Monthly Archives: February 2014

Prisoners Health Care

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We have recently been speaking about access to health information and the responsibility of doctors to tell patients what they believe is important and what will cause unnecessary harm to the patient.
During this conversation I have been questioning the judgment call of doctors for certain patients. For example, if a doctor is forced to treat a patient they strongly dislike – will they give more or less care to the patient? Furthermore, would they unknowingly withhold information simply because they do not like the patient. Of course, we would like to assume that all patient treatment would be exactly the same but this of course is not true. Beyond the doctors’ control, the care will shift slightly for a patient they favor over a patient they dislike.

 

Although a bit of a leap, I began thinking about healthcare and health information in prisons in the United States. As we stress the importance of doctors’ gauge on a patients, health, needs and information; what about patients who doctors may have prematurely judged?

 

As of 2012, there were 1,517, 013 prisoners in the United States. Prisoners have the right to adequate healthcare under the eighth amendment. This means that prisoners should not be subject to cruel and unusual punishment. Clearly this is not the case. Many claims have been main regarding the “deprivation of basic elements of adequate medical treatment”, “deliberate indifference” and most importantly “abuse of discretion”.

 

Of the current inmates approximately 800,000 suffered from a chronic condition that needs regular medical attention such as diabetes, previous heart attacks and hypertension.  Furthermore the treatment rate for mental health ailments tripled for individuals after incarceration. With the Americans prison members older than 55 growing faster than the population at large, may prisons must be prepared to provide them healthcare. This will cost approximately nine times more than healthcare for younger inmates. As the prison population rises, hospitals for prisons are becoming overbooked such as in California, which currently has three hospitals. Prisons must then contract to private hospitals for inpatient care that can cost approximately $850,000 per year for one inmate.

 

It is a raising concern for many that healthcare costs in prisons are continually raising. As the U.S. healthcare suffers from severe budget crisis, prisoners are being moved to hospitals and additional forms of treatment. Doctors treating prisoners are often cited for ignoring patient needs or abusing the right of doctor discretion, a topic we have discussed at length.

 

Knowing this information, the current U.S. healthcare system and the large cost of incarceration it is crazy not to ensure that inmates get the basic care that they deserve. But is it really possible to ensure that they will be receiving ethical care? If prisoners are placed in private hospitals, will that not factor into treatment? Will they be given complete treatment, or treated like a general patient? Is it unethical to do so? How can we ensure that a doctor will be using sound discretion which treating these patients?

 

Sources:

Gardner, Amanda. “Many in U.S. Prisons Lack Good Healthcare.” HealthDay. Jan. 16 2009. Web

 

Klein, Stuart. “Prinsoners’ Rights to Physical and Mental Health Care: A Modern Expansion of the Eight Amendment’s Cruel and Unusual Punishment Clause.” Fordham Urban Law Journal. 1978.  N.pg. Print

 

Williams, Timothy. “Number of Older Inmates Grows, Stress Prisons.” New York Times. N.pg. Jan. 26, 2012. Web.

 

 

(Mis) Informed Consent: A Doctor’s Perspective

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Prior to having read some of assigned essays on informed consent, I believed it to be a relatively cut and dry issue. Many of the articles or videos that I have reviewed on informed consent seem for the most part repetitive. Informed consent is important—a good thing. Without policies that detail protocol doctors must follow in regards to their treatment of patients, who knows how a patient may be taken advantage of? After all “doctor knows best”; if the law does not stand to protect the rights of patient, who will? Should a patient be of sound mind and of age, they should be given full disclosure regarding the purpose of a medical procedure, the risks and benefits, probability of risk as well as alternatives to treatment (Brody, 283).  I am not a doctor and thus am only able to see things from the patient’s side of the informed consent debate. It seems simple, really. For a physician to balk at the idea of thoroughly briefing and obtaining permission regarding what happens to their patients’ bodies is ridiculous, right?

If informed consent is so great, though, why do so many physicians see it in many cases as unnecessary or frivolous? In the process of searching for interesting essays or articles on informed consent from a physician’s perspective, I stumbled upon a brief opinion piece by John Kelly IV, an MD who is a regular writer for Outpatient Surgery Magazine. Although the opinion was humorous, I think it did a decent job of shedding light onto the ways in which informed consent may be good in theory, but not in practice. Two of the problems that he focuses on in particular are “nitpicking” and “catastrophizing” (Kelly). The consent form is a legal document and of course important; however, how explicit do they really need to be? It is one thing to list possible risks for a certain procedure—that is for the patient’s benefit. But how detailed does a doctor need to be in describing a surgery that is a part of their daily routine? Forcing doctors to stress and go back over every word in a consent form is a waste of time and if anything, could cause them to lose respect for and patience in the process of informed consent.

The major issue that doctors seem to be concerned about when it comes to informed consent based upon my and other students’ posts seems to be “catastrophizing”: the idea that being too explicit in the risks of procedures, some of which are incredibly low, can lead to discouraging patients to receive the treatment and care that is essential to their health (Kelly). How much information is too much?

I am not at all saying that the cons of informed consent outweigh autonomy, which is the moral issue at the center of the argument. I do, however, believe that there should be a movement to standardize policy across states to make the issue a little less hazy for all involved as well as help to maximize the use of doctors’ time.  Solutions that I can think of include an official electronic database on which the risks of various standard procedures are outlined so that patients can clearly view the costs and benefits prior to giving consent. Another option would be to hire hospital staff or train current staff to specialize in patient relations; people who can to sit down with individuals and talk them through the risks and alternatives, as well as their doctor’s recommendations.  I am not sure what other solutions have been proposed or initiated; but until a larger solution is settled upon, the autonomy of the patient will continue to trump physician convenience and efficiency, and rightly so.

Citations:

Brody, Baruch A., and H. Tristram. Engelhardt. “Adult Patients: General Issues.” Bioethics: Readings Cases. Englewood Cliffs N.J: Prentice-Hall, 1987. 282-86. Print.

Kelly, John, IV. “Cutting Remarks: (Mis) Informed Consent.” Outpatient Surgery Magazine. N.p., Feb. 2014. Web. 17 Feb. 2014. <http://www.outpatientsurgery.net/outpatient-surgery-news-and-trends/humor-and-jokes/cutting-remarks-mis-informed-consent–02-14>.

Contradictory Choices

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The concept of complexity of respect for personal autonomy is quite complicated.  Autonomy in medical ethics is defined as, “the ability of the person to make his or her own decisions” (Autonomy-Wikipedia).  Several questions such as which request to abide by, and how to know if a patient wants full or partial disclosure are entirely debatable.  In more instances than not patients change their minds regarding treatments, and this brings about the question of which request do we follow?  Childress questions, “Which choices and actions should we respect?  In particular is it justifiable to override a patient’s present autonomous choices and actions in the light of his/her past or (anticipated) future choices and actions?” (Childress, 310)  This is the key question I am going to address in my argument.

When it comes to present versus past or future autonomy, Childress believes that the present autonomous statement is the one to listen to.  I both agree and disagree with parts of this statement.  Firstly, if one is in an autonomous state of mind and is able to make his or her own decisions, then their present statements should be considered.  However, if one’s present autonomous requests completely contradict previous requests I think past autonomous opinions should be weighted more heavily.  As well exampled in Childress’s argument , a woman who has been courageous about her treatment all her life who suddenly decides she wants to stop treatment is acting out of character.  Although this is her present autonomous request, it should not be the end- all- be- all decision, because the authenticity is questionable.

Authenticity is another important concept regarding contradictory choices and is defined as, “an action is consistent with the attitudes, values, dispositions and life plans of the person” (Childress, 311).  As the previous example portrayed, the woman’s authenticity was not intact, because her new rash opinion entirely contradicted what she had previously believed.  Childress also argues that, “it would be a mistake to make authenticity a criterion of autonomy.  At most, actions apparently out of character and inauthentic can be caution flags that warn others to request explanations and justifications to determine whether the actions are autonomous” (Childress, 311).  This, I disagree with, because authenticity should be considered when a new judgment is inconsistent with previous ones.  If a new opinion harshly contradicts years worth of beliefs then wouldn’t it make sense to more heavily consider prior opinions?  Although this is very contradictory, an inauthentic statement should not change everything, it should mean little because long-standing opinions and beliefs more accurately represent one’s true stance.  Another important point brought about by Levi in Respecting Patient Autonomy is that, “..in many cases present autonomous decisions conflict with the interest of preserving or promoting future autonomy, and one must choose between the two.  This situation is perhaps most pressing when autonomous are greatly imprudent and likely to compromise future well-being in addition to autonomy” (Levi, 83).  This statement entirely supports my argument because usually the inauthentic, imprudent judgments of patients that are inconsistent with their character greatly compromises their future well-being.  Overall, I believe that past autonomous decisions that represent years worth of beliefs and opinions should be considered more heavily than rash, present autonomous decisions.

Interesting link regarding Doctors not respecting autonomy and pushing their own beliefs:

Sources:

1.)http://en.wikipedia.org/wiki/Autonomy

2.) Arguing About Bioethics- Holland

3.) Respecting Patient Autonomy- Levi

4.) Pressing Patients to Change Their Minds- Lerner

A Right to Life

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          In his essay “Autonomy and the Refusal of Lifesaving Treatment”, Bruce Miller claims that the concept of autonomous persons requires physicians to put aside any of their values and opinions in an obligation to respect a patient’s wishes (22, 1981). We know that physicians are tasked with the duty to save people’s lives, which makes the perplexing cases Miller brings up rather troubling. Is a person’s autonomy more important than a physician’s obligation to save lives? Miller claims that autonomy has four “senses” we should consider in order to help us answer this question. One of the senses Miller evaluates is “autonomy as effective deliberation”. Autonomy in this sense, Miller claims, occurs when a patient has knowledge of risks, alternatives, etc. and weighs these possibilities rationally (24, 1981). Therefore, the patient is autonomous only by free action (i.e. the patient makes a voluntary choice). This makes case 3, a hard case to understand because the patient wants to have the right to die, even though the treatment does not seem to have any negative side effects from what we read in the passage. This seems highly irrational and MIller believes that in cases like this, the physician is obligated, at the very least to encourage the patient to make a decision that involves effective deliberation as well as authenticity (27, 1981).

          Miller claims that autonomy through effective deliberation is something that is protected by informed consent; the patient should know of the consequences and alternatives and then weighs and evaluates both to come to a logical decision(25, 1981). However, a disturbing case in Canada challenges the principles of autonomy in all of the senses that Miller identifies. A 46-year old man, Mann Kee Li was diagnosed with cancer, but wanted doctors to do everything in their power to save his life. WIth this in mind, physicians decided to order a “do not resuscitate” order upon Li. They argued that any further treatment or intervention would have no benefit to the patient. The hospital’s vice president claims that physicians are not obligated to provide treatment that offer no benefit. Although the doctors might not be able to do anything further to treat Li, an order of a DNR means that should Li’s life suddenly be threatened, doctors are legally obligated not to resuscitate him. It is one thing to question whether or not someone is making an effective deliberation about whether or not they should die rather than receive treatment, but I do not think we can question Li’s effective deliberation that his life is one worth living. One thing that cannot be denied is that a physician’s duty, first and foremost, is to do all they can to save someone’s life. We can argue that a person’s autonomy may or may not outrank this right, but when a patient tells a doctor not that he has a right to die, but that he has a right to live, it seems inhumane not to honor it.

Works CIted

Miller, Bruce L. “Autonomy & the Refusal of Lifesaving Treatment.” The Hastings Center Report. no. 4 (1981): 22-28.

 

Cribb, Robert. “Family, doctors battle over ‘do not resuscitate’ order.” The Toronto Star, , sec. Life: Health and Wellness, Oct. 25, 2010. http://www.thestar.com/life/health_wellness/2010/10/25/family_doctors_battle_over_do_not_resuscitate_order.html (accessed February 16, 2014).

 

Autonomy, Informed Consent, & The Law

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The idea of informed consent has evolved over the years along with changes in medical practice.  In the past, medical care was based on paternalism, in which the doctor knew what was best for the patient.  Now, medical care has become more patient-centered as reflected in the informed consent forms patients sign before medical procedures. According to the article, informed consent is when the physician is required to obtain the patient’s consent after disclosing relevant information about the treatment (Liz et al, 299).  However, does that piece of document really represents its definition or does it simply represent the idea of autonomy?

Although physicians are required to disclose relevant information to patients before obtaining their consent, there are also legal standards as to what information must be disclosed.  Legal standards also vary by state.  For instance, “New York requires only that the practitioner provide information about reasonable foreseeable risks and alternative treatments, while the new Georgia statute requires disclosure of the nature of the treatment, any several specified risks, the likelihood of success, practical alternatives, and prognosis if treatment is declined” (Schuck, 916-917).  States have already designated what physicians must disclose to patients.  But does that leave the patient with any real autonomy?  What if the patient would rather not be provided with the information?  Or what if the patient wanted to be disclosed with all material risks?

Health care has increasingly become a legal matter.  Health care providers not only have a moral duty to act in the patient’s interest, but also a legal duty.  Physicians may find themselves in a court case if he or she did not follow state standards.  In Arato v. Avedon, the court considered a claim made by a deceased pancreatic cancer victim’s widow and children that the physician failed to disclose information concerning the statistical life expectancy of pancreatic cancer patients, which violated their duty to obtain his informed consent.  They claimed that if the patient had been properly informed of the high probability of early death, he would not have gone through painful therapies and would have avoided economic losses due to failure to put business and financial affairs into order.  The court eventually ruled that there was no rule of law that mandated the disclosure of specific information like statistical life expectancy (Schuck, 917-918).  This example makes me question how much influence the state has on informed consent.  The law doesn’t always determine what is moral and immoral.  When people think of informed consent, they usually talk about doctor-patient relationship.  I think it’s important to take into consideration what the law says because it greatly affects people’s actions.  In the court case discussed above, the court ruled in favor of the physician but does that mean the patient actually received all the relevant information regarding his condition?  Maybe yes, maybe no.

The law plays a big part in medical practice.  Not only does it tell physicians what they can and cannot do, it can also shape how people view what is considered informed consent.  The law exists to protect the people.  But is it too influential?  Childress states that “the ideal of autonomy must be distinguished from the conditions for autonomous choice” (309).  People can choose who or what to yield to when making decisions.  But does real autonomy exists when the state can ultimately decide what kind of information patients can receive?  Should the state be determining what is regarded as “important and relevant” information or should that be left up to the patients to decide?  Can patients make a real autonomous decision when a third-party can influence what information is given?

Citations:

Childress, James F. “The Place of Autonomy in Bioethics.” Arguing about bioethics. London: Routledge, 2012. 308-316. Print.

Lidz, Charles W., Meisel, Alan, Osterweis, Marian, Holden, Janice L., Marx, John H., Munetz, Mark R. “Barriers to Informed Consent.” Arguing about bioethics. London: Routledge, 2012. 299-307. Print.

Schuck, Peter. “Rethinking Informed Consent.” The Yale Law Journal 103.4(1994): 899-959. Retrieved from: http://www.jstor.org/stable/pdfplus/797066.pdf?acceptTC=true&acceptTC=true&jpdConfirm=true.

Fear of the Law

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The Canterbury v. Spence case brings our attention to the ethical issues of risk disclosure of a medical procedure. This type of case involves and compares the importance of several pillars of ethics: autonomy, benevolence and malevolence. There seems to be a question that is very difficult to answer, and may differ on a case-to-case basis: Does, “every human being of adult years and sound mind has a right to determine what shall be done with his own body…” (an issue of autonomy) trump a doctor acting in the patient’s best interest and avoiding harm to the patient (benevolence/malevolence)? (https://ereserves.library.emory.edu/reservesViewer.php?reserve=563719) It’s convenient to believe that the legal system keeps people on a moral path and helps people make decisions that are ethically sound and in the best interest of society as a whole. But in some cases, fear of the law may cause more issues than it does good.

Risk of a procedure is not the only type of information that doctors potentially keep from their patients. There is also the issue of disclosing errors that may have occurred during the process of a patient’s care. According to an article in Ghana Medical Journal (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2709172/) doctors often do not tell patients or their families when an error has occurred, whether it be in surgery or anything else related to the patient’s health care. Instead, the doctors and institutions tend to try and cover up these events to avoid legal issues. In this case, the doctors are putting their own well being above that of their patients. According to the report, healthcare errors lead to more deaths than motor vehicle accidents, breast cancer or AIDS in the US. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2709172/).

Putting your life, or the life of a loved one in the hands of a human, capable of error, is an act of immense trust. The article refers to the doctor-patient relationship as fiduciary; “one who owes to another the duties of good faith, trust, confidence and candour”. This is trusting the doctor to act in best interest of the patient. However, can a doctor do that if he is worried about the consequences of an error? If he puts his own well being before that of the patient’s?

In class, we have talked about the importance of intention in ethics. When it comes to health care and medicine, if someone’s life is at stake, people tend to care less about intention and more about the outcome. If an error results in a patient’s death, the family cares little about the doctor’s intention to do good, the focus is on the error that resulted in death. This is the responsibility and punishment that the doctor must shoulder as a casualty of his daily work.

Here we have two different types of disclosure: risk disclosure before a procedure, and disclosure of any errors after a procedure. For the first, the law helps to encourage doctors to share all possible complications with the patient, to avoid lawsuits should anything go wrong. For the second, the threat of the law dissuades doctors from disclosing human error events that may have occurred. This would lead us to the assumption that doctors’ morals are rooted in fear of the law rather then intrinsic human nature.

However, this is not always the case. Like in the Canterbury v. Spence case, doctors sometimes choose to not share some information that they believe may do more harm then good. They take the risk of the potential lawsuit in their effort to do what they believe is best for the patient. In this case, the doctor is putting the patient’s well being above his own. So which is more important, the patient’s autonomy or the doctor’s duty to do what he feels is best for the patient?

 

Citations

Edwin AK. Non-disclosure of medical errors an egregious violation of ethical principles. Ghana Med J. 2009;43(1):34–9. [PMC free article] [PubMed] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2709172/?report=classic

Informed Consent: Opinion Canterbury v Spence https://ereserves.library.emory.edu/reservesViewer.php?reserve=563719 Physicians’ obligations and patients’ rights.

 

Blame House

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housepic

People love to watch the heightened drama of the emergency room and hospital from the comfort of their own couch. They do not have to deal with the emotional stress nor feel faint from the physical sight of blood. All they see are attractive, smart doctors treating patients with ease. But this glamorized medical world is far from reality. Seldom to people recognize the moral dilemmas of medical treatment and professionalism depicted in popular medical television shows like House, M.D. and Grey’s Anatomy.

Faculty from the John Hopkins’ Berman Institute of Bioethics analyzed depictions of bioethical issues and professionalism over a full season of Grey’s Anatomy and House, M.D. and found that “the shows were “rife” with ethical dilemmas and actions that often ran afoul of professional codes of conduct” (Nauert). Informed consent was the most frequently witnessed bioethical issue. In the total of 49 cases, 43 percent were cited as “exemplary” consent, meaning that the depictions portrayed a balanced discussion with the patient about possible treatment options, and the remaining cases were classified as “inadequate” (Nauert). Inadequate depictions involved hurried, one-sided discussions and refusal of physicians to answer patient’s questions, sometimes even complete disregard for the informed consent doctrine (Nauert).

Occasionally, dismissal of informed consent seems justified by positive outcomes, as seen in the following clip from Grey’s Anatomy, when an autopsy is conducted on a deceased patient without the family’s consent: https://www.youtube.com/watch?v=0hgNQni0xdw. However, this is how the screenwriters wanted the situation to play out. In the real world, serious repercussions would obviously accompany the doctors’ rash decision.

While television’s impact on us is limited, it still has an influence on our expectations and beliefs about the world around us. It has shaped our perceptions of many careers like law enforcement and forensic science; medicine is no different. A previous study conducted by one of the co-authors of the article, found that more than 80 percent of medical and nursing students watch medical dramas on television (Nauert). What exactly are aspiring doctors learning from these shows? How do various depictions of ethical issues shape their moral perception of every day patient encounters?

As previously mentioned in other blog posts, physicians do not think informed consent is an “integral part of good patient care” (Lidz et al, 303). Perhaps the popular medical dramas are to blame.

Citations:

Lidz, Charles W., Meisel, Alan, Osterweis, Marian, Holden, Janice L., Marx, John H., Munetz, Mark R. “Barriers to Informed Consent.” Arguing about bioethics. London: Routledge, 2012. 299-307. Print.

Nauert, Rick. “Ethical Failures Found on ‘Grey’s Anatomy’ and ‘House'” LiveScience. TechMedia Network, 30 Mar. 2010. Web. 17 Feb. 2014. http://www.livescience.com/6240-ethical-failures-grey-anatomy-house.html

Canterbury v. Spence

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The opinion in Canterbury v. Spence provides a great opportunity for discourse on the patient’s right to informed consent, which sometimes opposes what the physician may think is best for their patient.  Just as soon as there is a rule regarding guidelines to informed consent, there is bound to be an exception to that rule.

 

As this case so clearly demonstrates, it is far from uncommon for a physician to be sued for malpractice in the event that something has gone wrong.  Because of this constant threat, one might think that doctors would be completely on board with informing their patient as thoroughly as possible, if only to prevent cases like Canterbury v. Spence from happening.  While ideally the fear of malpractice suits should not be the only factor motivating physicians to fully inform their patients, it may be a good starting point.

 

While Dr. Spence claims to have withheld the information because he had the patient’s wellness in mind, it seems reasonable that Canterbury may have been better served by being completely informed.  When a minute but potentially significant risk is involved, it may be better to over share, especially if the patient is of sound mind, as Canterbury allegedly was.  At that point, the patient has all the cards in his hand and makes a fully informed decision. This would also bring into account the relationship between the patient and physician. Ideally, the physician would be able to inform the patient of all potential risks and still trust that the patient would have enough faith in the physician’s educated opinion on what the course of action should be, as the doctor is clearly more well-versed on current medical practice.

 

An interesting point that O’neill brings up in his article “Some Limits of Informed Consent,” is how problematic informed consent can become when relating to issues of public health policy.  The examples he gives are those of water purity levels and food safety requirements.  It is simply not feasible to adjust these levels or regulations to individual choice, and it is unreasonable to assume that each individual would have the knowledge necessary to make a decision like that. The reason we have professionals who devote their lives to this field of study is for precisely that reason, and for the most part, we do well in trusting their expertise.

 

 

Bibliography

O’neill, O. “Some Limits of Informed Consent.” Journal of Medical Ethics 29.1 (2003): 4-7. Print.

 

Knowledge is Power

It’s rare to come across someone who refuses to hear information that is offered. In general, people want to know everything—whether it is ordinary gossip or their medical conditions. Therefore, there are many patients who desire informed consent because they want to know the details and reasons behind the medication they are assigned to take.

Informed consent is when a physician is “obligated to obtain the patient’s consent” and to “disclose relevant information about the treatment before obtaining consent and beginning treatment” (Lidz et al, 299).  However, nowadays, the doctor-patient relationship gap has widened and, as a result, there’s a lack of communication between the two. So, “physicians do not often fully inform” and “patients do not fully understand” because the doctors don’t have the time and/or desire to make those connections with their patients (Lidz et al, 299). So, while the patients should have an input on their medical decisions, it’s really the physicians who make them (Lidz et al, 299).

Time is of the essence. The time the physician has with his patient is limited, so the medical situations are treated as an event as opposed to a process. Lidz and his colleagues said: “medical decisions are processes that emerge and evolve over a period of time, not discrete events that occur only once” (Lidz et al, 300). However, usually, informed consent is given to a patient at a time where the medical decision is already made. For instance, when I was a freshman in high school, I needed knee surgery. I did not know what the surgery entailed until that day. I had an idea of what anesthesia was but I didn’t know exactly how it worked until I was about to go into the surgery room and my anesthesiologist started explaining to me what was going to happen. I remember thinking how fast-pace the process was. While she put the IV in me, she quickly asked me questions about any allergies to anesthesia and quickly explained to me how the medicine worked and how my body was supposed to react. At this point, I was already going into the operating room and even if I did not want to, I had to go through with it.

Though this example may be miniscule, I think it’s extremely important for one to be informed about their medical situation if they want to be. Though time is the main issue, I think it’s important for the physician himself to, at least, summarize a patient’s situation and give him or her a broad idea of the medication the physician is giving them. Additionally, it may be necessary to even discuss the side effects or why alternative medicine is or isn’t possible. However, unfortunately, physicians don’t think that informed consent is an “integral part of good patient care” (Lidz et al, 303) so they don’t make it a point in their limited time to discuss medical details that, perhaps, they should share with their patients.

Patients should be informed. Though the physician should share information, I think it’s up to the patient to ask questions so that they are knowledgeable and, therefore, make decisions for themselves. In The Place of Autonomy in Bioethics, Childress says that the principle of respect for personal autonomy includes being competent, informed, and acting voluntarily (Childress, 309). We should want to have respect for our personal independence by being knowledgeable.

 

Works Cited

Lidz, Charles W., Meisel, Alan, Osterweis, Marian, Holden, Janice L., Marx,
John H., Munetz, Mark R. “Barriers to Informed Consent.” Arguing
about bioethics. London: Routledge, 2012. 299-307. Print.

Childress, James F. “The Place of Autonomy in Bioethics.” Arguing about
bioethics. London: Routledge, 2012. 308-316. Print.

Communication is Key

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People, in general, only want to be communicated with and to know the risks associated with any procedure—be it medical or not. Personally, I believe that doctors should communicate normal risks found with procedures. If there are rare, but life threatening risks, the doctor should mention them out of courtesy, but it should not be required of the doctors. However, I also believe that it is unrealistic for doctors to communicate all of the rare risks associated with said procedures. Patients should research the procedure or medication prior to consenting to it, this way the patient will be able to ask well thought out questions. Because this should be happening, it means that patients need to be aware of what the doctor suggests with plenty of time to research and become used to the idea. Lidz points out that often patients are not fully aware of the procedure and risks until the night before. Perhaps having a group of professionals at a hospital or health care center to fully explain risks and benefits to patients is what is needed. Instead of placing full responsibility on the doctor or nurses, maybe explanations need to be delegated to a special staff trained in communicating with patients.

Patients also need to understand that any medical procedure is unnatural and all procedures carry risks, some more serious than others. It is also important to keep in mind the possible benefits of medical procedures and to weigh the risks and benefits. Because this takes some experience, doctors should clearly explain and give their personal recommendation. Because patients generally do not understand medical terms, it is important for doctors to communicate in simple, everyday terms. This is a barrier that Lidz hints at, but never fully comes out and states. This barrier is one between the knowledge of doctors and the knowledge of patients.

In a way, failing to adequately inform patients of risks is comparable to the food industry failing to inform consumers about the genetically modified food which has been shown to cause health problems. I use this example because, similar to informed consent, it is a topic that is often overlooked. In general, people only want to be aware of risks associated with anything that goes into their body. It is when they unknowingly take medications with severe, common risks that they become reasonably upset.

An interesting blog, written by Dr. Bernstein, brings up the issue of informed consent of “the level of resident participation.” Most patients consent to having a resident on the team during surgery, but often are unaware of how involved the resident is. According to the statistics found in the blog, “consent rates decreased from 94.0% to 18.2% as the level of resident participation increased.” Again, communication between doctors and patients is key to a well working environment to benefit everyone the most.

In conclusion, informed consent has evolved a great deal in the last century. However, there is still room for improvement.

 

 

M. Bernstein. (2013, September 16). Patient Informed Consent for the Teaching Hospital “Trainee” Care: Informing Realistic Scenarios. Retrieved from: http://bioethicsdiscussion.blogspot.com/2013/09/patient-informed-consent-for-teaching.html

Lidz, C. W., Meisel, A., Osterweis, M., Holden, J. L., Marx, J. H., Munetz, M. R. Barriers To Informed Consent. In S. Holland, Arguing about Bioethics (299-307). New York: Routledge.