HC.Wk5.InfConsent.Bb - Informed Consent Informed consent...

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Informed Consent Informed consent not in the Hippocratic Oath: its inclusion in our conception of doctor-patient relationship is an innovation. Some doctors claim that informed consent is a malign innovation Is informed consent a malign or benign innovation?
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Informed Consent What constitutes legitimate consent. Not merely saying yes, for instance, to participating in a research project. It means something more.
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Argument to show IC is a benign innovation 1. A person has a right to self-determination with respect to her body. 2. Medical interventions are invasive & affect the body intimately. 3. So, medical interventions are permissible only if the patient consents. 4. A doctor’s false disclosure (or non- disclosure) prevents such consent. 5. Therefore, to consent, a patient must be informed.
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Informed Consent Two exceptions to the requirement of informed consent. 1. concerns weak moderate paternalism 2. concerns paternalism to prevent loss of autonomy (Zembaty defends such cases) So important to consider Zembaty’s arguments.
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Realizing Informed Consent (IC) So far we have a defense of IC , but we lack any guidance on what counts as IC.
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Acting Autonomously Jude is considered an autonomous agent, provided he gets to choose (decide) whether or not to undergo some treatment /participate in the research. Valid consent requires that Jude deliberate before he consents . But genuine deliberation requires both information and understanding . These two requirements are the source of difficulties and controversies.
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Informed Consent and Paternalism It is in this context that I discussed whether IC is a malign or benign innovation. Doctors defend withholding information: “patients fail to grasp the technicalities of medical science” Isn’t this paternalism (weak or strong) and so unacceptable? The doctor has a duty to provide information readily understood by patients.
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While doctors have a duty to provide all possible information, but should the patient have the last say? Consider Atul Gawande’s piece (in section this week)
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Contemporary issues in informed consent Tuskegee syphilis Experiments 1932-72 Alabama (US Public Health Service) Government radiation studies 1944-74 Use of bio-warfare vaccines without consent of military personnel in the Gulf war. AIDS experiments in the developing countries
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Informed Consent and Human Research Codes The National Commission grounded requirement of informed consent in the ethical principle that includes that - individuals be treated as autonomous agents - individuals with diminished autonomy have the right to protection . WHO/CIOMS Proposed International Guidelines for Biomedical Research Involving Human Subjects
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Research Codes Experiments that involve human subjects are required to meet certain guidelines.
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HC.Wk5.InfConsent.Bb - Informed Consent Informed consent...

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