PP217 Lecture Notes - Lecture 5: Idiosyncrasy, Informed Consent
Informed consent
•
No one may touch a patient without explaining the procedure and
getting consent for it
•
Medical intervention without consent is battery under the law
•
Consent must be fully informed, voluntary, and given either by a
competent patient or a valid surrogate
1.
Being 'fully informed'
○
Patient must have enough information to make a responsible
decision
○
One they can be held accountable for
2.
Voluntariness
○
There are subtle ways the voluntariness requirement can fail
○
Natural contingencies- limited options available to the patient. No
person is acting to limit the patients options, but according to
Freedman the choice is voluntary
○
Reward for participation in research. Moral subsistence level: the
level of resources, well-being, etc, that everyone is entitled to-
rewards above this level, Freedman suggests are not coercive. But
to 'reward' someone with something they deserve already can be
coercive
§
Ex; if I offer you basic medical care on the condition that you
let e experiment on you, your consent to the experiment is
not voluntary
Competence
•
Infants, unconscious people, and people with mental illness may be
incompetent
1.
Wishes vs. interests
○
Something is in your interests if it will benefit you
○Generally we assume something is not in someone's interests if it
will physically harm them
○Informed consent is based on the patients expressed wishes
○A wish is a decision about what one wants
○When interests and wishes seem to be dramatically at odds- as
when a patient prefers death to a probably successful treatment,
we may be tempted to question a patient's competence
2. Idiosyncrasy vs. incompetence
○When dealing with apparently irrational wishes we don’t
necessarily know the patients true interests
○To disallow idiosyncrasy is to disallow autonomy. Patients must
generally be allowed wishes that do not make sense to us
3. Out-of-character wishes
○Idiosyncrasy doesn’t imply incompetence when the odd belief is
known to be stable- ex; Jehovah's witness
○A sudden change that seems explicable only in terms of some
mental disorder may be sufficient ground, especially when the
wishes expressed seems clearly at odds with the patients interests
Direct and Surrogate Consent
• Surrogate consent is obtained when direct consent can't be
1. Acting to promote interests
○Freedman argues that surrogate consent cannot be viewed as
protecting autonomy, so its purpose must be protection
○Surrogate is free to enroll the patient in experiments so long as
they're not harmful
2. Acting to promote wishes
○Surrogates are exposed to decide based on the wishes of the
patient, if they are known
○A living will or careful discussion is the best method
Consent and Medical Relationships
Saturday, June 30, 2018
8:23 AM
Document Summary
Patient must have enough information to make a responsible decision. One they can be held accountable for: voluntariness. There are subtle ways the voluntariness requirement can fail. Natural contingencies- limited options available to the patient. No person is acting to limit the patients options, but according to. Moral subsistence level: the level of resources, well-being, etc, that everyone is entitled to- rewards above this level, freedman suggests are not coercive. But to "reward" someone with something they deserve already can be coercive. Ex; if i offer you basic medical care on the condition that you let e experiment on you, your consent to the experiment is not voluntary. Competence: infants, unconscious people, and people with mental illness may be incompetent, wishes vs. interests. Something is in your interests if it will benefit you. Generally we assume something is not in someone"s interests if it will physically harm them. Informed consent is based on the patients expressed wishes.
