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Chapter 2

Health Sciences 2610F/G Chapter Notes - Chapter 2: Shared Decision-Making In Medicine, Paternalism, Advance Healthcare Directive


Department
Health Sciences
Course Code
HS 2610F/G
Professor
Patrick Clipsham
Chapter
2

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2: Patient-Doctor Relationship
February-13-13
1:01 PM
THE PATIENT-DOCTOR RELATIONSHIP
Informed Consent
Practical application of the principle of respect for patient autonomy
To consent freely patient must be of sound mind and must not be subject to any coercion or
undue influence
Consists of two components:
o Doctors disclosure of medical information to the patient -diagnosis, prognosis, available and
alternative treatments, risks/benefits and consequences of having or refusing treatment
o Competent patient decides whether to accept or forego treatment on the basis of this info,
one who understands the nature of their condition, consequences of accepting/refusing an
intervention for it
Serves as an ethical basis for a patient-doctor relationship characterized by mutual respect and
shared decision making
The greater the level of risk in refusing a treatment, the higher the level of competence should be
for the patient to make a decision
Less competent a patient and the greater the risk in not intervening, the stronger reasons and
justification there are for overriding a patients refusal
Some argue minimal competence is enough for a patient to consent to or refuse a treatment - if
patient is competent to accept it they are also competent to refuse it
Competence, risk and invasiveness of procedure
A terminal ill person who is in need of CPR from a stoke, the doctor is not obligated to perform it
because it cannot restore her to normal functioning or prolong their life
Patient is not competent to make decisions about treatment, an appropriately designed
"surrogate" can decide on the patients behalf, one of 2 ways:
o (1) they can make decisions about treatment as the patient would make them if he were
competent, exercising substituted judgement
o (2) can decide on a course of action that the surrogate believes is in the patients best
interests
Patients interests can be expressed in an "Advance directive" such as a living will, autonomous
patient can extend autonomy to a time when their no longer competent to make decisions
o (1) express what the patient would want doctors to do (or not do) to them
o (2) designate an individual to make decisions about treatment "surrogate"
Theme of directive should be regularly updated so that they accord with the patients interests at
or near the time when a decision about an intervention must be made
In absence of advanced directive, surrogate can be chosen in the form of a court-ordered guardian
In emergency cases where people are brought into the ER, doctors need not consult with patients
or families to make their decisions to intervene, presumption to treat
Parents decisional authority can be overridden in instances of abuse or neglect
Parental refusal of treatment on religious grounds presents unique problem
o Doctors have recourse to the legal system to obtain a court order to protect the welfare of
those incapable of protecting themselves
Patient who is confused about medical info might ask the physician to make the decision or at
least suggest a course of action , patient is transferring autonomy to the doctor BUT voluntary
request for help in making a decision could be described as an autonomous act
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