Week 4 & 5

Question 1

what are the 3 situations in which it is okay to interfere with someone’s autonomy? Do words count as violating autonomy?

Answer 1

1. they don’t know or understand what’s happening
2. they are going to harm you
3. they are going to harm another person
   - words don’t count

Question 2

whats the difference between freedom and autonomy?

Answer 2

freedom is always having choice at any given time whereas autonomy is knowingly agreeing to giving up some freedom (ie. going to uni)

Question 3

what are the 4 aspects of autonomy?

Answer 3

1. free action
2. effective deliberation
3. Authenticity
4. moral reflection

Question 4

What is free action?

Answer 4

• can be limited by internal & external forces
• autonomy is not automatic: you must demonstrate the ability to self-rule
• choice matters less than the process from which you came to that decision
• society sets standards and limits by saying what is “poor” or “reasonable” self-rule

Question 5

what is effective deliberations? what is ineffective deliberations caused by?

Answer 5

• a person “ruling themselves” shows good judgement
• good = reasoned (logical, sensible and intelligent) - doesn’t mean everything they choose is right but it means that they were able to articulate the process behind it
• ineffective deliberations can be caused by:
  1. misinformation (deception, lies)
  2. missing information (omission)
  3. mental/cognitive issues (delusions, compulsions)

Question 6

what is authenticity?

Answer 6

• you are being who you truly are, freed from external and internal constraints
• basically not being pressured by other people
• not so obvious often driven by a subtle power

Question 7

what is moral reflection?

Answer 7

• autonomy involves being able to Clearly articulate your values
• do you know why you would choose something or is it something you’ve adopted unconsciously and uncritically?
• if you don’t have an effective reflection you don’t have an effective deliberation

Question 8

what is respect for autonomy?

Answer 8

• can’t respect a patients autonomy by simply not breaking any rules – suggests a virtuous commitment to support the patient’s autonomy (advocate for it)
• respect the patients decision until you feel they are making the wrong choice bc of missing info (get informed consent)
• deliver the msg in a way that the person is in the best position to make the decision for themselves

Question 9

what is informed consent? and what are the 3 things you need for it? what do lawyers say about it?

Answer 9

• we have self-determination in medical matters so we should be treated as medical decisions are our choices as patients:
  1. be reasonably informed
  2. be allowed to make our decisions
  3. have those decisions respected
• informed consent is considered as a protective device against lawyers
• signature on a form might be legally compelling but it is the ethical minimum

Question 10

what does it mean to be “fully informed”? threshold concept?

Answer 10

• no set standard
• “threshold concept”: is where too little of something is wrong and you need to reach a level at which what you’re doing is okay (ethical obligation)

Question 11

Health care Consent Act (HCCA) 1996: what must consent have (4) and what do do with a minor?

Answer 11

1. relate to the treatment
2. be informed
3. be given voluntarily
4. not be obtained through misrepresentation

• minors should agree (ASSENT) –> legally they have no standing but this is the best kind of ethical practice

Question 12

what is on the consent checklist? (6)

Answer 12

1. nature of treatment
2. expected benefits
3. material risks
4. material side-effects: thing that might alter your life that are likely
5. alternatives
6. likely consequences: long-term prognosis

Question 13

royal college of physicians and surgeons of Canada: primary?

Answer 13

primary is not equal to absolute or total, but the weight of the responsibility is on the doctor
- doctors are allowed to delegate but need to make sure it happens

Question 14

what is appropriate information that informs consent? (6)

Answer 14

1. provide patients with all reasonable data
2. possible alternatives
3. risks of all possible procedures
4. without coercion
5. should encourage patients to make their own decisions
6. restrict your comments to your area of expertise

Question 15

what is the noble lie?

Answer 15

• to tell a lie that benefits the deceived person (this is moral behaviour)
• ** not lying to save your own ass

Question 16

how prevalent is lying?

Answer 16

• community members lied in 20% of their social interactions
  students: 33%
• lying was more common in phone calls than face-to-face chats
• 1/7 (14%) of lies are discovered as far the liars could tell
• 1 tenth of the lies were exaggerations while 60% were deceptions
• most lies were subtle (omission)
• more than 70% of liars would tell their lies agin

Question 17

what types of lies are there: False Positives & how common is it

Answer 17

• lies in which people pretend to act like someone or something more than they actually do
• trying to minimize harm that the truth is carry
• 20-30x more common than false negatives

Question 18

what types of lies are there: False Negatives

Answer 18

• lies in which people try to present a lesser opinion of something or someone

Question 19

The truth but not the whole truth: Commission and Omission

Answer 19

• factually accurate but incomplete
• Commission: you know the truth but you say something that isn’t the same - it is intentional and meant to make you think the opposite
• Omission: tell you things that are true but leave out a piece of info that they should really know- intentionally leave out info that matters
• • health care professionals tend to use omission to try and influence decision

Question 20

why has autonomy become such a strong concern in health care? (3)

Answer 20

1. history of patient misuse and abuse
2. rise of individualism and commercialization
3. rise of “informed” patients

Question 21

truthfulness and the rise of autonomy: what was it in the past and what is it now

Answer 21

• was a strongly paternalistic/maternalistic model to a “more autonomous” patient model
• the traditional view of medicine was to emphasize beneficence and truth was dependant on patient welfare

Question 22

Truthfulness vs. Beneficence: how does this relate to being informed about a medical condition?

Answer 22

• patients who are uninformed about their condition may fail to seek medical attention
• they may also make decisions that they wouldn’t have made if they were aware of the condition
• telling patients about their condition helps them find some peace in the knowledge that the doctors/ nurses can name their problem
• the reaction is much less negative than feared if the patient is told (usually don’t tell them bc sacred of how they will react)

Question 23

while being deceived, which of the 4 aspects of autonomy is impacted?

Answer 23

2. Effective deliberation: limits the effectiveness
3. Authenticity: not free of outside control
4. Moral reflection: interferes with the contents of the reflection

Question 24

In what exceptions would the Supreme Court grant that not telling the truth is okay?

Answer 24

• the individual has a condition in which telling the truth would result in them acting out in violence

Question 25

what is confidentiality? and how does autonomy conflict with confidentiality?

Answer 25

- we have the right to privacy - it comes from autonomy and conflicts with autonomy .. how? - the root of autonomy lies in the fact that social stigma could interfere with you going to health services but some times it is required for your identity to no longer be confidential (ie. person has HIV and spreading it)

Question 26

What type of positive effects does truth telling have on the patient?

Answer 26

- Patients adhere to treatment better - They have much higher satisfaction ratings - They have reduced co-morbidity (less pain, etc) They need less intervention

Question 27

what 3 things can happen in the event of an error? and what would the patient like?

Answer 27

1. litigation 2. hostile patients 3. college or hospital discipline - patients are less likely to sue if they get an apology

Question 28

why conduct research>

Answer 28

- research involving humans is premised on a fundamental moral commitment to advancing human welfare, and to examining cultural dynamics

Question 29

why do we need research ethics (3)?

Answer 29

1. correct past problems and abuses 2. prevent new problems and abused 3. law isn't enough

Question 30

what are 2 major past abuses?

Answer 30

1. Nazi Science: conducted research on people in concentration camps - they wanted to test the limits of human physiology (through O2 deprivation and freezing) 2. Tuskagee Institute (Alabama): "Study in Nature" that watched African American men come into a clinic with syphilis and they were not offered treatment so the researchers could see the natural progression of the body

Question 31

what was the Nuremberg Code 1947?

Answer 31

- voluntary consent of the human subject is absolutely essential - you have to agree to be experimented on

Question 32

What was the declaration of Helsinki 1964? (3) What is therapy and research? and what does it say about those in a control group?

Answer 32

* Physician treatment focus Therapy and Research 1. distinction between research where aim is 2. diagnostic or therapeutic for the patient 3. purely scientific without implying therapeutic value to the person subjected to the research - therapy: treating the patients and trying to restore them - research: trying to create and reproduce finding (not primarily focused on the patient) - those in a control group should get the best proven diagnostic and therapeutic method

Question 33

what is the Tri- Council Code?

Answer 33

- joint policy expresses the continuing commitment of 3 Councils to the people of Canada, to promote the ethical conduct of research involving human subjects

Question 34

what are the 4 basic principles of the Tri-Council Code?

Answer 34

1. respect for persons (not the same as autonomy) 2. non-maleficence 3. Beneficence 4. justice

Question 35

what are the 9 guiding ethical principles?

Answer 35

1. human dignity 2. free and informed consent 3. vulnerable persons 4. privacy and confidentiality 5. justice and inclusiveness 6. balancing harms and benefits 7. Non- maleficence 8. minimizing harm 9. maximizing benefits

Question 36

whats the difference with consent in terms of medical patients and research subject? and how is this based on rights?

Answer 36

- medical patient: consent must be respected - research subject: consent must be scrutinized - and can be rejected in the right cases - you have the right to medical care but you don't have the right to be a research patient ( it's your free choice, but not guaranteed to you as an inalienable right)

Question 37

Experiment on inmates? ethical?

Answer 37

- volunteer for dangerous drugs and research bc most of them are looking for someone to write them a parole letter or they need money for canteen (incentive)

Question 38

Experiment with sex workers in Asia and HIV?

Answer 38

- trying to see if your treatment or vaccine will benefit - test on sex workers but this is problematic bc they had lots of participants and they started finding out the women were coming in on buses bc of their pimp to make them get checked out so they were more marketable (did they really consent to this??)

Question 39

what is coercion?

Answer 39

forcible, against your will (not allowed in research)

Question 40

what are vulnerable populations and what are 4 elements of them?

Answer 40

- groups of people who have structural/systematic vulnerability to the powerful who may want research using them - 4 elements of vulnerable pop: 1. Institutionalized disparity of power 2. An inability to respect their own best interests 3. If the pop have to consider punishment or rewards before participating 4. Susceptibility to power

Question 41

what is inducement? what are 4 elements that are involved with it?

Answer 41

reward, ultimately your choice (allowed in research - not if they are undue) 1. something good, a gift, reward 2. seems irresistible 3. inducement causes taking of unusual risk 4. the risk-taking must create unethical or excessively risky situations

Question 42

what is voluntariness and how is this addressed in the case of coercion and inducement?

Answer 42

"would I do this, if I wasn't going to have this bad thing/harm happen?" "would you participate in the research if it turned out that the inducement was "out?"