PHI 237 1st Edition Lecture 12Current Lecture- Patients have right to make medical decision for themselveso Doesn’t mean they have tooo Can transfer right to somewhere elseo Explicit and passive consento One gives explicit by stating orally- Opt in vs opt outo Opt in – organ donations ex. Have to agree that organs be up for donationo Opt out – European … automatically collected unless patient explicitly states they don’t want organ being given to someone elseo Beuacho thinks opt in is better than opt out because maybe opt out wont have enough information given- Change in mind o Can be autonomouso Or caused by stress- Competence judgments vs imperial judgmento Imperial – test from score- Competence – applies to all act that competence applies- Different criteria for different propertiesXII. Intentional Nondisclosure1. Doctors do not have to disclose information in cases of emergency, incompetence and waiver. These are not controversial.- Not problematic- If emergency not enough time to get consent … they don’t ask just od it- Incompetence – some people be delirious or unconscious - Wavier – doesn’t want to be told certain things- Jehovah witness don’t voluntarily consent for transfusion but for life’s to be saved they do that-2. What is controversial is the doctor’s exercise of therapeutic privilege in which info is withheld on the basis that is would harm the depressed, emotionally drained or unstable.- Info withheld because it drains those that aren’t stable- Lose privilege If it is a serious consequence-These notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.3. The therapeutic use of placebos typically involves incomplete disclosure or even intentional deception. - Those who depend on placebos like psychological they can use biological placebos too-4. Arguments against such placebos stress the loss of trust in one’s physician, or clinicians in general, andthe disrespect of the patient’s autonomy by deceptive nondisclosure5. Some defenses of placebo stress consent to an unspecified generic treatment such as an effective medicine. An appeal may also be made to the patient’s prior general consent to the goals of treatment.6. Scientists could not do certain research if they must get the consent of everyone involved in say epidemiological research where hundreds of patient records are examined.7. Sometimes disclosures, warnings and opportunities to decline involvement are legitimately substituted for informed consentXIII. Understanding1. Some argue that patients can’t comprehend enough information or sufficiently appreciate its relevance to make decisions about medical care or research2. Such claims are an overgeneralization from an improper ideal of full disclosure and full understanding.3. Risks can be conveyed in numerical and nonnumerical probabilities. 4. In medical research, as opposed to clinical setting, there is frequently a misunderstanding that the research is therapeutic rather than research to benefit future populations5. Therapeutic misconception has been distinguished from therapeutic misestimation and therapeutic optimism.- Therapeutic misconception is the problem- Therapeutic optimism knows awes of themselves6. Too much information can cause just as much of a problem as too little. Doctors may provide too much information in order to avoid liability. XIV. Voluntariness 1. B and C use voluntary in a narrow form so it is not synonymous with autonomy. They define it as “willing an action without being under the control of another’s influence.”2. Not all influences are controlling. If a physician gets a reluctant patient to undergo a treatment on the threat of abandonment, then the influence is controlling. 3. B and C consider three forms of influence: coercion, persuasion and manipulation. 4. Coercion occurs if and only if one person intentionally uses a credible and severe threat of harm or force to control another- Force by police, hospitals, courts for voluntarily commitment- Doesn’t occur in dire situation- A threat for someone to agree5. Persuasion involves having a person come to believe in something through the power of the reasons put forth. - Persuading someone to agree for the force of reason6. Manipulation is a generic term for several forms of influence that are neither persuasive or coercive. 7. In health care the most common form is informational manipulation, a deliberate act of managing information that nonpersuasively alters a person’s understanding. 8. The most common form of manipulation is rewards, offers and encouragement.XV. A Framework of Standards for Surrogate Decision Making1. Surrogate decision makers are often authorized to make decisions for doubtfully autonomous or nonautonomous patients. 2. Every day surrogates make decisions to terminate or continue treatment for incompetent patients suffering from various cognitively impairing injuries and diseases3. There is a danger that the surrogate will rely more on their own values than those of the patient. This need not be intentional4. Three general standards are the substituted judgment standard, the pure autonomy standard and the patient’s best interests standard. - Have to replicate decision- Beauchant thinks this can be applied when the person is really incompetent- Cant figure out what they want-5. Substituted judgment involves the surrogate to try to decide as the patient would have decided if competent. 6 The surrogate should have a deep familiarity with the patient and his or her values and views. Merely knowing something in general about the patient’s is not adequate. 7. Pure autonomy is sometimes referred to as precedent autonomy. There is a clear statement, perhaps in the form of an advanced directive, about the desired care- Have to be given certain instructions of what’s completed when you loose competent-8. The interesting cases are where the patient is not comatose but conscious and perhaps rather content,though devoid of rationality and have interests that are perhaps opposed to those expressed in the AD9. The Best Interests Standard is relied upon when the patient’s autonomous preferences can’t be determined. - Standard can be abused- But apply it to a person in question not how other people feel-10. The surrogate determines the highest net benefit amongst the various