Phil 164 Lecture 8
Phil 164 Lecture 8 Phil 164H
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This 3 page Class Notes was uploaded by Elizabeth on Sunday October 16, 2016. The Class Notes belongs to Phil 164H at University of Massachusetts taught by J. Dixon in Fall 2016. Since its upload, it has received 3 views.
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Date Created: 10/16/16
Phil 164 - Medical Ethics I University of Massachusetts, Amherst Professor Dixon Lecture 7 Katz I. The Prehistory of Informed Consent ○ Informed consent not a thing, just them ○ Hippocratic Oath - give orders, conceal many things from patient ○ 3 arguments against informed consent 1. Dr.s have knowledge patients don’t; patients can’t understood a) Kats Response - can translate knowledge into simpler terms 2. Because of anxieties and consequent regression to child-like thinking, are incapable of comprehending information and making decisions a) Katz response - we do not know if childlike behavior is caused by fear or by Dr.s not giving information; we need more research on it 3. Dr.s commitment to altruism (has patient’s best interest at heart) gives them authority that won’t be abused a) Katz response - Dr.s can’t know what patient wants/needs II. The Age Medical Science and Informed Consent ○ Reason informed consent emerged → many more treatments options today III. The Impact of Law ○ 1950’s-1970’s → started to make laws; Dr.s had to legally inform patients, needed simple consent ○ The laws were the reason consent started being put into practice IV. Barriers to Joint Decisions Making A. Medical Uncertainty ○ Dr.s don’t know everything ○ Hard to inform (for informed consent) when a lot is unknown ○ We have learned of our own ignorance in science B. Patient Incompetence ○ Patients might not be able to comprehend information ○ Pain, anxiety, fear C. Lack of Patient Autonome ○ Autonomy contradicts beneficence ○ Dr.s must give information on alternative treatments not just offer one option V. Respect Autonomy ○ Primacy should be given to autonomy not to beneficence ○ Autonomy > beneficence VI. The Current State of Physician-Patient Decision Making ○ Not close to joint decision making Katz’s Central Argument 1. Can either give primacy to patient autonomy or beneficence 2. Dr.s’ and patients’ interests do not always align a. Financial Interests, wanting no treatment, wanting homeopathic treatment, Dr. have prefered treatments 3. Normal human adults have the right to determine what shall be done with their body and have their wishes/interests considered 4. Primacy of patient autonomy better ensures that premise 3 is realized as opposed to primacy being given to beneficence 5. Thus, patient autonomy should be given primacy over beneficence (in nearly all cases) Evaluating Katz’s Argument ● Doesn’t reference children or incompetent patients ● Doesn’t reference exceptions - are some cases okay to violate patient autonomy? Veatch I. For a clinician to guess at what is the best course for the patient, 3 assumptions must be true regarding the theory of good 1. Clinician must be expected to determine what will best serve the patient’s medical and health interests 2. Clinician must be expected to determine how to trade off health interests with other interests of well-being 3. Clinician must be expected to determine how patient should relate the pursuit of his/her best interests to other moral goals/responsibilities ○ Any theory (hedonistic, desire-fulfillment, objective list theories) comes to the same conclusion: Dr.s cannot determine the best course for a patient II. Well-being is complex and multifaceted 1. Organic well-being vs. other spheres of well-being 2. Only patient can balance the different areas of well-being III. Veatch’s Central Argument 1. If physicians are going to make initial estimate of which treatment best serves the patient’s interests, then they would have to be able to determine 1, 2, and 3, (above; under I.) 2. Physicians cannot adequately determine 1, 2, and 3 3. This physicians cannot adequately propose a course of treatment that serves the patient’s best interests 4. Even if physician could adequately determine 1, 2, and 3, this does not necessarily lead to the right course of action, all things considered 5. Physicians can’t determine what is right, all things considered 6. This physicians should not propose a single course for patient consent without giving alternative IV. Evaluation of Veatch ○ Doesn’t mention exceptions ○ Consequentialism - certain cases right to violate patient autonomy and make decision for them; Veatch didn’t reference this V. Proposed Solution ○ Liberal Alternative - give a giant, full list of all possible treatment options and then patient and doctor come to a conclusion 1. Veatch says this is unrealistic ○ Veatch’s solution - pairing patient and Dr. based on “deep values” Difference between Katz and Veatch ● Both are against best interest standard (Dr. decides what is in the patient’s best interests) ○ Why they think this ■ Katz - patient autonomy ■ Veatch - no matter the theory Dr. cannot know best interests of patient; well-being is too complex ● Katz argues for a list of all possible treatments being given to patient and then the patient makes a decision ● Veatch argues for abandoning informed consent and replacing it with deep value pairing (hoping interests would be more aligned between patient and doctor)
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