Ethics Exam #1 - Autonomy

Paternalism manifests as recommendations or decisions made:

1. on behalf of patients that reflect the interests of the clinician/stakeholder
2. without the patient's full consent or knowledge

True or False - paternalism implies good intentions on the part of the clinician/stakeholder, but undermines the patient's autonomy claiming that the clinician/stakeholder knows what is best for the patient

true

What are the three elements of informed consent?

1. threshold
2. information
3. consent

With informed consent, component patients _______

1. have the right to refuse unwanted treatments
2. may not be subjected to interventions without their consent
3. have the right to make choices that conflict with wishes of clinicians and family members

What are the threshold elements of informed consent?

competence and voluntaries

What is competence in regard to informed consent?

to understand and decide

What are voluntaries?

the choice in deciding

What are the information elements of informed consent?

1. disclosure
2. recommendation
3. understanding

What is disclosure?

a full explanation of risks/benefits

What is recommendation?

a proposed plan

What must understanding be?

demonstrable

What are the consent elements?

1. decision
2. authorization

What is a decision in regards to informed consent?

in favor of some plan

What is authorization?

approves the chosen planq

What is the informed consent process?

1. interactive - dialogue between the patient and provider
2. alternatives are presented
3. consequences/risks/discomforts explained
4. opportunities for questions provided
5. patient demonstrates understanding of purpose, procedures, alternatives, burdens and benefits, and consequences of not accepting that treatment
6. decisions are made voluntarily by patient (not coerced)

What is the ideal way for health related decisions to be made?

through informed consent

What is an advanced directive?

a decision about health care wishes and preferences made while in competent state in "advance of" debilitated condition

Are advanced directives formal or informal?

both - may be formal (write, witnessed, or notarized) or informal (discussions with loved ones or health providers)

What may be included in an advanced directive?

1. identification of a surrogate decision maker
2. statements about the kind of treatments one wishes to have performed in various health states

What are the different types of advanced directives?

1. living will
2. durable power of attorney for health care
3. combined health care directive and durable power of attorney for health care

What is a living will?

directives to healthcare providers, surrogates, and family members regarding wishes for medical treatments when individuals are no longer able to make the decisions for themselves

What is a durable power of attorney for health care?

an individual appoints an agent (aka surrogate or proxy) to make health care decisions when individuals are no longer able to make the decisions for themselves

What is substituted judgement?

1. a type of surrogate decision making based on what a patient would have wanted were he/she able to decide for themself
2. requires intimate knowledge of the individual's wishes, values, preferences, and lifestyle

What is the best interest standard?

1. a type of surrogate decision making based on what a "reasonable person" would want, given the balance of risks and benefits
2. used when there is insufficient information for a substituted judgment to be made

What is competence?

the LEGAL ability of a person to give valid informed consent

What is capacity?

the CLINICAL ability of a person to participate in decision making (no standard definition)

Which is more challenging to determine - competence or capacity?

capacity

Who is responsible for determining competence?

a judge