TOPIC 3

通報

問題一覧

Three specific professional duties entailed by the principle of autonomy

informed consent, veracity, privacy

Moral authority or right to make one’s own decisions

moral autonomy

Recognize moral authority to firm and act on their own judgements about how to live

moral autonomy

It is integral to respect for the dignity and worth of persons

moral autonomy

Implies a negative obligation to refrain from controlling others and a positive obligation to encourage patients to be more independent and responsible for themselves

moral autonomy

Where one exercises one’s moral autonomy

psychological autonomy

Competency to make one’s own decisions and the ability to reason and act rationally

psychological autonomy

Capacity to guide their lives according to their own desires, beliefs and intentions

psychological autonomy

Interfering with others’ liberty to prevent them from harming themselves

weak paternalism

Interfering with others’ liberty for the purpose of promoting their good

strong paternalism

View that physicians are justified in promoting the well being of patients as defined by the physician, regardless of whether the patient gives prior consent

medical patternalism

Forbids physicians from sharing their knowledge with layerpersons, thereby further undermining patients’ abilities to make decisions about their medical care

medical paternalism

Still accepted as temporary measure, such as when health care professionals entirely take over a patients’ medicak decisions during emergency, when the patient is comatose or in shock and relatives are not immediately available

medical patternalism

Defenders of paternalism now argue for restricting its role in medicine

true

Health professionals must respect the informed consent of their patiebts concerning a course of therapy

informed consent

Ongoing process and not something that is finalized with a signature on an intake form

informed consent

At every treatment point in time, patient has a right to know and a right to refuse

informed consent

Pts are given relevant informatuon concerning their condition and treatment options in a manner they can understand so that they can make an informed decision

information

Includes facts about what is involved uh the proposed therapy and alternative therapies, risks and benefits of proposed therapy and of alternative therapies, financial costs and whatever additional information the patient requests concerning therapy

relevant info

Recently proposed and emerged from feminist ethics, would require that providers and patients have a dialogue in which patients define what they uniquely need to know so that the decision is their own individualized decision

dialogical standard

Recognize in some states, defines it as the information that providers in a region agree is important for the patient to know

medical care standard

Says that relevant information is that which any reasonable person would want before making a decision

reasonable person standard or the pridebt patient standars

Patients must be free to make decisions without being coerced or otherwise manipulated

voluntariness

Physically forcing therapy on patients against their explicit desires is the most flagrant violation of this conditio

voluntariness

More common violation is the use of subtle threats or other forms of emptuonal manipulation

voluntariness

Most common of all is the use of deception to guide a patient to make a particular decision

voluntariness

Intentionally misleading a person, by lying, withholding important information, exaggerating, understating or using pretense

deception

Violates both the information and voluntariness conditions, and to that extent those conditions can be viewed as overlapping

deception

Patients must be sufficiently rational or competent to understand and make health care decisions

competence

Competent, autonomous adults fan authorize someone to make decisions for them in the event they become incompetent to make their own decisions

competence

Although psychological capacities and avilities that define autonomy can come in many different quantities, a person must attain some threshold of substantial decision making capacity to be allowed to make health care decisions

legal competency

Determing competency is sometimes complicated, esp bec there are no standardized objective tests with the appropriate reliability and validity to make that determination

legal competency

Relies on prior written or verbal statements made by the person to friends, providers or family

pure autonomy standard

May extend to decisions that conform to religious beliefs or even a consistent pattern of decision making when they were competent

pure autonomy standard

Codifies in law that organizations that accept medicare or medicaid must inform patients that the patients can institute advanced medical directives as well as refuse care

patient self determination act

Two conditions when non compliance is permitted

contrary, conflict with conscience

Guardians may be asked to render a substituted judgment for the patient

second standard

Use their knowledge of the patients and the patient’s history of decision making to imagine what the patient would want under the circumstances

second standard

Guardians base their decisions on what they think is in the best interest of the patient

third standard

Best interest standard can produce ver different decsions from what the patient might actially have chosen to do

third standard

Children younger than 18 years are considered competent

false

Court grabts autonomous healthcare decision making rights to a person younger than 18 yrs

emancipated minor

This award of rights usually goes to young adults whose parents refuse to act on their behalf, as is often the case with children who are thrown away rather than children who elect to run away

emancipated minor

Patients might not have the capacity to make autonomous decisions in some areas of their lives even though they have adequate competency in other areas

limited competency

Recognizes that there are times when otherwise autonomous individuals might be momentarily unable to deliberate thoughtfully and select a course of action

intermittent competency

When under great psychological stress, a person might easily be confused and unaware of choices available or might be unable to make an appropriate choice

intermittent competency

Duty to tell the truth to patients

veracity

Forbids deception or intentionally misleading someone

veracity

Deception undermines autonomy, violates the right to the truth, tends to generate a host of bad consequences and manifests dishonesty

true

The duty of truth telling overlaps the duty of informed consent, but nervetheless it is distinct

true

Rooted in general duty of truthfulness and as such, applies to all information rather than only to information about healthcare procedures

veracity

One of the more recent concerns: reporting medical errors

veracity

Failing to report errors that affect patient safety anf treatment conflicts with this

veracity

Duty to maintain confidentiality to information concerning patients by not divulging it to unauthorized persons

privacy

Scope of duty is broad and includes all information about patients obtained during professional interactions with them

privacy

Consists of any intimate and potentially sensitive information, including that concerning the immediate care provider, addtl health related information, financial information and other potentially sensitive information

privacy

May be compromised legally when medical records are ordered by the courts in criminal investigations

privacy

Reasons why confidentiality is extremely important

trust, respect, understanding, promote healthcare

Have the greates legal protection for the most intimate information about a person, because it is the type of information that is most important for successful diagnosis and treatment in these profession

psychiatry, psychology

Physical therapists are required to inquire about the personal lives of their patients on a deeper level to get to know them more. They should also lead patients to believe that their deepest secrets are legally protected in a court of law

both false

______ is increasingly at risk in health care settings

confidentiality

During hospital stay, a patient might assume only a physicial and few other health professionals have access to confidential medical information, but in fact possibly a hundred individuals, including financial workers, have access

true

Authorized abuses are institutionalized and legally permissible areangements that channel information acquired in health care settings to non health care parties

true

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