INFORMED CONSENT.F07 - HEALTH CARE DECISIONS...

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Unformatted text preview: HEALTH CARE DECISIONS COMPLEXITY/CAPACITY INFORMED CONSENT ADVANCE DIRECTIVES COMPLEXITY SEVERAL ISSUES MAKE H.C.DECISIONS COMPLEX: DISAGREEMENT BETWEEN DOCTOR AND PATIENT OVER TREATMENT CHOICES LIMITATION OF PATIENT ABILITY TO UNDERSTAND OR TO DECIDE CONFLICT BETWEEN CLINICAL AND ETHICAL GOALS EXAMPLES OF EACH. CAPACITY THREE FUNCTIONS CONSTITUTE CAPACITY: THE PATIENT MUST BE ABLE TO: 1. TO UNDERSTAND 2. TO REASON/JUDGE 3. TO DECIDE CAPACITY SOME EXAMPLES OF LACK OF CAPACITY: UNCONSCIOUS MENTALLY INCAPABLE INTERFERENCE OF SUBSTANCE ABUSE AGE CAPACITY DEGREES OF CAPACITY THE PHYSICIAN JUDGES CAPACITY. INDICATORS THE PRESUMPTION INFORMED CONSENT MEDICALSCIENTIFIC INFORMATION LEGAL ISSUES SOCIOCULTURAL ASPECTS ROMAN CATHOLIC CHURCH TEACHING MORAL ANALYSIS THE LARGER CATEGORY OF MEDICAL SCIENTIFIC INFORMATION MEDICAL COMMUNICATION TO WHICH INFORMED CONSENT BELONGS IS TRUTHTELLING. "INF.CONSENT"CONSISTS OF MD'S DISCLOSURE & PATIENT'S DECISION IT IS NECESSARY/USEFUL: IT SHOWS RESPECT FOR AUTONOMY IT STRENGTHENS RELATIONSHIP MEDICAL SCIENTIFIC INFORMATION HOW? WHEN? DISCLOSURE CONSENT DISCLOSURE CONSENT DISCLOSURE CONSENT WHERE? LEGAL ISSUES THREE CONSIDERATIONS: 1. DISCLOSURE 2. CONSENT 3. EXCEPTIONS: LEGAL DISCLOSURE ORIGINAL OBJECTIVE OF INFORMED CONSENT IS PATIENT RESPECT AND PROTECTION THE CONTEMPORARY SITUATION HAS ADDED PHYSICIAN PROTECTION. WHEN CHALLENGED, THERE ARE TWO DIVERSE STANDARDS USED IN COURTS: PROFESSIONAL STANDARD WHAT DO OTHER DOCTORS DO? LEGAL STANDARD WHAT WOULD AN ORDINARY PERSON NEED TO KNOW? LEGAL CONSENT INFORMED CONSENT MAY BE GIVEN: ORAL CONSENT WRITTEN CONSENT OTHER... LEGAL EXCEPTIONS THERE ARE FOUR EXCEPTIONS TO THE REQUIREMENT OF INFORMED CONSENT: EMERGENCY INCOMPETENCE WAIVER OF RIGHT THERAPEUTIC PRIVILEGE AN EXAMPLE OF EACH. SEVERAL DEVELOPMENTS WITHIN SOCIOCULTURAL DIMENSION MEDICINE HAVE INFLUENCED I.C.: AMERICAN LITIGIOUSNESS EMPHASIS ON AUTONOMY MEDICAL SPECIALIZATION HEIGHTENED PATIENT INITIATIVE WHAT DID THE PRESIDENT'S COMMISSION SURVEYS INDICATE? "ETHICAL AND RELIGIOUS ROMAN CATHOLIC CHURCH TEACHING DIRECTIVES" U.S. BISHOPS "GUIDELINES FOR LEGISLATION OF END OF LIFE DECISIONS" GENERAL RESPONSIBILITY ORDINARY/EXTRAORDINARY MEANS MORAL ANALYSIS 3 ISSUES: MORAL VALUES OBSTACLES TO INFORMED CONSENT FINAL EVALUATION PRINCIPLES MORAL VALUES SEVERAL MORAL VALUES ARE INVOLVED IN INFORMED CONSENT: HUMAN DIGNITY PATIENT TRUST RESPONSIBLE CITIZENRY PUBLIC HEALTH OBSTACLES THERE ARE SEVERAL OBSTACLES TO I.C. ON THE PART OF THE PATIENT: FEAR LACK OF ATTENTION LACK OF INTELLIGENCE OR UNDERSTANDING OBSTACLES THERE ALSO ARE OBSTACLES TO INFORMED CONSENT ON THE PART OF THE PHYSICIAN: UNWILLING/UNABLE TO DISCLOSE PATERNALISM ARROGANCE CONFLICT OF VALUES MORAL EVALUATION MORAL CONCLUSIONS: RIGHT OF PATIENT OBLIGATION OF PHYSICIAN HEALTH CARE: BASIC GOOD AND PERSONAL RESPONSIBILITY FAILURE TO DISCLOSE MORALLY UNACCEPTABLE ADVANCE DIRECTIVES INFORMED CONSENT MAY BE GIVEN BY TWO TREATMENT DIRECTIVES: LIVING WILLS MEDICAL CARE DIRECTIVES (e.g.DNR) OR TWO PROXY DESIGNATIONS: DURABLE POWER OF ATTORNEY HEALTH CARE PROXY ...
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