7. HUMAN RIGHTS AND DIGNITY IN CARE

Question 1

1. What is the Universal Declaration of Human Rights?

Answer 1

• it is a series of articles that sets certain standards to
  define the rights of all human beings
• it was signed in 1948

Question 2

2. What is Article 1 of the Universal Declaration of Human Rights?

Answer 2

• all human beings are born free and equal in dignity
  and rights
• they are endowed with reason and conscience
• they should act towards one another in a spirit of
  brotherhood

Question 3

3. What is dignity?

Answer 3

• it is when we show respect to someone
• it is the view point that a person is an individual being
  that deserves respect
• the respect of one’s human rights

Question 4

4. What is meant by dignity in care?

Answer 4

• this refers to treating patients as individuals
• patients are entitled to respect
• they are entitled to autonomy, privacy and self-worth
• this refers to ensuring that the patient does not feel
  dehumanised based on their illness

Question 5

5. What happens when a patient’s rights are compromised?

Answer 5

• they feel that their autonomy is not respected

Question 6

6. What do Human Rights refer to?

Answer 6

• they refer to respect for the person and their dignity
• human rights and moral rights are complementary

Question 7

7. What do Legal Rights reflect?

Answer 7

• they reflect the doctor’s duties
• they reflect the doctor’s obligation towards protecting
  citizens

Question 8

8. What does Dignity in care refer to?

Answer 8

• it refers to treating patients as individuals
• these patients are entitled to their own respect,
  autonomy, privacy and self worth

Question 9

9. Who developed the 4 Principles of Health Care in Ethics?

Answer 9

• Tom Beauchamp and James Childress
• they were developed in the 1979 book:
  “Principles of Biomedical Ethics”

Question 10

10. What do the 4 Principles of Health Care in Ethics provide to medical practitioners?

Answer 10

• they provide guidelines to make decisions
• this is useful for facing complicated situations involving
  patients

Question 11

11. What are the 4 Principles of Health Care Ethics?

Answer 11

1. Autonomy
2. Beneficence
3. Non-Maleficence
4. Justice

Question 12

12. What is the framework of Principles?

Answer 12

• they are general norms
• they leave considerable room for judgement in many
  cases
• they are not a precise action guide

Question 13

13. What is Autonomy?

Answer 13

• it revolves around self rule and self determination
• it is the ability to think, to decide and to act
  on the basis of your own thoughts and decisions
• it is the ability to do the above mentioned freely and
  independently

Question 14

14. How does Autonomy perceived in Health Care?

Answer 14

• a medical practitioner cannot impose treatment on an
  individual for whatever reason
• health practitioners need to help and support patients
  in coming to their own decisions
• health practitioners need to respect and follow those
  decisions

Question 15

15. In the domain of Health care, what forms can respecting a patient’s autonomy take?

Answer 15

Question 16

16. Read through this case.
    Are there any limits to the patient’s autonomy?

Answer 16

• the patient is not in absolute capacity
• this is due to the fact that he may have sustained a
  brain injury
• this can damage his reasoning and cloud his clarity
• he has the necessity for treatment
• he is a risk to others
  (he could have an infectious disease)

NB:
- the patient does have the right to refuse treatment
- the doctor may have to make the decision for the
patient is the patient is in a comma or not capable to
do so

Question 17

17. What is Beneficence?

Answer 17

• this refers to the moral importance of doing good to
  others
  (your patients)
• it is about taking actions to benefit and promote the
  welfare of other people

Question 18

18. What is Beneficence according to Beauchamp and Childress?

Answer 18

IT IS PERFORMING DEEDS OF:
- mercy
- kindness
- charity

Question 19

19. What are the 5 rules of Beneficence?

Answer 19

1. Protect and defend the rights of others
2. Prevent harm from occurring to others
3. Remove conditions that will cause harm to others
4. Help persons with disabilities
5. Rescue persons in danger

Question 20

20. What is Beneficence useful for?

Answer 20

• it helps to establish a process for ranking the available
  treatment options

Question 21

21. What 4 questions should a doctor ask themselves when it comes to using beneficence to establish a treatment?

Answer 21

1. Will this treatment option resolve this patient’s
   medical problem?
2. Is it proportionate to the scale of the medical
   problem?
3. Is this treatment option compatible with this patient’s
   individual circumstances?
4. Is the specific option and its outcomes in line with the
   patient’s expectations of treatment?

Question 22

22. Why is Autonomy vs. Beneficence a complicated topic?

Answer 22

• we have to asses the health professional’s opinion
  against the patient’s own views
• there is a divergence between medical interest and
  medical benefit
• there is a divergence between the patient’s best
  interests, their wishes and their preferences

Question 23

23. How does the best interest of the patient become a broader concept?

Answer 23

• it has to reflect the WHO definition of health
• this outlines that health is a state of complete physical,
  mental and social well-being
• the patient’s perspective must be included

Question 24

24. When does the doctor have to make sole decisions?

Answer 24

• they have to make these decisions if the patient is
  incapable or if they have no family or friends to help
  make the decision for them

Question 25

25. Read through this case. What can be said about Autonomy vs Beneficence?

Answer 25

IN EMERGENCY MEDICINE: - the principle of Beneficence is often given priority over the principle of respect for patient autonomy - the doctor has to make the best decision because the patient is unconscious

Question 26

26. What is Non-maleficence?

Answer 26

- health professionals should avoid harm on patients - most medical treatments have a chance of doing some harm (such treatments should not always be avoided) - the potential benefits, harms and their probabilities should be weighed up - this should help decide what is in the patient's overall best interests

Question 27

27. What are some examples of Maleficence in Health Care?

Answer 27

- doctors can cause harm by making the wrong judgement based on a lack of information - doctors can cause harm by confusing one patient's files with another

Question 28

28. How can we describe the relationship between Non-Maleficence and Beneficence?

Answer 28

- Health care professionals are encouraged to do good (Beneficence) IF FOR SOME REASON THEY CANNOT: - they are required to do the least harm (Non-Maleficence)

Question 29

29. Read through this case. How is this an example of Beneficence?

Answer 29

- the appendix could be successfully removed in situ - this would certainly improve the patients life

Question 30

30. Read through this case. How does Non-Maleficence tie into this?

Answer 30

- there is a high risk of infection in a non-sterile environment - there are low chances of a successful operation - there are no other clinical staff or surgical equipment available - there is no prior experience of doing an appendectomy at the roadside - not doing the surgery would avoid all the above mentioned harm

Question 31

31. What is a constant standard for Clinical Practice?

Answer 31

- Beneficence - Non Maleficence - these are in response to a specific situation for a specific patient

Question 32

32. What acts as a threshold for treatment?

Answer 32

- Non Maleficence - treatments that cause more harm than good should not be considered - a high risk factor deduces which treatments are not worth while

Question 33

33. How does Beneficence help with making a treatment decision?

Answer 33

- it helps to consider all the valid treatment options - we then prioritise based on this

Question 34

34. What is Justice?

Answer 34

- this is a principle that helps Health Professionals make decisions about: - time - money - clinical resources

Question 35

35. What two points are emphasised by the Principle of Justice?

Answer 35

1. Patients in similar situations should have access to the same healthcare 2. When it comes to determining the level of care that should be available for one set of patients: - we must take into account the effect of such use of resources on the other patients

Question 36

36. Look at this example. What can be said about Justice?

Answer 36

1. DISTRIBUTIVE JUSTICE: - this is the fair distribution of resources 2. SOCIAL JUSTICE - this is also known as Rights Based Justice - it focuses on the fact that benefits and burdens should be distributed fairly among members of a society - these resources should be distributed with respect for people's needs and rights

Question 37

37. What was John Rawls theory of Justice in 1971?

Answer 37

- fairness and equality should be evaluated from a position that is free of biases - there needs to be an equal access to health care services

Question 38

38. What two Principles did John Rawls advocate for in terms of Justice?

Answer 38

1. Everyone should be given equal liberty - this is regardless of their adversities 2. Differences among people should be recognised - this is done by making sure the least-advantaged people are given opportunities for improvement NB: - there should be no self interest from the doctor's side when making these decisions

Question 39

39. Read through this case. How do Autonomy and Justice apply to this situation?

Answer 39

1. AUTONOMY - the patients have the right to be given access to specialised health services - the patient has the right to make the treatment decision for themselves 2. JUSTICE - this is the allocation of resources - not all treatments can be funded for all patients - prioritising the cancer patients will limit the ability of the other patients to access healthcare resources