Ethics

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LaurenFleming
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66315
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Ethics
Updated:
2011-02-14 16:59:21
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2nd Midterm
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  1. Independence from the will of others
    the ability of a person to be the author of her own life; the ability to design one's own life plan, to control the course of one’s life.
  2. Independence from irrational, unreasonable motivation =
    the capacity for conscious, deliberate, reasoned choice about one's actions.
  3. FREEDOM FROM COERCION:
    •Physical coercion

    •Coercive options

    •Coercive influence
  4. FREEDOM FROM PSYCHOLOGICAL IMPAIRMENT
    •Needs relevant comprehension of circumstances.

    •Needs reasonable motivational response.

    •Sources of motivational impairment: addiction, phobia, physical illness, mental distress.
  5. CHOICE MUST BE INFORMED
    •Autonomous choice requires that a person possess adequate information, that is comprehensible.
  6. Minimal standard
    • Patient is able to express a preference; show
    • evidence of a choice.
  7. Outcome standard
    : Patient is judged competent or not on the basis of the content of her choice; judged not fully competent if choice is unreasonable.
  8. Status Test
    • Assessment of competence is made according to
    • status indicators: age, diagnosis, pain, medication.
  9. Function/process standard
    • Assessment of competence is based on the
    • decision-making functioning of the patient, the process of reasoning that leads to the decision
  10. lINSTITUTIONAL INFORMED CONSENT:
    A LEGALLY EFFECTIVE AUTHORIZATION given by a patient for medical intervention.
  11. ETHICAL INFORMED CONSENT
    THE AUTONOMOUS AUTHORIZATION of a medical intervention by a potential patient.
  12. Conditions for autonomous authorization
    • *Competence
    • *Disclosure
    • *Understanding
    • *Volutntariness
    • *Consent
  13. Competence
    capacity for rational/reasonable response
  14. Disclosure
    communication of adequate information
  15. Understanding
    patient comprehension of information
  16. Voluntariness
    freedom from coercive influence
  17. Consent
    patient authorization
  18. Full Disclosure
    Patient is given complete medical information to satisfy adequate disclosure.
  19. Professional practice
    Adequate disclosure is determined by the customary practice of physicians
  20. Subjective standard
    Adequate disclosure is determined by the particular needs of each patient
  21. Argument in favor of limited disclosure due to impractical communication.
    • *The information physicians have is too
    • technical, complex and difficult for a lay person to understand.

    *There is no obligation to do something that can’t be done (‘ought’ implies ‘can’).

    Therefore,

    *Physicians are not obligated to communicate information that would not be understood by patients, or that would be misunderstood.

    Therefore,

    *Physicians are not obligated to disclose complete information to patients.
  22. Reasonable Person Standard
    *Adequate disclosure is defined as information that a hypothetical (objective) reasonable person making the decision would find significant.

    Canterbury v.Spence (1972)
  23. Therapeutic Privilege
    *A physician may intentionally and validly withhold information, based on a sound medical judgment that to divulge the information would be potentially harmful to a depressed, emotionally drained or unstable patient.
  24. Privacy
    Sphere of existence free from control by others
  25. Private domain
    *closed to public space

    *Free From social control

    *Conduct poses no risk of harm to others
  26. Public Domain
    *Open to public space

    *Subject to social control

    *Conduct poses risk of harm to others
  27. Current AMA Statement on privacy
    *privacy is linked to freedom from intrusion by the state or other persons

    *It is also understood to refer to a domain of personal decisions about important matters

    *privacy can also be viewed as a necessary condition for maintaining intimate relationship that entail
  28. Health care contexts: four forms of privacy
    Physical pricavy

    Informationprivay

    Decision

    Associantail
  29. Physical privacy
    *Concerns individuals and their personal spaces in an institutional setting

    *Protects patients sense of personal dignity (non medical value of patient well being)

    *mitigates patient’s sense of personal vulnerability (promotes patent autonomy).
  30. Informational Privacy
    *concerns specific personal data

    *Defined as- “the claim of individuals to determine for themselves when how and to what extent information about them is communicated to others”

    *Defined as “protection of and control over information about oneself”

    *Defined as the right of the client to limit access of other persons to his or her personal information
  31. Decisional privacy
    *Focuses on personal choices

    *Freedom from interference in making certain kinds of decisions ex “personal” decisions
  32. Associational privacy
    *Concerns close relationships

    *Freedom to choose personal associates

    *Freedom to reveal or conceal different aspects of the self in different roles and relationships
  33. physical privacy

    definition in short
    control over personal space
  34. informational Privacy

    Definition in short
    control over personal decisions
  35. Associational privacy


    Definition in short
    control over personal associations
  36. Confidentiality in medical practice
    *Confidentiality is respect for the informational privacy of patients, which supports patient autonomy


    *Confidentiality is an impicit promise on the arty of health care providers to keep private the personal information that is disclosed to them

    *Confidentiality is the obligation of those who receive or gain access to personal or private information about a patient not to disclose it to others without the patients authorization
  37. Value
    *Confidentiality allow patient ot exercise control over personal information which supports patient autonomy

    *Confidentiality is part of mutual trust in medical decision making a non-medical value of patient well being

    Confidentiality- motivates patient to reveal information needed for therapeutic reason which promotes medical beneficence
  38. Proposals for partner notification
    • *Provider referral: patient authorizes clinical care provider or local health department to notify the
    • patients partner

    *Patient referral: patient agrees to notify his/her partner

    *Contract referral: Patient must notify partner by a contract date, after which partner is notified by the local health department.
  39. Direct Lying
    saying something known, believed to be untrue for the purpose of deceiving the patient.
  40. Withholding Information
    deliberate silence, or evasion, regarding relevant facts.
  41. Equivocation
    changing the meaning of relevant medical terms.
  42. Ambiguity
    using terms that cold be understood in more than one sense
  43. Mixed Signals
    inconsistent communication
  44. Misleading Communication
    leading patient to misunderstand the facts; failing to correct obvious misunderstanding.
  45. Argument in defense of deception or limited disclosure that emphasize the value of the principle of medical beneficence.
    • 1. Health professionals have a duty not to harm or to prevent harm – two of the duties under the principle of medical beneficence.
    • 2. Certain disclosures will be harmful to the patient.

    Therefore,

    3. Truth-telling conflicts with duties of beneficence. And the greater the harm foreseen, the more serious the conflict between the duties of veracity and beneficence.

    (Concepts and Cases,142)
  46. Argument in favor of limited disclosure due to impractical communication.
    • The information physicians have is too technical, complex and difficult for a lay person to understand.
    • There is no obligation to do something that can’t be done (‘ought’ implies ‘can’).

    Therefore,

    Physicians are not obligated to communicate information that would not be understood by patients, or that would be misunderstood. (145-6)

    Therefore,

    Physicians are not obligated to disclose complete information to patients.
  47. Arguments against deception or limited disclosure that emphasize the value of the principle of medical beneficence
    Truthful disclosure makes it possible for patients to express their feelings which can be therapeutic. (143)


    Knowing what is wrong and what to expect can remove needless fears and anxiety… “it is what patients do not know but vaguely suspect that causes them corrosive worry.” (143)

    That deception will be helpful and not harmful cannot be predicted with accuracy. (143)

    Negative consequences of disclosure tend to be exaggerated…when informing is done in a sensitive and tactful fashion.” (143)
  48. Arguments against deception or limited disclosure emphasize the value of patient autonomy.
    “In order to be self-determining in matters of their own health care, patients require adequate and reliable information… lack of information or false information impedes the patient’s capacity to make rational choices.” (144)

    Knowing the truth affords patients the opportunity to plan …helping patients to maintain a sense of control over their lives. (144)

    That physician and patient relate to each other in a truthful manner is necessary for mutual trust. (145)
  49. Independence from unreasonable, irrational motivation =
    the capacity for conscious, deliberate, reasoned choice about one's actions.
  50. Independence from the will of others =
    the capacity of a person to be the author of her own life.
  51. Moral autonomy =
    the capacity to function as a moral agent, respecting the intrinsic worth of each person.
  52. ACT UTILITARIANISM
    Particular acts of truthful communication are morally right according to their expected consequences.
  53. RULE UTILITARIANISM
    General adherence to truth-telling as a social rule is morally right due to the utilitarian consequences of adherence to the rule.
  54. KANTIAN DEONTOLOGY
    Truth telling is a perfect moral obligation; dealing dishonestly treats others as a mere means without intrinsic worth.

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