Respect for Persons

Question 1

describe the UNESCO Universal Declaration on Bioethics and Human Rights

Answer 1

• specific articles describing human dignity and rights relative to health care; benefits and harms; non-discrimination; governments’ responsibility; protecting future generation, protecting environment, biosphere and biodiversity

Question 2

describe fidelity, autonomy, veracity and avoidance of killing

Answer 2

• fidelity: loyalty, keeping promises
  
  • implicit social contract of medicine
  • confidentiality
• autonomy: respect for persons to make their own decisions; non-interference in the life plans of others
• veracity: truth telling
  
  • almost without exception
• avoidance of killing
  
  • withholding treatment vs. withdrawing treatment
  • letting die vs. killing

Question 3

describe the outcome of Natonson v. Kline (1960)

Answer 3

• this case tipped in the direction of thorough disclosure

Question 4

describe therapeutic privilege vs. informed consent

Answer 4

• therapeutic privilege: withholding of information by the clinician during the consent process in the belief that disclosure of this information would lead to the harm or suffering of the patient

Question 5

describe the professional standard, the reasonable person standard and the subjective standard

Answer 5

• profesisonal standard: physicians disclose what colleagues similarly situated would disclose (implies that only professionals know)
• reasonable person standard: what would a reasonable lay person want to know?
• subjective standard: what a reasonable person would want to know, adjusted by what the clinician knows or should know about the unique interests of the individual patient

Question 6

can physicians withhold the truth?

Answer 6

in general, NO

• in cases in which disclosure poses such a serious psychological threat of detriment to the patient as to be “medically contraindicated,” then the physician may withhold the truth
  
  • medically contraindicated = value judgement

Question 7

when is respect for persons (fidelity, veracity, autonomy, avoidance of killing) contraindicated, and therefore legal and ethical

Answer 7

• when common treatments serve no purpose (e.g. cataract surgery for a congenitally blind patient)
• when a patient may react badly (colonoscopy for a currently psychotic patient)
• in MOST cases, providing food, fluid, CPR, antibiotics and routine nursing procedures should be provided
• in other cases, they may actually do no good for the patient–from the patient’s perspective
• contraindications usually involve those who cannot make their autonomous wishes known and/or terminal illness

Question 8

define uselessness, grave burden and proportionality

Answer 8

• uselessness: a treatment does not serve a useful purpose
• grave burden: even if the treatment serves a useful purpose, it represents a grave burden ot the patient or for another
• proportionality: when harms outweight benefits