Lecture 6-autonomy Flashcards Preview

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Flashcards in Lecture 6-autonomy Deck (27):
1

Informed consent requires disclosure

Disclosure involves providing the relevant treatment information to patients

2

Informed consent requires disclosure
-Acceptable exceptions?

-Emergency
-Waiver
-Incompetency
-Therapeutic privilege (Very limited)

3

Informed consent requires disclosure
-Exceptions-emergency example?

Mass casualty

4

Informed consent requires disclosure
-Exceptions-Waiver example?

Patient tells you what to do in advance

5

Informed consent requires disclosure
-Exceptions-Incompetency example?

Unconscious patient

6

Informed consent requires disclosure
-Exceptions-Therapeutic privilege?

-*Very limited*
-If necessary for decision making, must present serious harm

7

Informed consent requires voluntariness
-What can constrain voluntariness?

-Voluntariness involves the right a patient has to make treatment decisions free from undue influence
-Internal and external factors constrain voluntariness

8

Informed consent requires voluntariness
-External factors include?

-Force
-Coercion

9

Informed consent requires voluntariness
-External factors include
-Force?

-Physical restraint/sedation

10

Informed consent requires voluntariness
-External factors include
-Coercion?

-Implicit/explicit threat
-Manipulation
-deliberate distortion of information to influence patient decision making-violates both the 'informed' and 'consent' aspects of informed consent

11

3 ways autonomy can get messed up?

-Autonomy and actions
-Autonomy and options
-Autonomy and decision making

12

Autonomy and actions
-Cases in which?
-Example?

-Cases in which we are influenced by physical force or coercion (institutionalization)
-Example-patient is restrained legally or patients in nursing care facilities

13

Autonomy and options
-Autonomy requires?
-Example?

-Autonomy requires that we have genuine options to decide between (access to care, awareness of alternatives)
-Example-patient who does not have adequate healthcare to receive a particular treatment

14

Autonomy and decision making
-Autonomy requires?
-Example?

-Autonomy requires that our relevant options be made known to us (disclosure)
-Example-physician does not tell patient about all potential options intentionally

15

Truth telling and medicine
-Exposes the?

Exposes the pressure point between autonomy and paternalism

16

Reasonable restrictions on autonomy?

-Harm principle
-Principle of paternalism
-Principle of legal moralism
-Welfare principle

17

Reasonable restrictions on autonomy
-Harm principle?

Prevention of harm to others

18

Reasonable restrictions on autonomy
-Principle of paternalism?

Prevention of harm the individual themselves

19

Reasonable restrictions on autonomy
-Principle of legal moralism?

-The prevention of law breaking including for the punishment of law breaking
-Acceptable to restrict someone's autonomy when they are breaking a law and when they are in jail their autonomy is highly restricted
-Assumption: the function of law is to enforce morality

20

Reasonable restrictions on autonomy
-Welfare principle

-Benefit to others
-Small restriction of autonomy of one person provides maximum benefit for others
-Example of this would be taxation-restrict income to provide services for everybody
-Assumption-We'd have to give up a negligible amount of autonomy to provide extreme benefit for others

21

Truth telling and medicine
-When might we want to protect the patient from the truth?

When a patient is extremely emotional

22

When might a patient want us to protect them from the truth?

Patient says not to tell them the results of a test before they have had a chance to talk to their family

23

Protective deception does not equal?

-preference for ignorance
-rather, protective deception involves considering whether the disclosure itself would cause suffering (either physical or emotional)

24

Protective deception does not equal preference for ignorance
-In severe enough cases?

In severe enough cases, such suffering may require the exercise of "therapeutic privilege"

25

Therapeutic privilege

An uncommon situation whereby a physician may be excused from revealing information to a patient when disclosing the information to the patient would pose a serious psychological threat, so serious a threat as to be medically contraindicated

26

What circumstances evoke "therapeutic privilege"?

?

27

Informed consent requires what 3 things?

Informed consent requires disclosure, voluntariness, and capacity