AUTONOMY
- Recognizing patients as persons who are
entitled to such basic human rights such as the
right to know, privacy and right to receive
treatment
- ability of a person to make their own decisions
without interference
- This principle assumes rational thinking on
the part of the individual and may be
challenged when the rights of others are
infringed upon by the individual
PATERNALISM
- Deliberate restriction of people’s autonomy by
health care professionals based on the idea
that they know what’s best for the clients- can
be justifiable at times
- Doing good should take precedence over
autonomy
PRINCIPLE OF AUTONOMY
- The right of the patient to accept or refuse the
physician’s treatment. His option to choose is
based on respect of his free will.
- Essential Elements:
A. The relationship of physician and patient is
governed by a moral contract.
B. The doctor promises to treat his patient
“according to his best judgment.”
C. The doctor, although he believes he knows
best, should fully inform his patient and defer to
the latter’s option to accept or reject the
proposed plans of management.
D. When the patient is incompetent, proxy
consent should be sought.
E. The patient’s right to decide is called
autonomy and should be respected unless his
actions constitute an evil act.
PRINCIPLE OF AUTONOMY
Auto- “self” Nomous- “governing”
Who gives proxy consent?
Power of attorney
Closest of kin
Adult- married- spouse, children of
major age
Below 18- parents, grandparents
No spouse- siblings, uncles/aunts
PRINCIPLE OF AUTONOMY
The doctor can decide:
Doctor can act as loco-parentis
If it is a matter of life and death
Court
E.g. Jehovah’s witness 12 years old
PRINCIPLE OF INFORMED CONSENT
It is a patient’s right to exercise freedom to
make decisions for his/her health. Appropriate
and necessary information are required so that
medical protocols and management may be
done for his interest.
PRINCIPLE OF FREE AND INFORMED
CONSENT
To protect the basic need of every human
person for health care and the person’s primary
responsibility for his or her own health,
(1) no physical or psychological therapy maybe
administered without the free and informed
consent of the patient, or,
(2) if the patient is incompetent, the person’s
legitimate guardian acting for the patient’s
benefit and, as far as possible, in accordance
with the patient’s known and reasonable
wishes.
Elements of Informed Consent
1.Disclosure
2. Understanding
3. Voluntariness
4. Competence
5. Consent
Who are incompetent?
Comatose
Below 18 yrs old
Mentally incoherent
BENEFICENCE
Duty to actively do good for patients
Primary goal of healthcare is to do good for
patients under their care
This principle may create a duty when the law
doesn’t- Doing something out of duty at times
Often conflicts with the principle of autonomy
Beneficent act: A nurse tries to help a patient
from acting on suicidal impulses
Good Samaritan Act
Non-Maleficence
Duty to prevent or Avoid Harm Whether
Intentional or Unintentional
Does not mean avoidance of harm altogether…
avoidance of harm unless the action promises
a greater good
Different issues on euthanasia, withholding and
withdrawing treatment and the use of artificial
nutrition and hydration
PRINCIPLE OF BENEFICENCE AND
NON-MALEFICENCE
(Patient Benefit and Avoidance of Harm)
VERACITY
Duty to tell the truth
Fundamental to the development and
continuance of trust among human beings-
truth telling, integrity and honesty
Every patient has the right to know the truth
At times, patients often suffer when he is told
the truth coldly, directly and clearly; so at times,
the truth is kept from the patient
General rules:
The patient’s right to know the truth
Health care professionals must not lie
“It is never licit to lie; one however is not
obliged to reveal the truth. On certain
occasions, one may be obliged to keep silent”
Guidelines:
Never lie or deceive a patient
One is not always obliged to tell the truth if one
judges that revelation could have a negative
effect on the patient
Sometimes, they may keep silent about the
truth until the right moment to reveal the truth.
At times, reveal it gradually
PRINCIPLE OF TRUTHFUL/PROFESSIONAL
COMMUNICATION
To fulfill their obligation to serve patients,
health care professionals have the
responsibility to do the following:
A. To strive to establish and preserve trust at
both the emotional and rational levels.
B. To share such information as they possess
which is legitimately needed by others in order
to have an informed conscience.
C. To refrain from lying or giving
misinformation.
D. To keep secret information which is not
legitimately needed by others and that if
revealed might harm the patient or others or
destroy trust.
Professional Secrecy
Secret- a thing which must remain hidden
Kinds of secrets:
* Natural secret
- by its very nature ought to remain hidden
despite the absence of an obligation
* Promised secret
- person promises to remain silent about any
event or fact
Ex: “I confide to a friend and he promises not to
reveal it”
* Confided secret
- arises from a commitment acquired before
receiving the information such that the secret
will not be communicated if not preceded by
this commitment
Ex: Professional secrets
Oath of Hippocrates
“My mouth will not make known what my eyes
have seen or my ears have heard or perceived.
My tongue will keep silence on the secrets I
have been confided”
Issues:
Data computerization/ charts
Divulging info to colleagues and friends
(comments in elevators, canteens)
“Famous people”, Names on doors
PRINCIPLE OF CONFIDENTIALITY
The following are subjects of Confidentiality
and should not be revealed to anyone except
for graver cause:
1. Private Secrets
2. Contractual Secrets
3. Professional Secrets
Graver Cause:
Personal decision
Repotable cause
(abuse, communicable)
Legal case (medico-legal)
When does a Secret Cease to Oblige?
One is not bound to keep silent when the
common good or social goods of a higher
degree are at stake
Public welfare prevails over a private good
Only reveal what is necessary to avoid a
greater harm
At times, physician faces a dilemma whether to
tell a spouse about serious medical findings, he
should act with common sense, judge the
goods at stake and act accordingly
“ MEDICINE cannot exist without trust, nor
trust without confidence, nor confidence
without secrecy”