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Autonomy in medicine
Ethics in the medical field
Importance of medical ethics to a health practioner
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Patient refuses blood
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The ethical and legal issues raised in this case are related to autonomy and beneficence. In health care, autonomy is the right of a competent patient to make informed decisions about the type of health care they would like to receive. This principle is founded on the concept of obtaining consent from the patient before administering any medication or medical procedure. Autonomy provides that a patient who has no mental incapacity has the right to decide whether to agree to medical treatment. This right is not restricted to what others consider as sensible provided the patient has the capacity to make the decisions.
A patent can only make an autonomous decision if they have the capacity to make rational decisions and the decision is not influenced by external constraints. The patient’s decision will be regarded as autonomous if the patient has the capacity to make decisions, has enough information to make the decision and makes the decision voluntarily. Patients who do not have the capacity to make decisions either due to mental issues or loss of consciousness cannot make autonomous decisions about the medical treatment they will receive. In such cases, it is the duty of the doctor to act
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Beneficent acts aim at improving the condition of the patient. It obligates the doctor to act in a manner that furthers the interests of the patient. It follows that the doctor should not inflict harm on the patient, prevent harm, remove harm and promote good. The goal of any medical treatment is to promote the welfare of the patients. Doctors have the capacity to promote the welfare of the patients and as such, their actions should be guided by beneficence. Due to their relationship with the patients, doctors are required to prevent harm as well as weigh the benefits of medical interventions against the risks associated with the procedures (Gillon,
Autonomy is a concept found in moral, political, and bioethical reasoning. Inside these connections, it is the limit of a sound individual to make an educated, unpressured decision. Patient autonomy can conflict with clinician autonomy and, in such a clash of values, it is not obvious which should prevail. (Lantos, Matlock & Wendler, 2011). In order to gain informed consent, a patient
According to Terrence F. Ackerman, as of the 1980s the American Medical Association had to include the respect for a person’s autonomy as a principle of medical ethics (Ackerman 14, 1982). This includes having the physician provide all the medical information to the patient even if the information could cause negative implication onto the patient. The physician is also expected to withhold all information of the patient from 3rd parties (Ackerman 14, 1982). Although it is seen as standard in today’s world, in
The ethical principle of nonmaleficence demands to first do no harm and in this case protect the patient from harm since she cannot protect. Nurses must be aware in situations such as this, that they are expected to advocate for patients in a right and reasonable way. The dilemma with nonmaleficence is that Mrs. Boswell has no chance of recovery because of her increasing debilitating mental incapability and the obvious harm that outweighs the intended benefits. If the decision were to continue treatment, suffering of the patient and family would be evident. Autonomy is the right to making own decisions and freedom to choose a plan of action. When making decisions regarding treatment of another person, it is important to respect the expressed wishes of the individual. John says that his mother would want to live as long as she could, but questions arise related to her quality of life and perception of prolonged suffering by prolonging the dying process. In BOOK states that quality of life changes throughout one’s life ...
In the case study, Betty was adamant in refusing treatment, despite the risks of the illness progressing and potentially leading to death; under the laws of the medical treatment act (1988) any adult who exhibits competency has the right to refuse treatment, even if refusal of care increases the risk to their health, this right is based on autonomy (3). The information outlined suggests that Betty was capable of making a decision as she fulfils all the elements of consent; therefore she is competent and has the right to deny treatment. Betty acknowledges the risks of not receiving treatment and admits that not receiving treatment will make it difficult, demonstrating her sound understanding of the risk and benefits of the outcomes. For a patient to fulfil the element of understanding they must receive, process and incorporate the information they are provided with into their own personal values and Betty demonstrates this level of understanding by sticking to her values, her decision to stay home and by acknowledging the difficulties and risks of not receiving treatment (3). Once Betty received a diagnosis she was informed by the paramedic of the outcomes and potential risks of not receiving treatment for her condition, Betty was sufficiently informed with information and risks relevant to her situation, enabling her to make an informed decision (3). In order for consent to be considered voluntary, a patient must consent to treatment in an environment free of threat and pressure; if a patients decision is genuine they will also accept responsibility for the outcomes and understand the risks (3). Voluntary consent is a slightly grey area in Betty’s scenario, her son is potentially placing pressure on Betty with his demands, however, Betty expresses responsibility by admitting it will be difficult to and
Providers must act in the best interest of the patient and their basic obligation is to do no harm and work for the public’s wellbeing. A physician shall always keep in mind the obligation of preserving human life. Providers must communicate full, accurate and unbiased information so patients can make informed decisions about their health care. As a result of their recommendations, providers are responsible for generating costs in health care but do not generate the need for those expenses. Every hospital has both an ethical as well as a legal responsibility to provide care, even if the care may be uncompensated.
Within public health, the issue of paternalism has become a controversial topic. Questions about the ethics of public health are being asked. The role of ethics in medical practice is now receiving close scrutiny, so it is timely that ethical concepts, such as autonomy and paternalism, be re-examined in their applied context (Med J Aust. 1994). Clinically, patients are treated on a one on one basis, but public health’s obligation is toward the protection and promotion of an entire population’s health. So, based on this difference, the gaping questions targeting public health now becomes, under what conditions is it right to intervene and override an individuals’ autonomy?
Alan Goldman argues that medical paternalism is unjustified except in very rare cases. He states that disregarding patient autonomy, forcing patients to undergo procedures, and withholding important information regarding diagnoses and medical procedures is morally wrong. Goldman argues that it is more important to allow patients to have the ability to make autonomous decisions with their health and what treatment options if any they want to pursue. He argues that medical professionals must respect patient autonomy regardless of the results that may or may not be beneficial to a patient’s health. I will both offer an objection and support Goldman’s argument. I will
This provides people with control over their health care when they cannot speak for themselves. In other words, a health care directive is a legal document recognized by a legislative body to promote autonomy (The Health Care Directives Act, 1992). Autonomy is described as the quality to function independently (Mosby, 2013). Autonomy is the fundamental concept of health care directives, it allows people to openly express their personal values and beliefs, without judgement of health care decisions, “…autonomous decisions as those made intentionally and with substantial understanding and freedom from controlling influences” (Entwistle, Carter, Cribb, & McCaffery, 2010). When all information is provided, the individual can make an informed decision about their health care and have a right to no influencing factors. The health care directive document provide people the opportunity to consent to or refuse treatment and who will have the authority to make decisions on the individual’s behalf if unconscious, or mental incapacity arise (The Health Care Directives Act, 1992). In order to fully practice autonomy, especially in regards to health care directives, the appropriate mental development is key to comprehending
Informed consent is the basis for all legal and moral aspects of a patient’s autonomy. Implied consent is when you and your physician interact in which the consent is assumed, such as in a physical exam by your doctor. Written consent is a more extensive form in which it mostly applies when there is testing or experiments involved over a period of time. The long process is making sure the patient properly understands the risk and benefits that could possible happen during and after the treatment. As a physician, he must respect the patient’s autonomy. For a patient to be an autonomous agent, he must have legitimate moral values. The patient has all the rights to his medical health and conditions that arise. When considering informed consent, the patient must be aware and should be able to give a voluntary consent for the treatment and testing without being coerced, even if coercion is very little. Being coerced into giving consent is not voluntary because others people’s opinions account for part of his decision. Prisoners and the poor population are two areas where coercion is found the most when giving consent. Terminally ill patients also give consent in hope of recovering from their illness. Although the possibilities are slim of having a successful recovery, they proceed with the research with the expectation of having a positive outcome. As stated by Raab, “informed consent process flows naturally from the ‘partnership’ between physician and patient” (Raab). Despite the fact that informed consent is supposed to educate the patients, it is now more of an avoidance of liability for physicians (Raab). Although the physician provides adequate information to his patient, how can he ensure that his patient properly ...
So let’s say this terminally ill patent is already in a vulnerable position whether it is because of family pressures, and/or mental stress from it all. They could also have a medically trained professional swaying them to take their life as well. Physicians are looked up too which makes this scenario seem as though it could happen so easily. Rita Marker, Executive Director, and Kathi Hamlon, Policy Analyst, say that:
In this diverse society we are confronted everyday with so many ethical choices in provision of healthcare for individuals. It becomes very difficult to find a guideline that would include a border perspective which might include individual’s beliefs and preference across the world. Due to these controversies, the four principles in biomedical ethic which includes autonomy, beneficence, non-maleficence and justice help us understand and explain which medical practices are ethical and acceptable. These principles are not only used to protect the rights of a patient but also the physician from being violated.
Will, J. F. (2011). A brief historical and theoretical perspective on patient autonomy and medical decision making: Part ii: The autonomy model. American College of Chest Physicians 139(6), 1491-1497.
This involves incorporation of the decision of the patient whose fate is under consideration. This principle of autonomy leads to informed consent or refusal, whereby treatment should not be initiated in absence of approval by the patient except in cases of emergency. The law supports the principle as a form of justice, provided there is presence of concise evidence supporting the patient's decision. The principle of autonomy highlights the main aspect of the dilemma of withdrawal of life support mechanism, the wellbeing of the patient. Other principles that must be factored in with regards to the patient are the principles of non-maleficence and beneficence, which require that treatment administered must not inflict harmful effects but should have the patient's best interests at heart.
There are principles that must be adheres to when assisting patients with limited capacity. These principles include the inability to: (1) Act; (2) Make decisions; (3) Communicate decisions; (4) Understand decisions; and (5) Retain the memory of decision. Where a patient lacks decision-making capacity, courts may make a declaration that treatment can be given lawfully, even without the patient’s consent. What is informed
...ns. Patients should not be so medically ill that they are unable to make this decision. Patients should be fully conscious and understand the implications of their decision. Everything should be documented possibly even videotaped that way the doctor doesn’t lose their job, receive a lawsuit or worst jail!