WEEK 25 part 2 Flashcards
List 4 moral principles applied to deal with moral dilemmas
- Respect for Autonomy
- Non-Maleficence
- Beneficence
- Justice
Principles are common in all kind of theories. Based on their common morality: list 4
- Pluralistic
- Universal accepted
- Common sense moral judgment
- ordinary shared moral beliefs.
Describe the balancing/weighing of principles
o “The process of finding reasons to support beliefs about which
moral norms should prevail.”
o Compare the relative weights and strengths of the principles
o Based on good reasons, not intuition
o Useful for reaching judgments for particular cases
Respect for autonomy define
Patients’ “rights to hold views, to make choices and to take
actions based on their values and beliefs.”
Obligations arising out of this principle of respect for autonomy.
list them
- Informed consent
- Confidentiality
- Truth telling
- Effective communication
one word.
Both an ethical and legal requirement
informed consent
list and explain elements of informed consent
PRECONDITIONS
o Competence (to understand and decide)
o Voluntariness (in deciding)
INFORMATION ELEMENTS
o Disclosure (of material information)
o Recommendation (of a plan)
o Understanding (of 3 & 4)
CONSENT ELEMENTS
o Decision (for/against a plan)
o Authorisation (of the chosen plan)
o Time-consuming process
o Capacity/competence assessment may be required
o Competent patient can:
communicate a choice
understand information provided
appreciate the consequences
reason about the options
Explain confidentiality
Maintaining a patient’s confidentiality is a cornerstone of the doctor-patient relationship
List factors where confidentiality can be breached.
National Health Act no 61 of 2003 - can be breached:
- Patient’s written consent
- Court order or any law requires
- Non-disclosure represents serious threat to public health
Explain TRUTH TELLING
HPCSA General Ethical Guidelines: Truthfulness a core value for good practice & the basis of trust
o Must not conceal the truth from a patient (unless they explicitly do not wish to be told the diagnosis)
o Disclosure of medical error & importance of good documentation of clinical notes
Explain effective communication
Patient centered care and good communication skills ethical requirement for maintaining the doctor-patient relationship
o Complexities of South African multilingual & multicultural context
o Role of interpreters & ethical challenges with confidentiality
what is meant by non-maleficence
Requires that we “first do no harm”
Prima facie (not absolute
Rules arising from non-maleficence
Do not kill
Do not cause pain or suffering
Do not incapacitate (prevent from functioning in the normal way)
Non-maleficence does not require us to act beneficently.
True or False
True
Traditionally ______ unacceptable in medicine
Killing
one word.
Casual action that results in death(intentional and wrong)
Traditionally killing
what is meant by Rule of double effect
intention vs foreseeable unintended negative consequences
What is meant by letting die
Avoiding intervention so that death occurs due to underlying disease/ organ failure/ injury (less wrong/acceptable)
Accidental killing or self-defense
are examples of?
Problematic! Vague and morally confusing
Non-maleficence also requires us to minimize ____ of harm
Risk
Patients must be informed of material risk. Give the Material risk.
-reasonable person would attach significance if warned of it
-Doctor should have reasonably aware that patient would attach significance to if warned of risk.
Risk may occur without harmful intent - casual agents may still be _____ or ______ responsible
Legally or morally
What is meant by standard of Due Care
Taking appropriate care to avoid causing harm, as a reasonable and prudent person would.
Negligence is the absence of?
Due Care
Negligence can be intentional and inadvertent. To show that you understand this terms. Explain them using examples.
- Intentional- eg failing to change a dressing as scheduled
- Inadvertent- eg forgetting that patient doesn’t want to know gender of a baby.
Negligence shown if:
1, Professional has duty of care to affected party
2. Duty breached
3. Harm experienced by affected party
4. Harm caused by the breach of duty
what sis meant about Malpractice
if the negligence fail to follow professional standards of care
What is meant by beneficence
Requires that we protect and defend the rights of patients, help patients, (act in their best interests).
Beneficence prevent or reduces harm.
True or false
True
List the implications of beneficence
- Clinical competence
- Balancing risks, benefits and costs
- Paternalism
Describe paternalism
Intentional overriding of person’s known preferences , in order to benefits or avoid harm to the person.
Describe active paternalism.
Doctor overrides patient’s right to decline intervention.
-Hard: despite informed, voluntary and autonomous decision e.g refusal to respect advance directive.
-Soft: nom-autonomous decisions/ non-voluntary conduct e.g severe depression preventing rational decision-making.
What is Passive Paternalism
Doctor refuses an intervention in the patient’s best interests. Easier to justify than active paternalism – doctor not obliged if patient’s request goes against acceptable standard treatment. Medical futility – if an intervention truly will not produce clinical benefit – cancels obligation to perform procedure. “Clinically non-beneficial interventions” preferred term.
Fair treatment
Justice
List obligations in 3 areas:
- Respect morally acceptable laws – Legal justice
- Respect patients’ rights – Rights-based justice
- Ensure fair distribution of limited resources –
Distributive justice.
Legal and Rights-based justice: working knowledge of
relevant laws. List those act
o National Health Act No. 61 of 2003
o The Children’s Act No. 38 of 2005
o Mental Health Act No. 17 of 2002
o Bill of Rights, South African Constitution
o Patients’ Rights Charter
What is meant by distributive justice
“Fair, equitable and appropriate distribution of benefits and burdens
determined by norms that structure the terms of social co-operation.”
list theories of justice
o Utilitarian (maximise utility)
o Libertarian (individual rights)
o Communitarian (communal good)
o Egalitarian (fair equal opportunity)
o Capabilities theories (quality of life depends on what able to achieve – 10 core
capabilities)
o Wellbeing theories (justice requires sufficient well-being in health, personal
security, reasoning, respect, attachment and determination)
