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Ethics Exam 1
Autonomy and Empowerment
| Question | Answer |
|---|---|
| Autonomy | State of being self-governing Freedom and ability to act in a self-determined manner |
| The Autonomous Person | Acts Intentionally Is Informed Acts Freely |
| autonomous person acts intentionally | The individual has the capacity to determine personal goals and formulate a plan of action deliberately |
| autonomous person is informed | The individual is thoroughly informed about their choices, understanding the risks, benefits, and alternatives |
| autonomous person acts freely | The individual is free from interference, coercion, or undue control by others when making decisions |
| Rights of Autonomy | Right to determine personal goals/ plans of action Liberty to act upon personal choices w/o obstruction Right to determine the course of own treatment or not Inc. decisions r/t end-of-life care Right to appoint decision-maker to act on behalf if can't |
| Legal Precedent | a previous court decision that can be used as a guide when deciding a similar case in the future |
| autonomy legal precedent | Justice Benjamin N. Cardozo ruled - [every person] of adult years and sound mind has a right to determine what should be done with his own body |
| In modern practice, autonomy encompasses | the fundamental rights to confidentiality, informed consent, and the absolute right to refuse treatment |
| Corresponding Duty | Providers have an obligation to provide patients with the information necessary to make informed decisions and to respect voluntary choices |
| corresponding duty: crucially | This includes respecting decisions that clinicians may perceive as "bad" or non-optimal |
| Preventing Harm | Restricting a person's freedom is sometimes considered to prevent that person from experiencing harm or causing harm to other non-consenting persons |
| while preventing harm restricts freedom, | it prevents harm and therefore may be ethically justified in specific circumstances |
| The Paternalistic Approach | Manifests as recommendations or decisions made on behalf of patients that reflect the interests of the clinician, without the patient's full consent or knowledge |
| While paternalism often implies good intentions on the part of the clinician, | it fundamentally undermines the patient’s autonomy by claiming the clinician knows what is "best" |
| cornerstone of patient autonomy | informed consent |
| elements of consent: Threshold | capacity competence voluntariness |
| capacity | The clinically-determined ability to understand and decide |
| competence | The legal ability to understand and decide |
| voluntariness | Having true freedom of choice in deciding without coercion |
| elements of consent: Information | disclosure recommendation understanding |
| disclosure | Full explanation of risks and benefits |
| recommendation | Proposed plan |
| Understanding | Must be demonstrable by the patient |
| elements of consent: consent | decision authorization |
| decision | The patient makes a clear choice in favor of a specific plan |
| authorization | The patient officially approves the chosen plan |
| The Consent Process: interactive dialogue | continuous conversation between patient and provider, not just signing a form |
| The Consent Process: alternatives presented | All viable treatment options, including doing nothing, are explained |
| The Consent Process: risks and benefits | Consequences, discomforts, and potential positive outcomes are thoroughly detailed |
| The Consent Process: opportunities for questions | Patients are given ample time to ask questions and seek clarity |
| The Consent Process: voluntary decisions | Patients demonstrate understanding and make uncoerced decisions |
| Non-Autonomous Persons: when consent is complex | people who can't meet elements of informed consent children under the legal age of consent and individuals who were never mentally competent or have lost competence |
| in cases when consent is complex, | alternative means of maintaining empowerment and decision-making must be utilized |
| maintaining autonomy | advanced directives substituted judgement best interest standard |
| advanced directives | Decisions made while in a competent state regarding future wishes, including Living Wills and Power of Attorney. |
| substituted judgement | Surrogate decision-making based on what the patient would have wanted, requiring intimate knowledge of their values. |
| best interest standard | Decision-making based on what a "reasonable person" would want, weighing risks and benefits when wishes are unknown. |
| AD decisions | Made about health care wishes and preferences while in a competent state, in advance of a debilitated condition |
| AD format | May be formal (written, witnessed, or notarized) or informal (discussions with loved ones or health providers) |
| AD representation | May include the identification of a surrogate decision maker |
| AD treatment scope | May include statements about the kind of treatments one wishes to have performed in various health states |
| Types of Advance Directives | living will durable power of attorney for health care combined directive |
| living will | Directives to healthcare providers, surrogates, and family members regarding wishes for medical treatments when individuals are no longer able to make decisions for themselves |
| durable power of attorney for health care | An individual appoints an agent (aka surrogate or proxy) to make health care decisions when the individual is no longer able to make the decisions for themselves |
| Combined Directive | Combines a Health Care Directive (wishes for treatment) and a Durable Power of Attorney for Health Care (appointment of proxy) into a single document |
| Combines a Health Care Directive (wishes for treatment) and a Durable Power of Attorney for Health Care (appointment of proxy) into a single document. | All 50 states have a form of advance directive legislation Includes “In Good Faith” immunity statutes for clinicians who follow patients’ advance directives |
| While AD Laws vary by state, most: | Define condition the pt must be in for the declaration to become effective or empower agent Define type of Tx that can be foregone Require certification procedures to ensure pt is in the requisite condition Define who can serve as an agent/ surrogate |
| Legal Decisional Authority | 1.Legal Guardian: Court-appointed ind. with primary legal authority 2.Next of Kin: Spouse, child, relative 3.Statutory Surrogate: named by specific statutory or common law provisions 4.The Court: ultimate decision-maker when no other authority present |
| Competence vs. Capacity | competence: The legal ability of a person to give valid, informed consent, determined by a judge in a court of law capacity: The clinical ability of a person to participate in decision making, assessed by healthcare professionals |
| Substituted Judgment | Decision making based on what a patient would have wanted were they able to decide for themselves. Requires extensive knowledge of the individual’s wishes, values, and lifestyle. |
| Best Interest Standard | Decision making based on what a “reasonable person” would want, given the balance of risks and benefits. |
| emergency situations: Consent is legally assumed if: | The patient is incapable of providing consent or refusal Medical treatment is needed immediately to preserve life or prevent serious impairment No one authorized to speak for the patient (proxy, next of kin) is readily available |
| Good Samaritan Laws protect | providers in emergency circumstances, meaning life-saving treatment may be administered without explicit consent |
| Guardianship & Refusal of Treatment: Lifesaving Treatment | Generally, a guardian may not refuse lifesaving treatments on behalf of an incompetent individual The state maintains a compelling interest in preserving life, which typically overrides a guardian's refusal in acute, life-or-death scenarios |
| A guardian may refuse elective care if: | The treatment is excessively risky (high probability of death) It is not obvious that the treatment is strictly necessary The treatment can be safely delayed until the patient potentially regains competence |
| Guardians may legally refuse medical intervention | for persons in a persistent vegetative state (irreversible coma) |
| Treatment may be refused if | the intervention would be completely futile in altering the patient's underlying state or terminal trajectory |
| Treatment may be refused if the intervention would cause | undue suffering without providing a proportional medical benefit to the patient. |
| Facilitating Empowerment | The process of empowerment ultimately comes from within an individual Nurses and clinicians serve as critical facilitators in this process The process is highly interactive, requiring constant dialogue and education |
Created by:
leh195