WEEK 4: THE PATIENT'S BEST INTEREST AND RESPECT FOR AUTONOMY Flashcards
What is humanism?
The ability to provide care based on the physician’s (or nurse’s) ability to maintain the perspective that the professional and patient are equal members of the human family.
What is professionalism?
Professionalism in medicine can be defined as a set of values, behaviors, and relationships that are essential to the practice of medicine.
State the fundamental principles of professionalism.
*Professionalism is the basis of medicine’s contract with society
*It is Primacy of patient welfare
*Patient autonomy
*Social justice
Recall Key Declarations that have guided Clinical Practice and Research.
*Hippocratic Oath
anoathofethicshistorically taken bydoctors
*The Nuremberg Code
a set of ethical research principles, developed in the wake of Nazi atrocities—specifically the inhumane and often fatal experimentation on human subjects without consent—during World War Two.
*The Helsinki Declaration
a set of ethical principles regardinghuman experimentationdeveloped originally in 1964 for the medical community by theWorld Medical Association(WMA).
*The Belmont Report
summarizes ethical principles and guidelines for research involving human subjects. Three core principles are identified: respect for persons, beneficence, and justice.
Describe the Fundamental Ethical Principles in Patient Care.
*Nonmaleficence or primum non nocere
“First do no harm”
*Beneficence
To “do good for the patient”. Your actions must be motivated by what is in the patient’s best interest
*Confidentiality
Privacy is fundamental to our professional relationships with our patients.
*Autonomy
Patients have the right to determine what is in their best interest.
Foundation of the principle of CONSENT in clinical practice and research
*Justice
Access to health and fair treatment is basic expectation of every individual
What are the major medico-legal issues in clinical practice?
1.Adverse medical incidents
Injurious/unintended/harmful effects of medical practice on patients. Include:
*Natural complications e.g. wound infection
*Failure to manage illness according to best practice e.g. improper hand washing technique
*Unexpected outcome of medical treatment
*Errors in prescribing, administration and monitoring of medicine/drugs
Negligence
*Can only be established in a court of law
Implies carelessness, inattention, abandonment, disregard, slackness, casualness, etc.
Medical errors not equivalent to negligence
Perfection is not the standard
To “Err is human!”
Courts more concerned with dishonesty and attempts to conceal errors.
*Communication/Disclosure
-Encompasses the transmission of information, thought, and feeling, such that it is satisfactorily received and understood
-Improved patient-doctor communication key to patient satisfaction and health outcomes
-Proper documentation is an integral part of communication
-Litigation often a consequence of unsatisfactory patient-doctor communication
*Consent
*Confidentiality
*Professionalism
*Other issues (rare!)
*Unfavorable outcome of patient’s condition
*Family/patient in denial
*Financial reasons
*Malice
State the 3 elements of consent.
1.Knowledge
Full knowledge of nature and extent of risks.
- Appreciation/Capacity to Consent
Comprehend nature and extent of risks.
3.Consent
The patient must subjectively consent or agree to the risk associated with the treatment, operation or procedure.
Based on the principle of autonomy.
What constitutes incapacity to consent?
*Mentally disordered person
*Person too sick to comprehend information required to give an informed consent
*Incapacity due to age (minors)
Persons under 21 years of age
Who may give consent for the incapacitated?
Consent for the treatment, operation or procedure may be given by the following, by order of priority:
*Spouse of that person
*Parent of that person
*Legal guardian of that person
*An adult child of that person
*A care-giver
What if the parent refuses to give consent for a minor?
Although a parent has the right of guardianship over the minor, the court, as upper guardian of all minors, has the right to intervene in the best interests of the child.
What if the parent refuses to give consent for a minor?
Although a parent has the right of guardianship over the minor, the court, as upper guardian of all minors, has the right to intervene in the best interests of the child.
If parent or legal guardian declines to give consent for a required procedure, the medical practitioner shall use his/her professional judgment and carry out the medical procedure or administer the treatment.
*Procedure must be carried out by a registered medical practitioner in an approved facility.
*At least one other medical practitioner has given his supporting opinion in good faith in writing (provided this shall not compromise treatment outcome of the child).
*Legal proceedings (civil or criminal) shall not lie against the medical practitioner with regard to performing the procedure under this section where that medical practitioner exercised reasonable care and diligence in carrying out his duties.
What is Confidentiality in Clinical Practice?
confidentiality is:
*The duty of a health care professional not to disclose to anyone else any information about his or her interaction with the patient, where the information was obtained by the professional in the context of the professional relationship.
Confidentiality is a rule of medical ethics, a human right as well as a statutory duty.
Why is the right to confidentiality protected?
Confidentiality is a human right protected by the Constitution of Botswana (re: section 3);
The right to confidentiality is protected under the right to privacy. The right to privacy protects the dignity of persons including their honour and reputation;
As a general rule, a practitioner shall not divulge, verbally or in writing, without the express consent of the patient, (or the patient’s parent or guardian, or, its next-of kin) any information regarding the ailments of the patient. (Re: The Botswana Health Professions Regulations, reg. 21).
*Patients are autonomous. They are self-determining, self-governing beings. They have the right to make choices.
*Individuals have the right to keep confidential any information which is personal, which if disclosed would or could be harmful to them.
Are there any limitations to the right to privacy?If so, why? And when would such a duty to confidentiality not apply?
*BHP Act and its regulations
*Shared confidentiality
The duty of confidentiality does not apply where –
*The practitioner is summoned to appear before a court of law and the court orders the disclosure of the information; or
*The information is required by another practitioner or by any legal representative who requires or is entitled to the information in the course of his or her professional duties.
*A person taking care of, living with or otherwise coming into regular close contact with the patient about such patient’s medical condition, where the patient is suffering from a communicable disease or has an infection which may be passed to such person if appropriate precautions are not taken.
What are the legal consequences of breach of confidentiality by health care professional?
*Caution or reprimand or both;
*Suspension for a specified period from practicing or performing acts specially pertaining to his or her profession; or
*Removal of his or her name from the register;
*Exposes the practitioner or employer or both to being sued for damages by the patient;
*May also constitute a breach of the practitioner’s contract of employment, thereby warranting disciplinary or administrative action by the employer.
