Day_5_101116_PHI+015+Presentation

Day_5_101116_PHI+015+Presentation - Dr Rulli PHI 015...

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October 11, 2016 Dr. Rulli PHI 015: Introduction to Bioethics 1
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Today’s Agenda Conditions of informed consent, continued Principlism, continued Next up: the case-based approach Reminder: Paper 1 due October 20 2
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Conditions for Informed Consent: 1. Competence 2. Understanding and appreciation of information 3. Voluntariness See Young, Chapter 44 in your textbook 3
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Conditions for Informed Consent: 2. Understanding/appreciation of information This is the most controversial condition: Two questions: How can clinicians ensure understanding? They can’t look inside your head to see if you understand something. So perhaps the focus should be on whether clinicians fulfilled a duty to disclose What information is necessary for understanding? We can’t disclose everything See Young, Chapter 44 in your textbook 4
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What Information Is Necessary for Understanding A reasonable patient standard Four Disclosure Requirements Necessary (not sufficient) for Informed Consent: 1. The nature of the procedure 2. Risks of the procedure 3. Alternatives to the procedure, if any 4. Benefits of the procedure See Young, Chapter 44 in your textbook 5
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Informed Consent Recap Informed consent to treatment is necessary to respect autonomy Informed consent must be: 1. By a competent patient 2. With understanding/appreciation of the information Knows nature of procedure Knows the risks Knows the alternatives Knows the benefits 3. Voluntary- free of coercion, undue influence, manipulation 6
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But what about not fully competent patients? “Competence”– legal term for having legal status to make one’s own decisions in a particular area (in this case, about medical treatment or research) Decision-making capacity is the basis on which competence determinations are made E.g. capacity to consent 7 For more on patients who lack capacity, see Elliott reading in Kuhse/Singer, Ch. 45
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Lacking Capacity Patients lacking capacity pose some of the greatest challenges, raise some of the biggest conflicts: What is best for them medically vs. what is most respectful of them, their past wishes, their families’ wishes Example: The child of a Jehovah’s Witness needs a blood transfusion, but this is impermissible in the religion. What should be done? 8
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Those who lack capacity Cannot consent to medical treatment or research Many ways one can lack capacity: Young child or infant Neurologically damaged adult Neurologically damaged infant Elderly person with dementia Adult with schizophrenia What matters or is in the best interest of each of these people may vary widely Note: Children of older age can “assent” rather than consent 9
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As you can imagine, there is a lot of disagreement Some consensus: on how to assess capacity Capacity assessments usually include: Is patient capable of understanding consequences of the decision?
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