Medical Decision-Making Flashcards
(23 cards)
What is autonomy from Kantian ethics?
- The notion of a patient’s self-determination in medical decision making is about autonomy
- Power of self-rule
- To be autonomous, one has to be competent
What is an issue with autonomy? (hint: vs)
An individualist account of autonomy (autonomy ideal) vs a relation notion of autonomy (relational autonomy)
What are the four conditions of autonomy ideal (according to Sherwin, p37)
Autonomous if the patient is:
1. Deemed to be sufficiently competent (rational) to make the decision at issue
2. Makes a (reasonable) choice from a set of options
3. Has adequate information and understanding about the choices
4. Is free from explicit coercion towards one option
What factors may limit the ability to exercise autonomy? (4)
- Cognitive: lack of info
- Psychological and physical: presence of pain, fear, guilt, anxiety, depression
- Financial: concern about affordability
- Social and cultural: social responsibilities, cultural expectations
What is competence?
The abilities, skills, and knowledge necessary to make a particular decision in particular context
What are the types of competence? (3) (Allen E. Buchman & Dan W. Brock)
- Minimal standard of competence: the ability to express a preference, or make a choice
- Content or outcome standard of competence: the preference or choice be a reasonable one or one that rational persons would choose
- Process standard of decision-making competence: the process of the decision-making determines whether a patient is competent
What are problems with the types of competence? (3)
- Minimal - Problem: not a standard of competence because it accepts every expressed choice of a patient
- Content or outcome - Problem: fails to respect patient self-determination.
- Process- Problem: seems to still trade on autonomy ideal
What is relational autonomy?
Understands autonomy as socially situated or contextualised
What are the two views of relational autonomy?
- Relational autonomy 1 (Care ethics) takes the relational to hold in the private sphere (interpersonal)
- Relational autonomy 2 (Feminist ethics) takes the relational to hold in the private and public spheres (social/institutional)
What are three ways relational autonomy 2 will play out?
(hint: oppressed)
- Not making decisions for oppressed people or being paternalistic towards them since this will increase their powerlessness.
- Helping oppressed people who by this fact lack autonomy develop their skills and thus help them to make better decisions.
- Making more choices (non-oppressive alternatives) available to oppressed people.
What are some limits to autonomy? (2)
- Paternalism: for the sake of beneficence or nonmaleficence
- Other stakeholders: for the sake of justice and responsibility to family
What is relational autonomy 3?
Communal ethics - evaluates the morality of actions or conduct by the force of those actions or conduct to enhance communal values
What is informed consent?
IC is the process by which a fully competent (rational, mentally mature) patient or subject participates in choices about his healthcare
What are the elements of complete IC? (2)
- Information disclosure (nature of condition, decision, treatment, alternatives, risks, etc)
- Assessment of Patient’s Consent/Understanding (competent to consent? Understood the information?)
How much information disclosure is enough? (3)
a) Reasonable HCP standard
b) Reasonable patient standard
c) Subjective standard
Three stages of IC through history
- Paternalistic stage (lasted for many centuries - do what’s best decided by Dr)
- Legal stage (patients’ rights decide)
- General therapy stage (emerged more recently - what’s a reasonable about of info given)
What’s the 4th stage of IC?
Individual therapy model - tailored to the individual patient
- Coping style: the style the patient employs to deal with painful/distressing situations (ex. monitoring, blunting)
- Locus of control: who or what holds the joker on events? (ex. internal - , external locus of control)
What are advantages of the individual therapy model?
Treats patient as an individual, better promotes beneficence/nonmaleficence, probes further where other models may not probe
Soft paternalism
The view that paternalism is justified if the person being interfered with is not acting voluntarily or knowledgeably
Hard paternalism
The view that paternalism is sometimes justified even in cases where the person being interfered with is acting voluntarily or knowledgeably
Weak paternalism
Holds that we may interfere only when
people are mistaken about facts
Strong paternalism
Holds that we may interfere when they are mistaken either about facts or values
In the case of the Korean man, what types of paternalism may be justified?
Soft and weak
