Proxy Consent

Deciding for Others

Principle of Informed Consent

• •


concerns the purpose of the procedure, the risks and benefits that are anticipated, the alternative procedures and the hoped for results never be withheld


material must be adapted to the subject's capacities If the patient cannot comprehend, then some third party, usually a family member but sometimes one appointed by the court, should be asked to act in the patient's best interest understands the situation clearly and that no coercion nor undue influence is exercised


Freedom to choose

 Whenever

possible, informed consent on the part of the subject is ethically and legally necessary  Sometimes, however, the subject is not able to give consent

“Hmm…I think I’ll go for option A. That means your getting me a new bag, right?”

 not

a subspecies of informed consent  a substitute for informed consent and is sought when acquiring informed consent is impossible  should be made in view of the good of the individual patient

Basic Conditions
 the

patient or research subject cannot offer informed consent  the person offering the consent ought to determine what the incompetent person would have decided were he or she able to make the ethical decision

Special Considerations

person given the right to make such a judgment for another should be one who knows the person well and who has a loving concern for the well-being of the person for whom the judgment is made if the person who has the right to make this decision decides something which does not seem to be in accord with the good of the patient, other responsible people may challenge the decision of the proxy and even bring the matter before the civil authority

A baby does not exist for society… it is society that exists for the individual, for the baby.


 The

objectives of the doctors are to:

Provide health care for infants and children at the request of the parents care for infants as agents of the community or society

 indicates

that decision making concerning medical therapy for infants and children is a collaborative process  both parents and medical team have an ethical responsibility to strive for the overall well-being of the infant or child


Both medical personnel and parents should be concerned with the overall well-being of the child; not only with the possibility of keeping the child alive • involves more than mere physiological function. • medical personnel must consider social and economic factors as they assess well being • Questions that must be considered:

does this therapy impose more burden than benefit upon the patient or? will this therapy be effective or ineffective insofar as the overall well-being of the patient is concerned ?


States and cities (society) should give high priority to the health and well-being of their children.
• Question: is enough attention and funding devoted by society to the health needs of children? • We are lacking:
  

primary preventative services follow-up rehabilitation chronic care services


In our pragmatic society the notion of protecting and enhancing the life of weak and debilitated infants might become unpopular
• As ethically-minded doctors, we must follow a different path

"No society whether family, village or state, is really strong if it will not carry its weak and even its weakest members. They belong to it no less than the strong, and the quiet work of their maintenance and care which might seem useless on a superficial level, is perhaps more effective than labor, culture, or productivity in knitting it closely and securely together. On the other hand, a community which regards and treats its weak members as a hindrance or even proceeds to their extermination is on the verge of collapse."

In other words… PROTECT ME OR ELSE!!!!

 Consider the goals of specific monitoring,

Addressing Neonatal Issues

diagnostic tests, therapies, or research protocols that are administered.  Center the goals of care on the patient and the family.  The patient is treated, but the family must live with the long-term consequences of the daily decisions made in caring for the baby.

What will be “good” for the baby?

A concept of the good must be refined to reflect the peculiarities of the patients, their conditions, the available treatment alternatives, the values placed upon those alternatives by relevant parties, the likely outcomes of treatment or nontreatment, and the influences of external considerations. Goods that are pursued include health, prevention or elimination of disease or morbidity (including iatrogenic sequelae of treatment), relief of unnecessary pain or suffering, and the prolongation of life.

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