Paternalism and Patient Autonomy - PowerPoint PPT Presentation

Loading...

PPT – Paternalism and Patient Autonomy PowerPoint presentation | free to download - id: 47ea63-ZDZiN



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Paternalism and Patient Autonomy

Description:

Vaughn, Chapter 3 What Autonomy is: Autonomy is a person s rational capacity for self-governance Its value is expressed in the Autonomy Principle: Autonomous ... – PowerPoint PPT presentation

Number of Views:405
Avg rating:3.0/5.0
Slides: 22
Provided by: SteveAs7
Learn more at: http://www.philosophicaladvisor.com
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Paternalism and Patient Autonomy


1
Paternalism and Patient Autonomy
  • Vaughn, Chapter 3

2
Autonomy
  • What Autonomy is
  • Autonomy is a persons rational capacity for
    self-governance
  • Its value is expressed in the Autonomy Principle
  • Autonomous persons should be allowed to exercise
    their capacity for self-governance
  • Vaughn, p.51

3
Paternalism, Weak and Strong
  • Paternalism benevolent action irrespective of
    or even contrary to the wishes of the
    beneficiary.
  • The term paternalism comes from Latin, pater,
    meaning father fatherly.
  • As such, Paternalism is always a violation of
    patient autonomy, though it may be justified,
    depending on circumstances.

4
Paternalism, Weak and Strong
  • What paternalism is not
  • Stopping someone from harming others (sometimes
    called delegated police authority)
  • Overriding a patients wishes in order to benefit
    the hospital, doctor, nurse, etc.
  • Overriding the patients wishes when they
    conflict with the health care providers values

5
Paternalism, Weak and Strong
  • Strong Paternalism (sometimes called extended
    paternalism) overriding of a competent
    patients wishes
  • Weak Paternalism (sometimes called cooperative
    paternalism) overriding of an incompetent or
    doubtfully competent patients wishes (Vaughn
    differs a bit, p.52, paragraph 2 prefer ppt
    definition)

6
Paternalism, Weak and Strong
  • Strong Paternalism overriding of a competent
    patients wishes
  • Is Strong Paternalism ever justified?
  • For government
  • To protect the rights of others
  • To protect an overriding state interest (is this
    the basis for prohibiting suicide?)
  • Are these technically paternalistic?

7
Paternalism, Weak and Strong
  • The government, however, has not authorized
    health care providers to use strong paternalism
  • -Garrett et al., p 41, paragraph 2 (Book is cited
    on slide 17 you do not need to retrieve this
    book)
  • Garrett provides
  • inability to know anothers values and
  • the possibility of multiple acceptable choices
  • as reasons to reject strong paternalism.

8
Paternalism, Weak and Strong
  • Weak Paternalism overriding an incompetent or
    doubtfully competent patients wishes
  • Courts have accepted weak paternalist excuses
    when overriding the patients wishes is required
    to relieve the patients serious pain or
    suffering
  • Weak paternalism is also mitigated if exercised
    to gain informed consent. Garrett calls such in
    the service of autonomy. Vaughn says as much p.52

9
Paternalism, Weak and Strong
  • Restraints restraints are justified on weak
    paternalistic grounds when patients are confused
    or disoriented, posing a danger to themselves.
    Their use should include safeguards
  • Periodic patient visits
  • Approval of supervisors and or physicians
  • Written justification

10
Paternalism, Weak and Strong
  • Garrett notes trepidation regarding paternalism
    on p 42
  • we insist that there is no general authorization
    for even weak paternalism. Each case needs to be
    studied, and exceptions should be made
    carefully.

11
Therapeutic Privilege
  • The law has recognized paternalism under the name
    Therapeutic Privilege.
  • Therapeutic Privilege the privilege of
    withholding information from the patient when the
    physician believes that the disclosure will have
    an adverse effect on the patients condition or
    health.

12
Therapeutic Privilege
  • 3 conditions guide the use of therapeutic
    privilege
  • Its use must not be based on generalities, but on
    the actual circumstances of the particular
    patient
  • The physician must have a founded belief, based
    on intimate knowledge of the patient, that full
    disclosure will have a significant adverse effect
    on the patient
  • Reasonable discretion must be used in the manner
    and extent of the disclosure

13
Therapeutic Privilege
  • Garrett dislikes this legal device notes 2
    problems with it
  • Research fails to confirm full disclosure
    adversely effects patient condition or health
  • It is a denial of patient autonomy

14
Futile Treatment
  • Vaughn notes that sometimes physicians and
    patients disagree in reverse the patient wants
    treatment and the physician refuses.
  • Can happen over
  • amputation fetish
  • worthless or unproven drugs, but more often,
  • Sanctity of life v. Futility

15
Applying Major Theories
  • Look at pp 56, 57.
  • Utilitarians will be tempted to use Paternalism.
    Why?
  • How can J.S. Mill think its okay to let someone
    ruin their life (supposing they choose to die or
    shorten their life by refusing treatment)?
  • How can Kantian physicians allow someone under
    their care to commit suicide by refusing
    treatment? Isnt suicide always wrong?

16
Applying Major Theories
  • On page 57, the book says Natural Law theory is
    more paternalistic than Kantian ethics, but
    doesnt say why.
  • Why should it be?
  • What is the doctrine of double effect?
  • Read the six examples under Applications here
    http//plato.stanford.edu/entries/double-effect/

17
Applying Major Theories
  • What would a Virtue Theorist think?
  • How would Aristotle go about deciding whether
    Paternalism is always or never justified?

18
References
  • Vaughn, L. (2010). Bioethics
  • Garrett, T. M., Baillie, H. W., Garrett, R. M.
    (2001). Health Care Ethics (4th Edition)

19
Cases for Evaluation
  • Case 1 Prayer, Medicine, and a Childs Death
  • Do you agree with the courts decision to reverse
    the manslaughter conviction?
  • Should parents have the right to refuse medical
    treatment for their children on religious
    grounds?
  • What moral principle would support your judgment?
  • See the rest on page 60, Vaughn.

20
Cases for Evaluation
  • Case 2 State Paternalism and a Pregnant Woman
  • Do you agree with the Supreme Courts decision?
    Why or why not?
  • Should the state force pregnant women to behave
    in certain ways while carrying a fetus?
  • Is a pregnant woman guilty of fetal abuse if
    she refuses to eat properly?
  • Drinks any amount of alcohol?
  • Forgoes prenatal care?

21
Cases for Evaluation
  • Case 3 Medical Futility
  • Do you agree with the hospitals decision to
    withdraw care?
  • Do you agree with the childs parents?
  • Do you accept the sanctity of life view, or think
    quality of life should determine what to do in
    cases like this?
  • How do you justify your view?
About PowerShow.com