PHIL380 Test 5 Study Guide (FINAL EXAM)

Informed consent

An autonomous authorization of a medical intervention or involvement in research by an individual person.

Effective consent

Obtaining consent by simply following procedures

Autonomous authorization

Involves a contractual agreement between the patient and physician concerning a specific treatment plan.

Competence

The ability to perform a task or make a decision. Distinguishes persons who can and cannot give informed consent.

Paternalism

The infringing of a person’s autonomous wishes or desires for beneficent or non-maleficent reasons. Can involve rational persuasion, coercion or force, or a form of manipulation such as pretence, lying, or nondisclosure.

Anti-paternalism

Paternalism is never justifiable because it violates individual rights, unduly restricts free choice, and is too easily abused and institutionalized.

Weak paternalism

The right to prevent self-chosen conduct only when it is substantially non-voluntary or non-autonomous. The obligation to prevent a patient’s self-chosen conduct only when it is substantially nonvoluntary or nonautonomous and the patient might harm herself or others.

Autonomy condition

The patient is, under the circumstances irretrievably ignorant of relevant information, or her capacity for rational reflection is significantly impaired.

Harm condition

The patient is likely to be significantly harmed unless a paternalistic intervention takes place.

Ratification condition

It is reasonable to assume that the patient will, at a later time, with greater knowledge or the recovery of her capacity for rational reflection, ratify the decision to intervene by consenting to it.

Strong paternalism

It is sometimes proper to infringe on a person’s autonomy in order to benefit the person even if he/she is substantially autonomous.

Coercion

The use of legal, physical, and/or psychological force or restraint on a person for the purpose of controlling actions and choices. Achieves unwilling compliance for right reasons. Results justify using undesirable means. Not preferable, but sometimes justifiable.

Manipulation

A means of altering another's beliefs or behavior by subverting or by-passing his/her rational capacities usually by appealing to emotions or other appetites. Two types: non-deceptive and deceptive. Achieves willing compliance for wrong reason. Results more important than means. Not preferable nor usually justifiable.

Lying

Verbalizing to person or group what one believes to be a falsehood with the intention of deceiving that person or group of persons. Intentionally verbalizing what one believes to be a falsehood to a person or group of persons who have the right to the truth.

Pretense

The intentional act of leading a person to adopt or maintain a false belief. Broader than lying because it takes into account non-verbal communication and leading people on while not specifically lying.

Therapeutic privilege

A physician may intentionally and justifiably withhold information, based on “sound medical judgement” that to divulge the info would be potentially harmful to patient.

Benevolent deception

Deception is justifiable when it fulfills obligations of beneficence and non-maleficence.

Placebo

A substance ot treatment that is medically inert for the specific condition being treated, but is given under the falsehood of treatment to the patient.

Confidentiality

Occurs when one person discloses information to another, whether through words or physical examination, and the person to whom the information was disclosed implicitly or explicitly agrees not to disclose that information to others without the original person's permission.

Probability of harm

Part of harm assessment. The likelihood that a specific hazard will result in an adverse event.

Magnitude of harm

Part of harm assessment. The intensity, severity, or extent of the adverse consequences resulting from a risk event, such as physical injury, psychological distress, financial loss, or social damage.

Whistle Blowing

The disclosure of illegal, immoral, incompetent, or negligent practices by a colleague or superior with the purpose of halting such practices by a colleague or superior with the purpose of halting such practices for the welfare and safety of patients.

3 Functions of Informed Consent

To preserve respect for autonomy and autonomous choices by patients (primary).

To protect patients from harms

To encourage medical professionals to act responsibly

5 major conditions for autonomous authorization

-Has the capacity to make an informed decision

-Has a substantial understanding of the procedure

-Is in substantial absence of control by others

-Intentionally chooses the procedure

-Authorizes a professional to perform the procedure

3 standards for competency

-Outcome standard: Patient is judged competent on basis of outcome of his/her decision

-Category standard: Patient is judged competent on basis of his/her category or status

-Functional standard: Patient judged as competent if they are able to function as a decision maker in a given context

3 aspects for determining competency

-Does patient understand relevant information to make a decision

-Is patient willing and able to communicate with caregivers about the decision he/she is making?

-Is patient able to reason about decision as well as other relevant alternatives against a background of reasonably stable personal goals and values

2 standards for decision making for incompetent patients

-The Best Interest Standard: The decision is made by a proxy in light of what is deemed in the best interests of the patient according to an accepted general standard.

-The Substituted Judgement Standard: The decision is made by a proxy who attempts to be a substitute for the patient himself in light of the patient's specific wishes and desires.

3 standards concerning disclosure

-The Professional Practice Standard: Adequate disclosure is determined by customary rules or traditional practices of the professional community.

-The Reasonable Person Standard: Adequate disclosure is measured by significance that a “hypothetically” average reasonable person would attach to a risk in deciding whether to submit to a procedure

-The Subjective Person Standard: Adequate disclosure is determined by what a particular patient in a particular situation or context would consider significant to know in order to attach a risk factor in deciding to submit to a procedure

Refusal of Treatment

The right to an informed refusal of treatment is a corollary of informed consent. Patients have moral obligation to inform physicians of their reasons to refuse treatment. Specific reasons a patient states for refusing treatment need not be in agreement with values of physician or of society as a whole. Is there a limit to refusal treatment?

Guidelines for Refusal of treatment

-Patient has right to refuse treatment when elements of informed consent have been met

-Patient has duty to articulate as clearly as possible his/her reasons for refusal of treatment

-Right to refuse may be limited when intention of refusal is to cause significant harm to oneself

-All refusals of treatment should be carefully witnessed and documented

Weak paternalism guidelines

-The Autonomy Condition

-The Harm Condition

-The Ratification Condition

Strong paternalism guidelines

-Patient at risk of injury or illness

-Risks to patient are not substantial

-Projected benefits outweigh any risks

-No feasible alternative exists

-Infringement of autonomy is minimal

-Action involves least infringement necessary in circumstances

Types of Deception

-Intentional Non-Disclosure - The intentional withholding of information which a patient has a prima facie right to know. The easiest form of deception to justify because obligation to disclose is dependent on special relationships.

-The Therapeutic Privilege - A physician may intentionally and justifiably withhold information, based on “sound medical judgement” that to divulge the info would be potentially harmful to patient

-Pretense - The intentional act of leading a person to adopt or maintain a false belief

3 Arguments in Favor of Justified Deception

-Benevolent Deception - Deception is justifiable when it fulfills obligations of beneficence and non-maleficence

-Physicians cannot know the “whole truth” about diagnosis and prognosis or if they could know it they would not be able to communicate it or that the patient could not comprehend the “whole truth” if they heard it.

-Some patients do not want to know the truth about their condition and they may indicate this through various signals, not just words

5 Arguments Against Deception

-It is not certain that being truthful with a patient will in fact be injurious to him. Even in cases where there is a strong probability of causing harm, this result has not always occurred.

-It is erroneously assumed that deception can always or generally be effectively carried out.

-If the deception is discovered or suspected, the effect upon the patient is much worse than a frank and full truthful statement would have produced. 

-The momentary good which occasionally results to individual cases frond exception, cannot be compared with the greater evil of adopting a general character that almost always proceeds from a breach of the truth. If deception is successful, it will reinforce deception. 

-If deception is adopted as a common rile, i.e. that the truth may be sacrificed in urgent cases, the very purpose of the deception will be defeated.

Problems with confidentiality

-The rise of the health care team.

-The need for third party involvement

-More sensitive and personal information is being included in a patient's file.

Guidelines to reduce Confidentiality Problem

-In the private doctor’s office, the traditional model can and should, for the most part, still be upheld

-In hospitals or large scale group practices, steps should be taken to provide access only to those who have a “need to know”.

-Patients need to be informed about confidentiality and their rights concerning it.

-Every effort should be made to avoid wanton, often inadvertent, but avoidable exchanges of confidential information that occur frequently in hospital rooms, elevators, cafeterias, etc.

Conditions for Infringement

-Legal Obligations: Sometimes one is required by law to report certain information to proper authorities.

-Moral Obligations: One may be morally obligated to infringe a persons confidentiality if keeping confidentiality might bring significant harm to the patient himself.

-One is morally obligated to infringe confidentiality if there is a serious danger to a third party or the general public at large, a person or group of persons is at serious risk of harm, the disclosure would prevent the harm with a good degree of probability, the breach is necessary to prevent the harm (no other way, not just "another way"), the breach of confidentiality is limited to the amount and kind of information that is necessary only to protect the person or group.

3 situations where blowing the whistle is appropriate

1) Criminal activity/fraud, 2) Health and safety dangers, and 3) Significant environmental breaches