M1 reading objectives

Question 1

ancient v contemporary oath

Answer 1

suicide/ abortion, swearing to deities, sex with patients, surgery on patients, teaching others, new focuses on equality across race/ gender

Question 2

fundamental shift in the oath

Answer 2

key fundamental of keeping the patient’s best interests in mind is still there, but new means of accomplishing this= race equality, more open to procedures, privacy, do not practice outside bounds of knowledge

Question 3

3 core elements of medical professionalism

Answer 3

1- moral commitment to ethic of medical service= devotion to medicine (drives improvement- fiduciary role)
2-public profession of values (psychological motivation, accountable to public, policing other MDs)
3-negotiation on social values (how to pay/ what treatment; vaccines, education; PMS, homosexuality)

Question 4

stages of activism

Answer 4

1- routine advocacy- advocating for patient values first= daily
2-internal dissent- internal to group/ institution
3-public dissent-organize community support, op-ed, follow rules, but make clear you do not approve
4-direct disobedience- break rules directly
5-indirect disobedience- call attn to wrong= change dress code
6-principled exit from practice

Question 5

competence

Answer 5

competence to decide is relative to the decision; personality may be a factor, as well as divergent two party interests

Question 6

judgement issues

Answer 6

competence judgements= gate keeper in health care

-may lead professionals to override patient decisions; physicians do have de facto power to override

Question 7

autonomy

Answer 7

absence of constraints (liberty) and capacity for intentional action (agency) required for autonomous decisions

• kant= due to inherent worth of each person
• mill= society should let freedom as long as it doesn’t infringe upon freedom of others

Question 8

informed consent

Answer 8

one must be 1-competent to act, 2-receive disclosure, 3- comprehend the disclosure, 4-act voluntarily, 5-consent to the intervention

Question 9

disclosure

Answer 9

transfer of info from phys to patient

Question 10

influence

Answer 10

1- coercion= threat of force; 2- persuasion= comes to believe through reasoning of prof.; 3- manipulation= combo of 1 and 2

Question 11

substituted judgement standard

Answer 11

used only for once-competent patients and only if another can “don the mental mantle” and make a judgement they would’ve made =respects all previously made autonomous choices

Question 12

best interests standard

Answer 12

surrogate determines highest net benefit= quality of life
-criterion= well being; can override previous documents in rare cases (present situation could be different that expectation)
=focus on value of life for the person LIVING it, not the value of their life to others (worth/ enhancement to others)

Question 13

pure autonomy standard

Answer 13

eliminates dubious autonomy; applies to formerly autonomous, now-incompetent who expressed relevant, autonomous treatment preferences in the past= “precedent autonomy”- look at previous pattern of decisions and use to decide
-problem= surrogates could skew decisions considered

Question 14

3 standards related in practice

Answer 14

objective is to protect autonomy in a clear and coherent framework

• runs from 1-autonomously executed advanced directives, to 2-substituted judgement, to best interests with 1>2>3
• if previous competent left no traces of preference or directive, then best interests std is used