In this PPT you will learn what is autonomy whether is important or not and so on. Every one of us should mentally capably for thinking and decision making and that's why we are humans, but there are people who are not mentally complete and their which or needs depend on others and it's really sad. consent and confidentiality are important and are the reason why you are a good doctors. The confidentiality brings you a new customers who trust you because you keep their information secrets and this type of confidentiality is part of Hippocrates Oaths.

1. 2. Autonomy,
Competence,
Minor, Consent, &
Confidentiality:
Dr. Ayub Abdulkadir (Dr. Alto)
Medical Ethics

2. Autonomy:
• From Greek autos (self), nomos (rule of law).
• Self rule with no control, self determination, self
governing.
• Autonomy grants every competent adult patient
the absolute right to do what he wishes with his
own health care.
• Although beneficence-or doing what is good for
people is a high aim and ethical principle,
autonomy is considered more important and
takes precedence.

3. • Justice Cardozo wrote, "Every human being of adult
years and a sound mind has the right to determine
what shall be done with his own body and a
surgeon who performs an operation without his
patient's consent commits an assault, for which he
is liable in damages, except in cases of emergency
where the patient is unconscious and where it is
necessary to operate before consent can be
obtained."

4. • Types of autonomy:
1. Behavior.
2. Emotional.
3. Cognitive.
• Each patient should decide the answers to these
questions for himself this is autonomy:
I have the right to do what I choose with my own
body as long as I understand the consequences of
my decisions.

5. • A doctor can violate this autonomy if you are doing
something potentially dangerous, such as building a
bomb, because this activity can harm others.
• A doctor can violate your confidentiality only if you
have HIV, tuberculosis, or a sexually transmitted
disease because these conditions can harm an
innocent third party.

6. Competence:
• The ability to do something successfully or efficiently.
• Or sate of having sufficient knowledge, judgment, skill,
or strength.
• Competence is a legal term.
• The physician makes a determination of the capacity of
a patient to comprehend her medical problems based
on whether there is an organic delirium due to a
medical condition such as a sodium problem, hypoxia,
drug intoxication, meningitis, encephalitis, or a
psychiatric disorder.

7. Minor:
• Is a person under the age of 18.
• With some exceptions, minors are
generally not considered competent to make etheir
own decisions.
• Only a parent or a legal guardian can give consent
for a minor.
• Neighbors, aunts, uncles, and grandparents cannot
give consent for treatment of a minor.
• This rule does not cover life-threatening or serious
emergencies.

8. • Consent is always implied for emergency
treatment.
• A physician should not withhold blood or surgery in
a life-threatening accident just because the parent
is not present.
• For example, a 10-year-old boy accidentally runs
through a glass window at school and lacerates the
radial artery.
• His teacher brings him to the emergency
department.
• The boy is bleeding and needs both a blood
transfusion and surgery to correct the defect. What
should you do?

9. • Emergency treatment of a minor does not need
express written consent.
• Parental consent is implied.
• Saying that you had to ask another person such as
the teacher, the principal, the school nurse, the
babysitter, or the grandparents for consent before
giving emergency treatment would be the wrong
answer.
• Seeking a court order is also a wrong choice in an
emergency because it delays the treatment and
because in an emergency it is implied that the
parents would consent if they were there.

10. • Partial Emancipation:
• Emancipation: process of being set free from legal,
social, or political restriction.
• Although only a parent or guardian can give
consent for procedures and therapies for a minor
there are some exceptions to this rule in the areas
of prenatal care, contraception, sexually
transmitted disease (STDs),and substance abuse.
• For example, a l6-year-old girl comes to see you in
clinic to discuss contraception. She is generally
healthy but is not accompanied by a parent. What
should you do?

11. • Abortion in a Minor
• The rules on parental notification for abortion are
less clear because there is no national standard.
Some states require parental notification and some
don’t.
• For example, a 16-year-old girl comes to see you in
her first trimester of pregnancy. She is seeking an
abortion. What should you do?
• The answer is to encourage the child to notify the
parents herself, which would be best.

12. • Emancipated Minor:
• A small number of minors, particularly at older ages
such as l6 or 17, may be considered 'emancipated'
or freed of the need to have parental consent for
any medical care.
• The criteria are that the minor is married, self-
supporting and living independently, in the military,
or the parent of a child that they themselves
support.

13. • An emancipated minor is free to make health care
decisions in all areas, not only, just STDs, prenatal
care, contraception, or substance abuse.
• Serious medical conditions or procedures such as
organ donation, surgery, or abortion may require a
specific court order to allow the legal standing of
emancipation to be fully valid.

14. Consent:
• Is the voluntary agreement that a patient gives to
allow a medically trained person the permission to
touch, examine, and perform a treatment.
• The two types of consent are:
1. Informed consent.
2. Implied consent.

15. 1. Informed (or expressed)
consent:
• Means that the patient agrees to the proposed
course of treatment after having been told about
the possible consequences of having or not having
certain procedures and treatments.
• The patient’s signature on the consent form
indicates that the patient understands the limits or
risks involved in the pending treatment or surgery
as explained by the physician.
• The goal of informed consent is to protect patients’
rights to decide for themselves about their own
healthcare treatment.

17. • All OPTIONS MUST BE DESCRIBED:
• you must fully inform the patient of the risks and
benefits of each procedure prior to undergoing the
procedure.
• The explanation must be in language that the
patient understands and include full information
regarding alternative treatments.
• The patient cannot make an informed choice for
one treatment if she does not know of the
existence of other.
• Keep in mind that: BTNEFICENCE IS NOT
SUFFICIENT TO ETIMINATE THE NEED FOR
CONSET.

18. • For example, you inform a patient about the risks
and benefits of bone marrow transplantation for
chronic myelogenous leukemia. You fully inform
the patient about the risk of transplantation,
including the possibility of developing graft versus
host disease. After the transplantation the patient
develops graft versus host disease, which is hard to
control. The patient learns that there is an
alternative treatment called imitanib (gleevec),
which does not include the risk of graft versus host
disease, but which will not cure the leukemia. The
patient files suit against you. What will be the most
likely outcome of the suit?

19. • The Doctrine of Informed Consent requires the
physician to explain the following in understandable
language:
1. The patient’s diagnosis, if known
2. The nature and purpose of the proposed treatment
or procedure
3. The advantages and risks of treatment
4. The alternative treatments available to the patient,
regardless of their cost and whether they will likely
be covered by the patient’s insurance
5. Potential outcomes of the treatment
6. What might occur, both risks and benefits, if
treatment is refused.

20. • Procedures in which an informed consent form
should be signed include the following:
1. Minor invasive surgery.
2. Organ donation.
3. Radiological therapy, such as radiation treatment
for cancer.
4. Electroconvulsive therapy.
5. Experimental procedures.
6. Chemotherapy.
7. Any procedure with more than a slight risk of
harm to the patient.

21. 2. Implied Consent:
• Patient indicates by behavior that he or she accepts
procedure (i.e., offers arm to have blood sample
drawn).
• Consent is assumed in medical emergencies when
patient cannot respond to give consent.
• Implied consent can be difficult to interpret because it
is based on another person’s interpretation.
• When a patient is seen for a routine examination, there
is implied consent that the physician will touch the
person during the examination. Therefore, the touching
required for the physical examination would not be
considered the crime of battery.

22. • Exceptions to Consent:
a) A physician need not inform a patient about risks that are
commonly known. For example, physicians need not tell
patients that they could choke swallowing a pill.
b) A physician who believes the disclosure of risks may be
detrimental to the patient is not required to disclose
them. For instance, if a patient has a severe heart
condition that may be worsened by an announcement of
risks, the physician should not disclose the risks.
c) If the patient asks the physician not to disclose the risks,
then the physician is not required to do so.
d) A physician is not required to restore patients to their
original state of health, and in some cases, may be unable
to do so.
e) A physician may not be able to elicit a cure for every
patient.
f) A physician cannot guarantee the successful results of
every treatment.

23. CONSENT IS IMPTIED IN AN
EMERGENCY:
• For example, a 50-yeaR old construction worker
arrives at the emergency room by ambulance after
an accident lacerating his arm. He has lost so much
blood he is unconscious. There is no family member
available to sign consent. What should you do?

24. Assignment:
Does telephone consent is
valid? Explain shortly?
8 marks
Dead line is 25.10.2022

25. Confidentiality:
• The patient information must be kept secret or
private.
• Physicians have a strong professional mandate to
maintain the confidentiality of patients.
• Confidentiality also includes keeping a patient's
medical information private even from his friends
and family unless the patient expressly
says it is okay to release the information.

26. • For example, a 42-year-old man is hospitalized with
chest pain. The patient is awake and alert.
• His wife comes to you demanding information
about the patient, saying that she is his wife. She
shows her identification card verifying this. What
should you tell her?
• Answer: You cannot release medical information to
anyone about a patient unless the patient gives
you permission to do so.

27. • RELEASE OF INFORMATION:
• Information transfer between physicians involved in
the care of patients is a common occurrence.
However, the information can only be transferred if
the patient has signed a consent or release form
requesting the transfer of information. It is the
patient who must sign the consent to release the
information, not the health care provider.
• This is how the system guarantees that the
patient's medically privileged information only
transfers to those people to whom the patient
wants it to go.