Health Sciences 2610F/G Lecture Notes - Lecture 4: Scott Storch, Bioethics, Neonatal Intensive Care Unit

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Ethics Lecture 4
Management of Medical Information
Themes for today:
1.) Autonomy
2.) Informed Consent
3.) Truthfulness & Honesty
4.) Confidentiality
- autonomy root principle for a lot of things that drive that patient doctor relationship
- new concept for patients autonomy but very strong element
Autonomy
J.S. Mill said:
We should never interfere with a person’s freedom except in three situations:
he or she doesn’t know or understand what’s happening
he or she is going to harm you
he or she is going to harm another person
Mill said each of you has right to decide for self (radical idea at the time), advocated that
each of us have strong liberties even if others think it’s bad for you to do that as long as
don’t interfere with autonomy of others
first point: if you’ve been lied to, or mentally impaired (can override here) ie. someone
tells you this is safe to take but actually made u so sick you can say that was not an
autonomous act bc you were lied to
autonomous act until you find out that you don’t know what you were agreeing to
second point: harm gets tricky, according to Mill says speech should be free no such thing
as harmful speech
third point: can intervene if someone going to hurt you or hurt someone else
what if harming selves do they understand they’re harming self? ie. if psychotic and
cutting self bc they think there are bugs under their skin according to Mill you can
interfere with their autonomy, but if someone says i want to commit suicide and not
driven by depression etc cannot interfere
Autonomy – 4 Aspects
1.) Free Action
2.) Effective Deliberations
3.) Authenticity
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4.) Moral Reflection
Autonomy – 4 Aspects
1.) Free Action
- Can be limited by internal and external forces
- Autonomy is not automatic: you must demonstrate the ability to self-rule
- Society sets standards and limits by saying what is “poor” or “reasonable” self-rule
- first point: can you actually do it, freedom is ability to try to do those things
- second point: if show up impaired then can impede patients autonomy
- 3rd point: subjective bit, if patient can show reasoning behind why doing/not doing something
then we can respect choice, but what does society see as reasonable? —> Jehovah’s witness
refusing blood right as decide as an ADULT, different with children
Autonomy – 4 Aspects
2.) Effective Deliberations
- A person “ruling him/herself” shows good judgment
Good = reasoned (logical, sensible, intelligible)
- ineffective deliberations can be caused by:
1.) misinformation (deception, lies)
2.) missing information
3.) mental/cognitive issues (delusions, compulsions)
-1st point if have argument as to why don’t want it then that has to be respected
1) were told lie or only part of truth
2) you’ve left stuff out maybe by accident
3) literally detached from reality in some way, and cannot be taught to see what they want you do ie.
patients on medications
Autonomy – 4 Aspects
3.) Authenticity = you being who you truly are, freed from external (and internal!) constraints.
- most associated with existentialist philosophers post world war 2 when became most popular
- you can literally have someone leaning into you saying don’t do this etc (external)
- internal —> ie. whole life parents said nice ppl don’t do this so that’s on your mind
- not authentic —> have all made choices bc someone told us to
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- inauthenticity —> athethist baptizing kids to keep peace between grandparents
4.) Moral Reflection
- Autonomy involves being able to clearly articulate your values
- Do you know why you would choose X?
- Or is it something you’ve adopted unconsciously and uncritically?
- able to make your own decisions
- you’re authentic, after made decision there is moral reflection
- how did behaviour reflect what you believe and how would you do it differently
- third point: pre cursor to regret in healthcare —> haven’t had sufficient time to think about what
to do
-we can’t respect a patient’s autonomy by simply not breaking any rules:
- consent rules, for example
-suggests a virtuous commitment to support the patient’s autonomy – to advocate for it
- Janet Storch:
“…kept in command of themselves.”
- require doctors to respect their autonomy
- ways for doctors to get their ways —> if doctor doesn’t want you to do something just talk about
risks over and over again so they eventually think it’s too risky for them to do
- NICU home of place like this —> parents incapable of making a decision at the moment if not
respecting autonomy would push them to make a decision, respect for autonomy if let them think
about it so they can make THEIR decision not YOUR decision
Informed Consent
If we have the right to self-determination in medical matters and we are free to choose whatever option
we want for ourselves:
it is logical that we should be treated like medical decisions are our choice as patients.
be reasonably informed
be allowed to make our own decisions
have those decisions respected
- you have the right to know what you are agreeing to
- ie. if telling doctor symptoms then he gives u prescription before done talking —> not informed
consent
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