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Informed consent and vulnerable populations

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This is a presentation for my Medical Ethics course at Bowling Green State University, Summer 2012

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Informed consent and vulnerable populations

  1. 1. Informed Consent andVulnerable PopulationsMEDICAL ETHICS-SUMMER 2012BOWLING GREEN STATE UNIV.
  2. 2. Lecture Goals Explain the connection between informed consent and patient autonomy Outline the basic requirements of informed consent Define the concept of a vulnerable population and explain why it’s more difficult to obtain informed consent from them.
  3. 3. Autonomy and Informed Consent Autonomy-the capacity to make choices about one’s own life, on the basis of one’s own values and concerns Protected by a right The requirement that physicians obtain informed consent ensures (or at least makes it more likely) that a patient’s choices are autonomous
  4. 4. Why Think Autonomy Matters? Mill-In most cases, individuals are the best judges of what is best for them. Coercion, even when done for the individual’s own good, is usually a greater harm . Kant-Capacity for autonomy is what makes our lives valuable. When we cease to have this capacity, we cease to count as persons in the morally relevant sense. Value Pluralism
  5. 5. The Conditions of Informed Consent Not all instances of consent count as informed consent Three Conditions-Competence-Understanding-Freely Given or Withheld
  6. 6. Competence In medical practice, patients are assumed to be competent. Decisions at odds with medical advice are not, in themselves, evidence of incompetence. Illness, injury, or medication may lead to a loss of competence.
  7. 7. Understanding Diagnosis, treatment protocol, risks, benefits, side effects, aftercare and long-term maintenance, alternatives Professional standards tend to emphasize disclosure, rather than understanding. (Full disclosure, Medical Community, and Reasonable person) Understanding is difficult to measure. Difficult to give a neutral presentation of information. This can (perhaps) be avoided by explaining the values which underlie a physician’s recommendation.
  8. 8. Freely Given or Withheld No such thing as implicit consent in the medical field. Absence of coercion or manipulation, whether intentional or not. Physicians and family members most likely culprits.
  9. 9. Vulnerable Populations A group of individuals whose capacity to give informed consent is impaired or eliminated, in virtue of their status as members of that group. Examples: Children, disabled, people with psychological disorders, terminally ill, prisoners, people who lack a high school education.
  10. 10. Two Common Mistakes Race Elderly These are frequently cited as examples of vulnerable populations, but they are not. Nothing about being a member of a particular race, or being of a certain age, is in itself an impairment on informed consent.
  11. 11. Two Famous Cases WillowbrookParents of severely disabled children could only be admitted to the “hepatitis” wing of the school. Tuskegee Syphillis StudyA multi-decade study of syphillis, participants were all black men living in the rural South.

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