Basic Principles: ABCD AUTONOMY · 08-Oct-16 2 Medical Ethics Copyright by Dr Imran Sabri Intended...
Transcript of Basic Principles: ABCD AUTONOMY · 08-Oct-16 2 Medical Ethics Copyright by Dr Imran Sabri Intended...
08-Oct-16
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AUTONOMY BLOCK 1.1
Dr Imran Sabri Coordinator, Medical Ethics College of Medicine King Faisal University
Copyright by Dr Imran Sabri
Basic Principles: ABCD
1. Autonomy
2. Beneficence: Doing Well
3. Confidentiality
4. Do Not Harm: Non-Maleficence
5. Equality and Fairness: Justice
6. Truth telling
7. Preservation of Life
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Online Teaching Ethics
kfumed.com
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Medical Ethics
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Intended Learning Outcome
Patients Autonomy and Importance.
Rights of Patient
Consent, Decision Taking Capacity, Disclosure, Voluntariness and Truth telling with respect to Patient autonomy .
Ethical and legal Issues in autonomy.
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AUTONOMY
Autonomy, literally meaning self-rule, has been defined as the capacity to think, decide, and act on the basis of such thought and decision, freely and independently (Gillon, 1986).
“Right of patients to make decisions without any influence”.
Allow Doctor to educate but does not allow to make the decision for the patient.
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Case Scenario: Autonomy
A 55-year-old man has a 3-month history of chest pain and fainting spells. You feel his symptoms merit cardiac catheterization. You explain the risks and potential benefits to him, and include your assessment of his likely prognosis without the intervention. He is able to demonstrate that he understands all of this, but refuses the intervention.
Can he do that, legally? Should you leave it at that?
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Discussion
This patient understands what is at stake with his treatment refusal. As he is competent to make this decision, you have a duty to respect his choice. However, you should also be sure to explore his reasons for refusing treatment and continue to discuss your recommendations.
A treatment refusal should be honored, but it should also not be treated as the end of a discussion.
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PATERNALISM
The policy or practice on the part of people in authority of restricting the freedom and responsibilities of those subordinate to or otherwise dependent on them in their supposed interest.
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Rights of Patient to have
Medical Treatment in full dignity
Access information related to treatment
Choices of treatment and No.
Privacy and Confidentiality
Complaint.
Live
Receive respect and honor from doctors
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Autonomy vs
Beneficence Copyright by Dr Imran Sabri
Patient refusing treatment
Fear and Anxiety.
Improper information
Poor Doctor-Patient relation
Incompetency
Financial Burden
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AUTONOMY: WHAT TO DO
1. Respect Patient’s right to make his own decisions
2. Teach patient’s to be able to make their own choices
3. Support patient in their individual choices
4. Do not force patient to do things
5. ‘Informed Consent’ is an important outcome of this principle
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Consent Consent can be defined as the ‘‘Autonomous
Authorization of a medical intervention by individual patients’’ .
Permission for compliance of certain act
Consent has three components:
Capacity,
Disclosure
Voluntariness.
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TYPES OF CONSENT 1. IMPLIED CONSENT.
2. EXPRESSED:
1. Oral or Verbal
2. Written Consent
3. INFORMED CONSENT.
4. Surrogate Consent: Consent given by Legally authorized persons
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Informed Consent
It is consent [Permission] obtained after giving proper information to the patient and the patient understand what is going on.
Requirement of patient understanding:
1. The Nature of Applied Procedure
2. The risk involved in treatment
3. The consequences or outcome of Tt
4. The alternatives treatment
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Competency & Capacity
Ahliyyat is the intellectual capacity to understand, analyze, and judge information.
Capacity is ‘‘functional abilities’’ to make a specific decision.
Patient is psychologically or legally capable of adequate decision-making.
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Requirement of Capacity
Validity: Has to be made when competent
Applicability Have anticipated the situation [Disclosure]
And the implications of the decision
The decision must be Voluntary
What is Your Opinion in ??
Decision taken by a minor [Child]?
Decision Taken by Insane
Decision Taken by Family Members
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DISCLOSURE
It mean to provide provide information about a proposed medical investigation or treatment to the patient.
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Voluntariness
Patient’s right to make treatment decisions and decisions about his or her personal information free of any undue influence.
Voluntariness is an ethical requirement of valid consent.
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Truth Telling
It is practice and attitude of being open with patients
Authenticity and genuineness Doctor and patient relationship.
Avoidance of Lying, Misrepresentation, and Non-disclosure in interactions.
‘‘truth’’ might harm the patient.
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Summary and Conclusion
Autonomy is right of patients to make decisions without any influence
Patients has the right to take treatment or refuse treatment.
Consent, Capacity, Disclosure, Voluntariness, Confidentiality and Truth telling are important components of Autonomy
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Further Reading
The students handbook of Medical Ethics-Y1
Cambridge Textbook of Bioethics.
Ethics of Medical Profession by Saudi Council of Health Specialties.
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Books Recommended
1. Students Handbook of Medical Ethics: Y1 [College Manual]
2. Code of Ethics for Healthcare Practitioners [SCHS]
3. Professionalism and Ethics Handbook for Residents (PEHR): A Practical Guide. [SCHS]
4. Cambridge textbook of Bioethics by Peter A. Singer and A.M. Veins
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References 1. Introduction, Code of Ethics for Healthcare Practitioners,
The Saudi Commission for Health Specialties, Department of Medical Education & Postgraduate Studies, Riyadh 2014. ISBN: 978-603-90608-1-9.
2. http://missinglink.ucsf.edu/lm/ethics/index.htm , University of California San Francisco website last accessed on May 22, 2015.
3. Hussein GM, Alkabba AF, Kasule OH. Professionalism and Ethics Handbook for Residents (PEHR): A Practical Guide. Ware J, Kattan T (eds). 1st Edition. Riyadh, Saudi Arabia: Saudi Commission for Health Specialties, 2015.
4. OH Kasule. “Medical Ethics from Maqasid Al Shari’at”, ISHIM, 4;7. http://www.ishim.net/ishimj/jishim4_7_8/Vol4No7/EDITORIAL.htm
Copyright by Dr Imran Sabri. Email: [email protected]
Copyright by Dr Imran Sabri. Email: [email protected]
Any Further Clarification
Dr. Imran Sabri, MD Coordinator, Medical Ethics
Department of Biomedical Sciences
College of Medicine, King Faisal University,
PO Box No. 400 Al-Ahsa-[31982]. KSA
Tel. [o]. +966-135897810
Email: [email protected]
Web http://www.kfu.edu.sa
Web: www.forensicindia.com
Copyright by Dr Imran Sabri, MD. Email: [email protected]