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KEY CONCEPTS IN MEDICAL ETHICS

I.

Informed Consent

a.

Patient makes a free decision to proceed with a medical intervention with a good understanding of the nature and risks of the procedure

b.

Elements of Informed Consent

i.

Threshold:  voluntariness and capacity (see below)

ii.

Information:  disclosure, recommendation, and understanding

iii.

Consent: decision and authorization

II.

Voluntariness

a.

Autonomous authorization from the patient

b.

Freedom to make decision without control by others or use of threat/force

c.

Factors that threaten voluntariness

i.

Consent not valid if obtained by coercion or manipulation

ii.

Physicians must be mindful how they frame information!

III.

Decision Making Capacity

a.

Four aspects of capacity

i.

Understanding- comprehending the medical info

ii.

Appreciation- ability to determine significance of info as it applies to their situation

iii.

Reasoning- comparing alternatives in light of consequences

iv.

Expressing a choice

b.

6 Elements of Capacity

i.

Understanding of condition/treatments

ii.

Intact judgment

iii.

Ability to reason through risks/benefits

iv.

Consistency with previous values

v.

Ability to communicate

vi.

Making a decision

c.

Sliding scale notion of capacity: requirements for determining level of capacity vary depending on complexity, seriousness, or uncertainty of decision

IV.

Disclosure of Information

a.

Disclose information necessary for patient to make a judgment

b.

3 Standards for Disclosure

i.

Professional Standard

ii.

Reasonable person standard

iii.

Subjective standard

c.

7 Elements of Disclosure

i.

Invitation to participate in decision

1.

“I’d like to know how you feel about this”

ii.

The nature of the decision/clinical issue at hand

1.

“This medication would help with…”

iii.

Discussion of alternatives

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