Informed Consent andVulnerable PopulationsMEDICAL ETHICS-SUMMER 2012BOWLING GREEN STATE UNIV.
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.
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
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
The Conditions of Informed Consent Not all instances of consent count as informed consent Three Conditions-Competence-Understanding-Freely Given or Withheld
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.
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.
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.
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.
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.
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.