PHIL 335 Lecture Notes - Lecture 4: Deontological Ethics, Lumbar Puncture, Maximum Risk
3 Jun 2018
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Unit 4
1. Illustrate, with an example, how a particular asymmetry might be operative in the
therapeutic relationship between patient and physician. How might the effects of this
asymmetry be minimized?
An example of an asymmetry in the therapeutic relationship between patient and physician is
medical knowledge. A physician has a wealth of medical or specialized knowledge while many
patients have limited medical knowledge. The effects of this asymmetry could be minimized by
the physician providing the patient with knowledge and appropriate resources. Some resources
could be pamphlets, and information or support groups. This would empower the patient and
give the patient autonomy, creating a more equal relationship, where the patient could contribute
to the conversation as well as make educated decisions about his health.
2. What are the benefits and limitations of the paternalistic model? Aside from emergency
situations, can you think of other cases in which the paternalistic model would be
ethically acceptable?
The paternalistic model has benefits and limitations. A few benefits include time efficient,
objective, as well as promoting patient health and wellbeing. Unfortunately, this model also has
some limitations. The patient’s wishes are ignored and the patient has limited participation.
Therefore, as a result of the paternalistic model, the patient’s values are not taken into
consideration and ultimately the physician determines what is best. The paternalistic model
would be morally acceptable when dealing with a child or patient who is not able to make
informed decisions, if there is no alternative decision maker present.
3. Which model of the therapeutic relationship, including the hybrid model introduced in
this unit, do you think could best accommodate interaction not only with a patient, but
also with her or his family? Explain.
The interpretive - deliberative hybrid model of the therapeutic relationship would be
accommodate interactions between healthcare professionals and patients or family. For the
reason that the emphasis in this model is on fact finding and determining patient values. Some
examples of this are: genuine consent, adequate information, thoughtful deliberation, as well as
autonomy (of patient, family, and healthcare professionals). This model requires the
characteristics of a ‘good doctor’ such as caring, integrity, responsibility and kindness. However,
in the current medical world, there is minimal time and a great deal of patients to see so it is a
challenge for healthcare professionals to treat each patient this way. Also, most Doctors, for
example, are not given any training in regards to counselling patients which makes this model
difficult to approach. If somehow basic education about counselling could be incorporated into
the Doctors busy schedules, maybe that would make the goals of this model more achievable.
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4. What is moral distress? Provide an example, and discuss two ways in which health care
workers can deal with this phenomenon productively.
Moral distress can be caused by compromising one’s moral integrity, or going against your
values and what is ethically right. In healthcare, this is a serious issue and is more than mere
discomfort. When a nurse, for example, does a task that she feels is not in the best interest of the
patient, or is told to not complete a task that she considers to be in the best interest of the patient
moral distress occurs. A specific example of this is a nurse being told to not give a patient pain
medication, even though she feels the patient is in a great deal of pain. The nurse may think that
because this patient is in so much pain, they need stronger pain medication or an increased
frequency of pain medication. When the doctor refuses to order the pain medication, the nurse is
left in moral distress. It is noted, as a guideline to dealing with moral distress, that healthcare
professionals can consult their unique code of ethics and talk to a manager about their ethical
dilemmas. However, in my experience, we can consult our code of ethics or manager as much as
we want but usually, it doesn’t get us very far and it feels more like a formality. As a result, this
guideline is not always followed. One true way health care workers can deal with moral distress
productively, in my opinion, is to support co workers and learn how to respectfully stand up for
the morally acceptable decision. This can mean saying no more often to tasks that cause moral
distress and explaining your position regarding why the task should or should not be done.
Unit 5
. What are the core components of competence to consent?
The core components of competence to consent are consciousness, understanding and reasoning.
1. Consciousness: is the patient alert and oriented or are they comatose? The comatose will
obviously be unable to consent to treatment.
2. Understanding: measure this in a cognitive dimension. We are not supposed to assume
that the patient doesn’t understand the surgery if their choice doesn’t follow what we
want for them.
3. Reasoning:if the patient does decide against the intervention then the doctor will ask for
the reason why the patient has decided again the treatment. The doctor will do this to
make sure that the patient has had the chance to think about all the consequences and
potential problems associated with refusing the treatment.
Remember that the standards for competence in relation to research are much higher because of
the increased dangerous situations involved with a patient participating in research.
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Document Summary
Unit 4: illustrate, with an example, how a particular asymmetry might be operative in the therapeutic relationship between patient and physician. An example of an asymmetry in the therapeutic relationship between patient and physician is medical knowledge. A physician has a wealth of medical or specialized knowledge while many patients have limited medical knowledge. The effects of this asymmetry could be minimized by the physician providing the patient with knowledge and appropriate resources. Some resources could be pamphlets, and information or support groups. A few benefits include time efficient, objective, as well as promoting patient health and wellbeing. The patient"s wishes are ignored and the patient has limited participation. Therefore, as a result of the paternalistic model, the patient"s values are not taken into consideration and ultimately the physician determines what is best. The interpretive - deliberative hybrid model of the therapeutic relationship would be accommodate interactions between healthcare professionals and patients or family.
