Philosophy 242 MEDICAL ETHICS SUM2014, M-F, 9:40-10:40, SAV 156 INSTRUCTOR: BENJAMIN HOLE OFFICE HOURS: M-F, 10:40-11  EMAIL: BVHOLE@UW.EDU

Agenda Today Clicker Quiz Discuss some of the “Patient Autonomy” case studies Chapter 5 – “Informed Consent” (lecture) Discuss case studies Tomorrow Continuing discussing case studies about informed consent Special attention to Dax’s Case (and dialogue with Robert Burt) Please set your Turning Technology Clicker to channel 41 Press “Ch”, then “41”, then “Ch”

Non-autonomous action Beneficence Utilitarianism All the above According to the textbook, the overriding of a person’s actions or choices even though he or she is substantially autonomous is called Strong paternalism Weak paternalism Non-autonomous action Beneficence Utilitarianism All the above None of the above

John Stuart Mill endorses strong paternalism. True False

According to the textbook, the ability to render decisions about medical interventions is known as Consent Informedness Full disclosure Competence Voluntariness

Autonomy “A person’s rational capacity for self-governance or self-determination.”

Case Study: Medical Futility “A 17-month-old deaf, blind, and terminally ill* child on life support … declared his case hopeless last month and … that continuing treatment is potentially painful and is prolonging the child’s suffering.” Do you believe that life should be preserved at all costs (the sanctity of life view)? Why or why not? Do you believe that the quality of life is more important than the preservation of life in cases like this? If so, how would you justify your view? *a terminal neurometabolic disorder called Leigh’s disease

life should be preserved at all costs (the sanctity of life view) Strongly Agree Agree Somewhat Agree Neutral Somewhat Disagree Disagree Strongly Disagree

Case Study: Prayer, Medicine, and Death 1990: “David and Ginger Twitchell, a Christian Science couple … who relied on prayer rather than on doctors as their young son lay dying from an obstructed bowel, were convicted of involuntary manslaughter …” 1993: “The Supreme Court of Massachusetts … reversed the manslaughter conviction …” “Do you think that parents should have the right to reject medical treatment for their children on the basis of religious beliefs? What moral principle would support your judgment? Should religious liberty be construed to allow parents to do anything with their children as long as the actions are based on religious considerations? If not, what sorts of actions should and should not be allowed?” (pg. 80)

Parents should have the right to reject medical treatment for their children on the basis of religious beliefs Strongly Agree Agree Somewhat Agree Neutral Somewhat Disagree Disagree Strongly Disagree

Case Study: State Paternalism and Pregnant Women “Should the state force pregnant women to behave in certain ways while carrying a fetus? If pregnant women can be legally punished for “fetal abuse,” how should it be defined? Is a pregnant woman guilty of fetal abuse if she refuses to eat properly? Drinks any amount of alcohol? Forgoes prenatal care? Whose interests should be given greater weight – the woman’s or the fetus’?” (pg, 82)

The state should force pregnant women to behave in certain ways while carrying a fetus Strongly Agree Agree Somewhat Agree Neutral Somewhat Disagree Disagree Strongly Disagree

Informed Consent “The action of an autonomous, informed person agreeing to submit to medical treatment or experimentation.”

Case: Sexual Ethics “Mr. Supervisor makes a series of increasingly less subtle sexual overtures to Ms. Employee. These advances are consistently and firmly rejected by Ms. Employee. Eventually, Mr. Supervisor makes it clear that the granting of ‘sexual favors’ is a condition of her continued employment.” Ms. Employee agrees to grant sexual favors to Mr. Supervisor. Has Mr. Supervisor has gained Ms. Employee’s informed consent? Thomas Mappes, “A Liberal View of Sexual Morality and the concept of Using Another Person”

Mr. Supervisor has gained Ms. Employee’s informed consent Strongly Agree Agree Somewhat Agree Neutral Somewhat Disagree Disagree Strongly Disagree

Conditions of Informed Consent The patient is competent to decide. Competence: the ability to render decisions about medical interventions She gets an adequate disclosure of information. She understands the information. She decides about the treatment voluntarily. She consents to the treatment.

Courts and legislatures have mandated the disclosure of: Informed Consent Courts and legislatures have mandated the disclosure of: The nature of the procedure The risks of the procedure The alternatives to the proposed procedure, including the option of no treatment The expected benefits of the proposed treatment

Informed Consent Waiver—The patient’s voluntary and deliberate giving up of the right to informed consent. Therapeutic privilege—The withholding of relevant information from a patient when the physician believes disclosure would likely do harm

Informed Consent & Ethical Theory Utilitarianism Kantian Deontology Bentham: it always depends … Mill: informed consent is required Informed consent is always required A waiver of consent is probably permissible …

Case Studies “Informed Consent”

Informed Consent or Not? A woman consents to be put on a feeding tube to maintain nourishment. However, later that night she “becomes disoriented and seems confused about her decision to have the feeding tube”. The next day the patient is lucid, says she does not remember being disoriented or confused, and again consents to the feeding tube. Has the woman given her informed consent? Should she be judged competent? Should her final agreement to the procedure be sufficient to establish informed consent, or should her earlier waffling and confusion also be taken into account?

The woman has given her informed consent Strongly Agree Agree Somewhat Agree Neutral Somewhat Disagree Disagree Strongly Disagree

Informed Consent and Organ Transplants “(AP) A woman in her 30s who is one of the four organ transplant patients (who became) infected by HIV and hepatitis (because of the transplant) was not told that the infected donor was high risk” “The donor had engaged in high-risk behaviors, according to a screening questionnaire, but standard testing showed the donor did not have AIDS or hepatitis C.” “If Jane Doe had not become infected with HIV and hepatitis after her transplant, would the failure of the donor network and the university to fully inform her about the donor have been morally wrong?” For fully informed consent, did they need to disclose the risky behavior?

Jane Doe was given her informed consent Strongly Agree Agree Somewhat Agree Neutral Somewhat Disagree Disagree Strongly Disagree

Adolescent Informed Consent “a 14-year-old youth was brought to the pedantic emergency department by his mother for evaluation for altered mental states” “Given the ongoing epidemic of West Nile virus at the time of presentation … the mother was absolutely insistent that a spinal tap be performed” “Because of the assurance of confidentiality, the patient disclosed that he had bought a large amount of dextromethorphan…” Who, if anyone, in this scenario should be allowed to give informed consent to treatment (or no treatment)? Should the physician regard the 14-year-old as a mature minor? What actions should the physician take if she regarded him as a mature minor?

Who, if anyone, in this scenario should be allowed to give informed consent to treatment (or no treatment)? 14-year-old Mother Other