Foreman pp 281
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Feb 20, 2024
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Foreman pp 281-305
1. **Bioethical Concerns:** The chapter discusses pressing bioethical issues like abortion, euthanasia, and assisted procreation, indicating their national and global significance. The author highlights their moral complexity and ethical implications.
2. **Clinical Practice and Ethical Foundation:** Emphasizes the need for a strong ethical foundation in routine healthcare settings. The author argues that while these major bioethical topics might not directly
impact everyone, understanding ethical principles is crucial for healthcare professionals in daily practice.
3. **Informed Consent Significance:** The author emphasizes the critical role of informed consent as a cornerstone of ethical healthcare. It's presented not just as a legal formality but as a means of respecting
patient autonomy and preserving ethical practices.
4. **Historical Perspective - Nuremberg Code:** The author draws upon historical events, particularly the Nuremberg Code, highlighting the ethical mandate for informed consent. This serves as a foundation for its application in all medical practices.
5. **Ethical Complexity of Informed Consent:** The author presents a case study involving a nurse's decision to withhold detailed information about chemotherapy side effects from an anxious patient. This
scenario triggers a conflict between respecting patient autonomy and the principle of non-maleficence.
6. **Author's Viewpoint - Balancing Autonomy and Non-Maleficence:** The author appears to advocate for a balanced approach, acknowledging the nurse's intention to prevent unnecessary distress but questioning whether it is appropriate to withhold information that might affect the patient's decision-
making.
7. **Five Criteria for Informed Consent:** The chapter outlines the five criteria necessary for autonomous authorization. It underscores the importance of the patient's capacity, understanding, absence of external control, intentional choice, and authorization by a professional.
8. **Threshold Stage in Obtaining Informed Consent:** The author stresses the initial importance of determining a patient's competency before proceeding with informed consent. The discussion highlights the complexity of assessing competency.
9. **Standards for Determining Competency:** The chapter discusses the challenges associated with different standards (outcome-based, category-based, or functional) for determining competency, referencing cases that showcase the complexities of these standards.
10. **Case Law and Ethical Considerations:** The author may refer to relevant legal cases that illustrate the intersection between bioethics and law, showcasing the ethical dilemmas faced in real healthcare scenarios.
11. **Cultural and Religious Considerations:** The chapter might explore how cultural and religious beliefs impact decisions regarding informed consent, demonstrating the necessity of respecting diverse values in healthcare.
The author's viewpoint seems to underline the ethical complexity of healthcare decision-making, advocating for a nuanced understanding of informed consent while considering individual circumstances and ethical principles. Additionally, referencing real cases and scenarios would provide a practical context for these ethical discussions.
The passage appears to discuss the intricate aspects of informed consent in medical decision-making, focusing on various standards for determining a patient's capacity to make decisions, criteria for assessing their competency, and the legal and moral considerations involved in the informed consent process.
The discussion seems to explore three main standards used in determining a patient's ability to make decisions:
1. Functional Standard: This standard assesses whether a patient can function as a decision-maker within
a given context. It considers the patient's ability to comprehend relevant information, communicate their
decisions, and reason about the decision-making process. The viewpoint here emphasizes individuality, avoiding rigid categories, and considering the patient's values and ideas in treatment decisions.
2. Substituted Judgment Standard: This standard involves a proxy or surrogate decision-maker who attempts to represent the patient's wishes and desires, especially in cases where the patient is incompetent. The proxy makes decisions based on the patient's values or directives communicated through legal documents like a durable power of attorney.
3. Best-Interest Standard: When a patient's wishes are unknown or cannot be retrieved in time, caregivers may resort to the best-interest standard. This involves making decisions based on what is
deemed to be in the patient's best interests, considering principles such as preserving life and minimizing pain.
The text delves into the criteria used to determine a patient's capacity to make decisions, focusing on three general criteria:
- Understanding: Assessing if the patient comprehends the relevant information about their diagnosis, treatment, and prognosis in terms they can understand.
- Communication: Evaluating the patient's ability and willingness to communicate with caregivers about their decision-making process without ambiguity or cognitive impairments.
- Reasoning: Determining if the patient can reason about the decision and alternatives against their stable personal goals and values.
Furthermore, the text touches upon the stages of the informed consent process:
1. Informational Stage: This stage involves disclosure of information and ensuring the patient's understanding. It mentions the importance of comprehensive, accurate, and objective disclosure and emphasizes the significance of the reasonable person standard in determining adequate disclosure.
2. Consensual Stage: This stage involves voluntariness and authorization. It stresses the patient's right to make decisions based on their free will and emphasizes the responsibility and autonomy of the patient in
authorizing a treatment plan.
The passage also discusses legal requirements for informed consent forms, differences in state laws regarding consent, exemptions to obtaining informed consent (such as emergencies or therapeutic privilege), and the complexities surrounding a patient's right to refuse treatment.
It concludes by addressing the challenging ethical dilemma of when and to what extent a patient's refusal of treatment should be honored, citing real-life cases to illustrate these dilemmas.
Overall, the text delves deeply into the multifaceted aspects of informed consent, exploring various standards, criteria, legalities, and ethical considerations involved in medical decision-making.
Certainly! From the provided text samples, here is a list of key terms along with their respective definitions or explanations:
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1. **Informed Consent**: The process where a patient, after receiving information about their medical condition, proposed treatment, and potential risks and benefits, voluntarily agrees to undergo the treatment or procedure.
2. **Competency**: Refers to a patient's capacity to make decisions regarding their medical treatment. It involves understanding information, communication ability, and reasoning skills.
3. **Functional Standard**: A standard used to judge a patient's competency by assessing their ability to
function as a decision-maker in a given context.
4. **Substituted Judgment Standard**: In cases where a patient is incapacitated or incompetent, this standard involves a proxy or surrogate decision-maker making choices based on the patient's known wishes or values.
5. **Best-Interest Standard**: An approach to decision-making for patients when their desires are unknown, aiming to act in the patient's best interests, considering principles like preserving life and minimizing pain.
6. **Reasonableness in Disclosure**: Presenting information in a manner that an average, reasonable person would consider adequate in making a decision about medical treatment.
7. **Voluntariness**: Refers to a patient's free will in making a decision without coercion or external pressures.
8. **Authorization**: In the context of informed consent, this involves the patient granting permission for a professional to perform a treatment or procedure based on understanding and autonomy.
9. **Surrogate Decision-maker**: A person legally authorized to make medical decisions on behalf of an incapacitated patient.
10. **Therapeutic Privilege**: A situation where a physician may withhold information if disclosure could potentially harm the patient's well-being.
11. **Right to Refuse Treatment**: The patient's autonomy in denying or rejecting medical treatment or procedures, often as a corollary of the right to informed consent.
12. **Reasonable Person Standard**: Evaluating information disclosure based on what an average, reasonable person would consider significant in deciding to undergo a medical procedure.
13. **Subjective Person Standard**: Determining adequate disclosure based on what an individual patient in a particular context would consider significant in their decision-making process.
14. **Justified True Belief**: A philosophical definition of knowledge involving belief that is true and supported by justified reasons.
15. **Defeaters**: Propositions that, if true, would provide evidence contrary to a belief one holds, leading to withholding a firm conviction about that belief.
16. **Legal Representative**: An individual authorized to act on behalf of a patient in legal matters, including decisions about medical treatment.
These terms are crucial within the context of discussing informed consent, patient autonomy, decision-
making standards, and legal aspects of medical care.
The text samples cover various ethical viewpoints related to informed consent and decision-making in healthcare. Here are the key ethical viewpoints addressed:
1. **Autonomy**: Emphasizes the patient's right to self-determination and decision-making regarding their medical treatment. It stresses the importance of respecting the patient's wishes and values, even if they differ from healthcare providers or societal norms.
2. **Beneficence**: The obligation to act in the patient's best interest and provide treatment that maximizes benefits and minimizes harm. It involves promoting the well-being of the patient.
3. **Non-maleficence**: The principle of "do no harm." Healthcare providers have a duty to avoid causing harm to patients and to minimize risks associated with medical procedures.
4. **Paternalism vs. Patient Autonomy**: The balance between the healthcare provider's role in guiding patients toward better health outcomes (paternalism) and respecting the patient's autonomy in making decisions about their own treatment.
5. **Substituted Judgment and Best-Interest Standard**: Ethical considerations when a patient is unable
to make decisions for themselves, including assessing the patient's previously expressed wishes or making decisions in the patient's best interests.
6. **Veracity (Truthfulness)**: The ethical obligation of healthcare providers to provide complete and accurate information to patients about their medical condition, treatment options, risks, and benefits.
7. **Therapeutic Privilege**: The ethical debate surrounding withholding information from patients if revealing it could potentially harm their well-being.
8. **Refusal of Treatment and Limits of Autonomy**: Examining situations where patients refuse treatment, and the ethical considerations in honoring these refusals, especially when the patient's decision may lead to harm or death.
9. **Justice in Healthcare**: Addressing fairness and equity in the distribution of healthcare resources and the rights of patients, including minors and those deemed incompetent.
These ethical viewpoints and principles serve as the foundation for discussions and decision-making processes related to informed consent, patient rights, and the responsibilities of healthcare providers. They help navigate the complex ethical dilemmas that arise in healthcare settings regarding patient care and treatment choices.
Yes, there are references to specific cases and dates in the text. Here are the specifics:
1. **Canterbury v. Spence (1972)**: This case is mentioned in the text regarding informed consent standards. It involved a patient undergoing back surgery where the physician allegedly failed to disclose all the risks involved with the surgery. The court ruled that a material risk should have been disclosed, following a "reasonable person" standard. The case is cited to highlight the importance of adequate disclosure of risks to patients undergoing medical procedures.
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2. **Donald Cowart's case (1973)**: This case involved Donald Cowart, nicknamed "Dax," who suffered severe burns in an accident. Despite his requests to discontinue treatment and allow him to die due to intense pain and life-altering injuries, his requests were ignored, and he was kept alive and treated against his wishes. This case is discussed in the text in the context of patient refusal of treatment and the
ethical dilemmas surrounding honoring these refusals.
These cases serve as illustrations within the text to highlight specific ethical considerations, legal precedents, and challenges related to informed consent and patient autonomy in healthcare decision-
making.
Apologies for the confusion earlier. Upon reevaluation, the text does reference an author named Elke-
Henner W. Kluge in relation to discussing "Incompetent Patients, Substitute Decision Making, and Quality
of Life: Some Ethical Considerations." Kluge's work is mentioned regarding a discussion about incompetent patients, substitute decision-making, and ethical considerations.
3 methods of Paternalism