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PHI 204 - The Patient-Doctor Relationship

PHI 204 - The Patient-Doctor Relationship






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    PHI 204 - The Patient-Doctor Relationship PHI 204 - The Patient-Doctor Relationship Presentation Transcript

    • The Patient-Doctor Relationship (Biomedical Ethics) Charles Lohman
    • Informed Consent The 2 Components
      • INFORMED CONSENT – a practical application of the principle of respect for patient AUTONOMY
        • The 2 components:
          • 1.) DOCTOR’S DISCLOSURE
            • DOCTOR’S DISCLOSURE of medical information to the patient includes diagnosis, prognosis, available, and alternative treatments, and the risks, benefits, and consequences of having or refusing treatment.
          • 2.) COMPETENT PATIENT
            • The COMPETENT PATIENT can decide whether to accept or refuse treatment on the basis of the DOCTOR’S DISCLOSURE.
              • The COMPETENT PATIENT is one who understands the nature of their condition and the consequences of accepting or refusing an intervention for their condition.
    • Informed Consent Beneficence -v- Autonomy
      • If the patient is a COMPETENT PATIENT
        • A patient’s AUTONOMY outweighs a doctor’s duty of BENEFICENCE.
        • A patient’s AUTONOMY is consistent with the doctor’s duty of NON-MALEFICENCE.
      • If the patient is NOT a COMPETENT PATIENT
        • Some say use a SLIDING SCALE
          • They say the required level of COMPETENCE should be on a SLIDING SCALE from low to high risk.
            • A physician’s PATERNALISM can outweigh a patient’s AUTONOMY and an intervention can be JUSTIFIED.
        • Some say MINIMAL COMPETENCE
          • They say a patient with MINIMAL COMPETENCE is enough for a patient to accept or refuse treatment.
    • Informed Consent Designated Surrogate
      • For a patient that is NOT COMPETENT, a designated SURROGATE can decide on the patient’s behalf.
        • A SURROGATE can act in 2 ways.
          • 1.) The SURROGATE can make decisions about treatment as the patient would make if he/she were COMPETENT, thus exercising substituted judgment.
          • 2.) The SURROGATE can decide on a course of action that he/she believes is in the PATIENT’S best INTEREST.
    • Informed Consent Advance Directive
      • A patient’s INTERESTS can be expressed in an ADVANCE DIRECTIVE
        • For example, a living will allows an AUTONOMOUS patient to extend AUTONOMY to a time when he/she is no longer COMPETENT to make decisions.
      • ADVANCE DIRECTIVE can serve 2 goals.
        • 1.) It can express what the PATIENT would want doctors to do or not do.
        • 2.) It can designate an individual to makes decisions for the PATIENT.
    • Informed Consent Parents -v- Child
      • IN GENERAL, parents can make decisions about their children’s TREATMENT because they are the best JUDGES of their children’s best INTERESTS.
        • A parental refusal of an intervention should be respected.
          • BUT the parents DECISIONAL AUTHORITY can be overridden if it causes direct and serious harm to the child.
        • MATURE MINOR can exercise personal AUTONOMY as long as they are not overly influenced or coerced by his/her parents.
    • Informed Consent Patient-Physician Relationship Models
      • INFORMATIVE model - The patient applies personal VALUES to determine which TREATMENTS to ACCEPT or REFUSE.
      • PATERNALISTIC model - The physician completely determines what is in the patient’s best INTEREST independent of the patient’s VALUES.
      • INTERPRETIVE model - The physician chooses a medical intervention that best fits the patient’s VALUES.
      • DELIBERATIVE model - The decision about treatment follows from SHARED deliberation between physician and patient.
    • Therapeutic Privilege
      • THERAPEUTIC PRIVILEGE - a doctor can WITHHOLD medical information when it is potentially HARMFUL to a patient.
      • Two main objections
        • 1.) Doctors can exaggerate or otherwise make mistakes in assessing the BENEFITS and HARMS of disclosure and nondisclosure.
        • 2.) WITHHOLDING medical information fails to respect the patient’s AUTONOMY and fails to fulfill the doctor’s DUTIES of HONESTY and FIDELITY.
    • Confidentiality
      • CONFIDENTIALITY - a doctor discloses medical information about a patient to the patient alone.
        • The duty to inform can override the duty to uphold CONFIDENTIALITY in specific instances.
      • Two arguments supporting physician’s obligation to uphold CONFIDENTIALITY with their patients.
        • 1.) Respect for the patient’s AUTONOMY and PRIVACY
        • 2.) Keeping TRUST between doctor and patient
    • Cross-Cultural Relations
      • The meanings Western doctors and non-Western patients attach to terms may be reflections of DIFFERENT belief systems.
        • This can be accommodated within a broad Western model of INFORMED CONSENT.
            • Explaining the reasons for treatment(s) in culturally different terms is an alternative way to adhere to the duties of NONMALEFICENCE and BENEFICENCE.
          • Example, Autonomy
            • In some cultures, it may be common for a competent adult to freely delegate DECISIONAL AUTHORITY to another adult. Although this differs from the Western liberal understanding of INDIVIDUAL AUTONOMY and INFORMED CONSENT, it can be interpreted as a different expression of AUTONOMY and CONSENT.