University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

98

Pages:

2
Author:

Mariam A. A.

Doctor and patient relationship • Classical view: autonomy, non-malfeasance, beneficence, justice • Ethical processes: accountability, inclusiveness (decisions should be made explicitly with stake-holders views in mind), openness and transparency (decisions should be publically defensible), reasonableness (decisions should be based on reasons i.e. evidence, principles, values), responsiveness (should be opportunities to revisit and revise decisions as new information emerges throughout the crisis) • Ethical values: duty to provide care, equity, individual liberty, privacy, proportionality, protection of the public from harm, reciprocity, solidarity, stewardship, trust Professionalism: body of skills and knowledge, commitment to high standards of service, varying degree of self regulation and autonomy, moral and ethical standards of behaviour 12 Patient preferences – respect for autonomy • Is the patient mentally capable and legally competent? Is there evidence of incapacity? • If competent, what is the patient stating about preferences for treatment? • Has the patient been informed of benefits and risks, understood this information, and given consent? • If incapacitated, who is the appropriate surrogate? Is the surrogate using appropriate standards for decision making? • Has the patient expressed prior preferences, e.g. Advanced Directives? • Is the patient unwilling or unable to cooperate with medical treatment? If so why/ • In sum, is the patient’s right to choose being respected to the extent possible in ethics and law? Quality of life – involves principles of beneficence, nonmaleficence, respect for autonomy • What are the prospects, with or without treatment, for a return to normal life? • What physical, mental and social deficits is the patient likely to experience if treatment succeeds? • Are there biases that might prejudice the provider’s evaluation of the patient’s quality of life? • Is the patient’s present or future condition such that his or her continued life might be judged undesirable? • Is there any plan and rationale to forego treatment? • Are there plans for comfort and palliative care? Medical indications – beneficence and non-maleficence • What is the patient’s medical problem? history? diagnosis? prognosis? • Is the problem acute? chronic? critical? emergent? reversible? • What are the goals of treatment? • What are the probabilities of success? • What are the plans in case of therapeutic failure? • In sum, how can this patient be benefited by medical and nursing care, and how can harm be avoided? Contextual features – loyalty and fairness • Are there family issues that might influence treatment decisions? • Are there provider (doctors and nurses) issues that might influence treatment decisions? • Are there financial and economic factors? • Are there religious or cultural factors? • Are there limits on confidentiality? • Are there problems of allocation of resources? • How does the law affect treatment decisions? • Is clinical research or teaching involved? • Is there any conflict of interest on the part of the providers or the institution?