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College of Nursing
An author contracted a terminal disease. His physician knows of a drug that if taken can prolong his life for ten years. Without the medicine, the prognosis is two to three years. Following the physician’s recommendation, the author takes the medication and starts what he anticipates will be his greatest work. Unfortunately the medication leaves his mind clouded, and he loses his creative ability to write. He is faced with the problem of taking the medication and extending his life by seven to eight years. Without the drug, however, during his remaining two to three years he would be clear minded, which would potentially allow him to finish his work. The author discontinues his treatment against the doctor’s recommendation. His desire to complete his greatest literary From Paternalism to Patient Autonomy Paternalism consist of acting in a way that is believed to protect and advance the interests of another even though the actions may be against the desires, or may in fact limit the freedom of action, of the individual. Provider-Patient Relationship The following are series of hypothetical models used for examination of providerpatient relationship by Robert Veatch: Engineering Model-The physician acts as a scientist who deals only with facts Priest Model-The physician operates from the moral position knowing what is best for the patient. Collegial Model-shared decision-making model where the patient is accorded the right to make decisions and to have control over his own life whaenver significant decisions is to be made. Paternalistic Model: the interaction is designed to assure that the patient makes the decision the best promote his her health and well being. The health provider is functioning in the role of a guardian. Informative Model- the health care provider supplies the patient with al relevant information and allows the patient to select the intervention he or she wishes. Interpretative Model- The interaction in this model id designed to elucidate the patient’s values and what he or she really wants, then to help that patients select the interventions compatible with those values. The health care provider is functioning as a counselor and advisor. Deliberative Model- The health care provider seeks to help the patient determine and choose the best health-care related values that can be realized in the particular clinical situation. Informed Consent Elements of informed consent: Edge R. and Groves J. R. (1999) Ethics of Health Care: A guide for Clinical Practice. C & E Publishing Inc. San Juan Metro Manila. 2nd Edition. pp. 100-113.
Siena College Taytay CHAPTER VII: AUTONOMY VS PATERNALISM: A CONTEST BETWEEN VIRTUES 1. Disclosure: The nature of the condition, the various options, potential risks, the professional’s recommendation and the nature of consent as an act of authorization. 2. Understanding: IN the US most states require that the physician provide information at a level that a hypothetical reasonable patient would understand. 3. Voluntariness: No efforts towards coercion, manipulation, or constraint are allowed. The patient must be in a position to practice self-determination. 4. Competence: Decision in regard to competence usually takes into account experience, maturity, responsibility and independence of judgment. 6. Consent: Autonomous authorization of the medical intervention.
College of Nursing
Standards of Disclosure Professional Community Standard- Based on the concept that the practitioner and patient were bound in a fiduciary relationship in which the difference in levels of information and patient trust binds the professional to act in the patient’s behalf without allowing any conflict of interest. Reasonable Patient Standard-Holds the amount and kind of information needed that which a hypothetical reasonable person would need in order to understand the nature of the condition and the various options. Patient-Centered Standard-Relies on the unique nature and abilities of the individual patient to determine the amount of disclosure needed to satisfy the requirements of informed consent. Competency Determination Common Factors used in Decisions Regarding Patient Competence 1. The patient’s ability to make choices about care. 2. The patient’s consistency with his own values. 3. Age 4. Nature of the illness. 5. The attitudes and values of the physician responsible for the decision. 6. The clinical setting. Ad litem- is a guardian appointed to prosecute or defend a suit on behalf of a party who is legally incapable of doing so, such as an infant or an insane person. Brain-dead- an individual who has no clinical evidence of brain function upon physical examination. This includes no response to pain and no cranial nerve reflexes. Reflexes include pupillary response (fixed pupils), oculocephalic reflex, corneal reflex, no response to the caloric reflex test and no spontaneous respirations. Persistent vegetative state (PVS)- a condition of patients with severe brain damage in whom coma has progressed to a state of wakefulness without detectable awareness. Do not resuscitate (DNR) order- a written order from a doctor that resuscitation should not be attempted if a person suffers cardiac or respiratory arrest. Such an order may be instituted on the basis of an advance directive from a person, or from Edge R. and Groves J. R. (1999) Ethics of Health Care: A guide for Clinical Practice. C & E Publishing Inc. San Juan Metro Manila. 2nd Edition. pp. 100-113.
Siena College Taytay CHAPTER VII: AUTONOMY VS PATERNALISM: A CONTEST BETWEEN VIRTUES someone entitled to make decisions on their behalf, such as a health care proxy; in some jurisdictions, such orders can also be instituted on the basis of a physician's own initiative, usually when resuscitation would not alter the ultimate outcome of a disease, and is designed to prevent unnecessary suffering.
College of Nursing
Edge R. and Groves J. R. (1999) Ethics of Health Care: A guide for Clinical Practice. C & E Publishing Inc. San Juan Metro Manila. 2nd Edition. pp. 100-113.