be a legal cut off
+ there if more than just law to protect from bad decisions
+ autonomy should be respected especially as children start to be able to be exposed to risk factors for ill health at their own choice - drinking alcohol, smoking, extreme sports without adult supervision
how should decisions be made for children without autonomy (babies, infants etc)
best interests - basic and developmental
approaches to parental autonomy
parental rights
best interests
pros and cons of parental rights argument
+ parents share values/beliefs with children
- dont have a right to impose beliefs on others
- parents have duty to ensure child reaches autonomous adulthood
parental autonomy best interests argument
+ parents know child more than anyone else, family welfare is relevant to child
- parents may be too emotionally involved, lack of objective weighing up
- personal values/beliefs may mean they consider effective treatment as unacceptable
risks and benefits of tissue donation as a child
risks - physical harm to child donor, transplant fails for recipient and causes grief and guilt
benefits - altruisim, saving a life, if sibling dies without transplant, guilt and grief
professional guidance for children participation in research
minimal risk of harm
not possible to do in adults
condition specific to children
parental consent
age of consent for children
16+
court approval for major decisions with parental disagreement over 16
what are the requirements for Gillick competency
ask child if you can tell parents - if they say no, respect it
assess child maturity - understanding etc
likely to suffer harm without treatment given
what is utalitarianism
consequence based approach - whatever decision brings greatest happiness is right (benefit is measured by overall happiness from consequences)
pros and cons of utalitarianism decisions
+ democratixc, each persons happiness has value
+ intuitively 10 lives better than 1
- certain actions always wrong
- not all consequences can be forgiven
- may justify heinous acts for greater good
rights based approach to decisions
moral obligation placed on people to uphold rights of others
negative rights - may not harm us, may not steal from us may not kill us etc
positive rights - autonomy, education, healthcare (things that must be provided)
pros and cons of rights based approach decisions
+ protects all individuals, incl marginalised and lacking power
- no power shifting possible
what is the concept of justice
reciprocal relationship between individuals + society - all humans valued equally
if human life valued equally - justice means ensuring equal capability to flourish - access to healthcare
requires that societal structures value people equally
is justice equity?
no, instead removing barriers and engaging with priorities instead of helping those with barriers overcome them
how does listening and enagaging with those affected by conditions help (co-production)
informs understanding of health inequalities
identifies meaningful needs
informs sustainable and effective interventions
what is the concept of equity
recognising that people have different needs to achieve the same outcomes
what is the mental capacity act
decisions made on behalf of a person lacking mental capacity must be in individuals best interests
what is best interests
physical and emotional interests (values, aspirations, likes/dislikes)
autonomy interests
interaction of best interests and mental disability
previous best interests should be considered
health vs wellbeing
medical interests dont always = best interests
bad health decision may be in someones best interests/medical interest may not align with best interests (therefore their wellbeing)
importance of free will
being free to make ones own choices helps us flourish as humans
what do autonomous choices require
ability to understand information
ability to form values
ability to make decisions based on values and understanding
how does one enable autonomy to patients
provide adequate information clearly explain give time to consider options don't pressure patient non-judgmental approach provide reasonable choices
positive impacts of autonomy on care
helps drs give better advice enable better decision making improve mutual understanding improve trust improve adherence
how can doctors go against their moral instincts in treatment?
by talking to the patient and understand each others perspective
what is paternalism
overriding/undermining patients autonomy based on healthcare professionals view of patients best interests
what falls under paternalism
presenting one side of the argument
withholding information
coercion
lying
arguments for/against withholding information being lying
for - intention is the same then lying = withholding morally. wrong to assume patients dont want to know. esp if you know the patient would be influenced by the information
against - withholding restricts autonomy less. patients may actively collude in withholding. impossible to tell patients everything. less likely to cause mistrust
what offenses may be committed if a doctor acts without consent
criminal - assault and battery
civil - claim for damages
situations where consent is not required
emergency - obtaining consent may lead to damage to the patient
implied - llifting top after asking if they can be examined, not good for invasive treatment
waiver - decision given to someone else
best interests - unconscious, dementia etc
what is expressed consent
oral or written permission
what is consent
a competent person that understands the nature of the treatment based on information in broad terms without coercion who then gives permission
what is competency
understand information
retain information
use information to make a decision
communicate the decision
arguments for paternalism
patients may be depressed if given bad news
patients are laymen so may put undue weight to certain side effects
what is duty
certain actions are right or wrong in themselves irrespective of consequences
e.g to not kill, not torture etc
but how is it decided?
what are the conflicting duties of abortion
duty to respect autonomy
duty to not end life
what is virtue
a character trait a human being needs to flourish/live well
foetal rights
no legal rights til birth
being pregnant doesnt take your rights away - can engage in harmful behaviours, refuse medical treatment
paternal rights over foetuses/pregnant women
once born
none during pregnancy - no say in abortions, no legal right to be consulted/informed of one
legal grounds for abortion
pregnancy under 24wks or
necessary to prevent gradve/permanent injury to mother or
continued preg would be greater risk than termination or
substantial risk of serious physical/mental handicap
what is consequentialism
actions ethically right/wrong determined by overall consequences of the action
problems with consequentialism
certain actions always wrong
consequences aren’t always clear
could justify heinous actions for greater good
doesnt take rights into account
