New: Instructions for exercise 2.
Guest lectures:
Consent issues: treatment vs. experimentation, and competent vs. incompetent persons.
Reibl, 44, had surgery to remove an occlusion in an artery. The reason for the surgery was future risk of stroke, and concern about current headaches and hypertension. The surgery was well performed by Hughes, but the patient had a stroke and became paralyzed. He sued on the grounds that he had not been sufficiently informed of the risk of surgery: of 60-70 such operations performed by the doctor, 8-10 had died. The patient needed another 1.5 years of work to qualify for a pension, and said he would not have had the operation if he had known how risky it is. An Ontario court ruled in favor of the plaintiff, but was overturned by the Ontario Supreme Court, but supported by the Supreme Court of Canada.
Question: Was Hughes liable? Unethical?
The issue: What should doctors do to insure that when patients consent to a procedure they are adequately informed?
Standard 1 (UK): A physician needs to disclose what another physician in a similar situation would disclose.
Standard 2 (US): A physician needs to disclose what an ordinary reasonable person would want to know.
Standard 3 (CDN): A physician needs to disclose what an objective reasonable person in the patient's particular position would want to know.
Subjective: Would the patient have had the operation?
Objective: Would the patient have had the operation if reasonable?
Doctors have a duty to protect health.
People have a right to have health protected by physicians.
Doctors have a duty to disclose risks.
People have a right to determine what is done with their bodies.
Standard of comprehension: information must be pitched at a level that the patient can understand.
Comprehension problems:
Should a patient or the patient's family be responsible for medical decisions?
Should the concept of autonomy be broadened to include family units?
1. Stephen (S.D.). 7 year old boy, severely retarded, blind, no communication, no abilities, in pain. Needs a shunt to survive. Parents deny permission to put in the shunt, but the courts rule that he should get it.
2. Eve. 24 year old moderately retarded woman with aphasia. Her mother wanted to have her sterilized, but the Supreme Court of Canada rejected sterilization.
3. Samantha. 11-year old girl with advancing bone cancer. She does not want more treatment, but her parents do. Eventually, the parents decide to discontinue chemotherapy.
4. Tattoos and piercings.
5. Blood transfusions for Jehovah Witnesses.
1. The patient should always decide.
2. The parent or legal guardian should always decide.
3. Courts may make decisions based on the best interests of the patient.
4. Physicians may decide based on what an ordinary reasonable person would decide under similar circumstances.
5. Proxy decision makers should try to put themselves into the situation of the patient and then decide from that perspective.
1. None?
2. Same rights as other persons?
3. Limited sets of rights?
Computational Epistemology Laboratory.
This page updated Oct. 29, 2012