What ethical principle underpins the Paternalistic Model of Patient-Doctor Relationships?
- Beneficence, Acting in pt best interests
* Typically involves trade-off between beneficence and autonomy
Give Critiques to the Paternalistic Model
- How do we know what is in a person’s best interests?
- Must know more: Patient values, preferences, wishes, particular perspective on their situation as they are an expert in their own life. Would know what would work for them.
- Must include good communication
What ethical principle underpins the Informed Model of Patient-Doctor Relationships?
- Ethical Principle of respect for autonomy
* May compromise beneficence
Critique the Informed Model
- Respect for autonomy is not just about giving information / letting person choose what they want
- Information may reduce autonomy (info overload)
- Need to facilitate autonomy, information presented that is relevant to pt, their values, preferences.
- Requires dialogue and doctors views
- How information is presented influences decisions, potential for manipulation (paternalism within an informed choice)
State why it is important to adopt a patient-centred approach with respect to underpinning shared decision making
- Autonomous decision making involves responsibility for consequences of decision
- Potential psychological harm of living with poor outcome following a decision, risk of informed model
What ethical principle underpins the Shared Model of Patient-Doctor Relationships?
- Facilitates autonomy + Beneficence
- Shares responsibility
- Includes patient and doctor perspective more explicitly
- Requires dialogue
- More complex relationship between pt and dr
Critique the Shared Model
- Patient access to information, ability to process complex information, communication difficulties (e.g. language barrier)
- If value shared decision making need to ensure it is available to everyone (principle of justice)
What is required when making pt your first concern? - GMC States
- Developing a relationship with pt
- Making decisions in the best interests of your pt from their perspective
- Respecting their preference/values (including their preference for model of decision-making)
- This requires dialogue
What is a lie of omission in the medical context?
- Deliberately not providing information that a patient would probably want to know
Use ethical reasoning to identify and critique limits to the obligation to be open and honest with patients about their care.
- Therapeutic Privilege - If telling a patient something may cause them severe harm - Ethical argument in favour of, in specific circumstance, withholding information during consent process, Done for the patient’s benefit
- However, still problematic, who is positioned to determine what is best for patient? Does undermining autonomy harm patient? What if something goes wrong directly related to withheld information
What do patients need to know when things go wrong?
- Patients should be informed as soon as possible - Open and Transparent
- Share all you know/believe about situation including:
- What went wrong
- Why it went wrong
- Possible consequence for the patient
- Explain where there are still uncertainties
- Should also apologise to patient
What is the GMC guidance on saying sorry to a patient?
- (saying sorry) - Implied - Only meaningful if genuine
- What happened
- What can be done to deal with harm caused
- What will be done to prevent someone else being harmed
Describe and differentiate between the statutory and professional duties of candour
- Professional duty of candour - Set out by GMC and failure to comply will result in GMC professional consequence
- Statutory Duty of Candour - Set out by statute - Legal requirement with legal consequences. Formal process triggered by incident resulting in harm to patient dependent on: Level of harm + Cause and effect
Describe key points of GMC guidance on raising concerns relating to patient safety and professional behaviour.
- All Drs have duty to raise concerns where they believe pt safety is compromised by practice of colleagues / systems, policies and procedures in organisations in which they work
- Must also encourage and support a culture in which staff can raise concerns openly and safely
- Justification - Need to ensure pt safety and quality of care
