Cultural Competence and Informed Consent in Health Care: Confronting a Fetal Abnormality

The concept of paternalism involves the notion that one person, generally a person in a position of authority, has the right to intervene and override the autonomy of another person. In terms of historical context, medicine is one area in which paternalism has occurred frequently. Throughout the ages, physicians and doctors have been placed in a position of authority in which they acted upon the bodies of their patients without those patients’ full knowledge or understanding. However, there has been a distinct shift in modern times regarding paternalism. With the publication of The Silent World of Doctor and Patient, Jay Katz advocated for a new attention to be given to the autonomous control of the patient. Katz noted that historically speaking,

To argue the first premise, he appeals to common knowledge that doctors hold their occupations because they are more knowledgeable in a medical context on the options for improving health and longevity. With this in mind, he then establishes that individuals who consult physicians do so in order to prolong their life and improve their well-being. By establishing these foundational premises for paternalism in a medical context, Goldman can now argue that given a patient that is determined to be acting out of line with his true values and his actions might result in harm that is severe, certain, and irreversible, it is the physician’s professional to override the patients’ immediate rights in order to preserve that patients’ more long-term desires. But how can the physician determine whether the patient is acting in line with his true values in the case of withholding medical information from the patient?

Decision making in the setting of healthcare is influenced by ethical, legal and professional frameworks that provide standards of conduct by appealing to ethical principles, moral rights and virtues (Tonti-Filippini, 2011). These principles give credibility to decision making in healthcare with International and National frameworks (Tonti-Filippini, 2011). Examples include the Universal Declaration of Human Rights, Code of Professional Conduct, the Australian Charter of Heath and the Australian Health Practitioner Regulation Agency (Murray, 2009).

I will argue that it isn’t permissible to withhold information from Merry regarding her medical condition. First, I’ll begin discussing the autonomy and paternalism in the context of the doctor-patient relationship. Second, conceptual issues of ethical dilemma, soft and hard paternalism, and the proposed justification of its implications. Perhaps the strongest argument is how a patient should be treated when they are not acting fully rational.

In the realm of medical ethics, there are many topics that are debated and discussed, but there is not necessarily one clear, correct answer. One of these topics is paternalism. Many questions are bandied back and forth: is it beneficial, should it be disallowed entirely, are there instances when paternalism is good and beneficial, and the list goes on. For each of these questions there have been authors who have provided their comments. One such author is Alan Goldman. He draws a very firm line on paternalism, simply put: medical paternalism is deleterious to a patient because it intrudes on their primary rights of liberty and autonomy. This paper is going to expound upon Goldman’s viewpoint in detail, going through

There comes a time in any health care worker’s life where they have to make difficult decisions. Many physicians have to make tough calls when they try to do what is in the best interest for the patients, and sometimes there are points where the physicians have to ask for help from the patient’s family members and ask what the is in the best interest for the family. This example shows up in the case of Dr. Benitz, the chief neonatal physician at Stanford University which explains that some of the children that show up in his clinic have a very slim chance of surviving he then goes on to explain that one baby that was in the clinic on the day of this interview was born pre mature and “weighed only 13 ounces. This is where Dr. Benitz says he

Even though everyone seemed to agree and felt the same way about the situation, it was difficult to rationalize or logically defend what we felt was the right thing to do, which would involve breaking patient confidentiality. Some of the principles that we thought could be used to defend our position were beneficence, non-maleficence, and utilitarianism. Going back to the Dr. Pellegrino’s article, the population-based ethics, in which the physician takes the role of a social servant for the good of the society, could also be used to defend our position. This discussion served as a motivation to not just learn the ethical principles, but also to become more knowledgeable in how to apply the ethical principles to different situations. It also encouraged me to develop the virtue of prudence in order to be prepared for the tricky situations that may arise in clinical

I could not phantom what my family’s life would be like if my mother had agreed to those risky experimental procedures. I’m so thankful she said no each time because if she’d given in, I don’t know if my father would be here today. This experience has lead me to realize some critical disparities within health care. Healthcare should be provided to everyone. The potential cost of health care can deter persons in need of treatment. Whether a general checkup or an emergency room visit, the expenses that arise from either of these visits can result in a financial burden for patients -- especially the ones who do not have much money to begin with. From how I see it, healthcare is a privilege. Money directly affects health care and treatments. This is turn can question informed consent for proposed medical treatments. One major health care disparity is the proper implementation of informed consent from health care professional to patient. This is an issue because money's influence on health care can deter from what should be in the best interest of the

To support my stand, I will use the Principlism approach articulated by Beauchamp and Childress (B&C) in their textbook principles of biomedical ethics (Beauchamp & Childress, 2013). B & C thoroughly develop and advocate for four principles that lie at the core of moral reasoning in health care: respect for autonomy, nonmaleficence, beneficence, and justice. The reason behind selecting this approach is because these Principles derived from the “common morality” and thus, they are universally binding in all healthcare settings everywhere. The principles are binding regardless of the ethical theory one adhere to or believe in, because everybody recognizes the importance and the strength of the common morality. Consequently, the Principlism approach provides a means for proceeding with ethical analysis even when persons disagree in theoretical matters.

At the start of this this course, I did not think much of how bioethics and legal medicine were connected. Week after week I am beginning to understand how important it is to evolve into a society with guidelines to better serve not only physicians but, all patients as well. In “Medical and Ethical Encounters” by John R. Carlisle, he enlightens us on how in actuality, good practice in law and medicine, is the gateway to superior health care in the united states. In the mid-1970s Beauchamp and Childress formulated a statement known as “the four principles of bioethics. Autonomy of a person to have his say respected by the physician is vital. Beneficence, to always promote health and wellbeing ultimately with an outcome of good over bad. Nonmalfeasance

When medical care providers are forced to make decisions and these decisions “violate one of the four principles of medical ethics” so that they can adhere to

The healthcare industry has taken the stance that every patient has a right to be informed before making health care decisions. The end of the last century saw the development of a healthcare model centered on the patient’s autonomy and choice. This was in attempt to do away with the paternalistic and authoritarian manner that had previously characterized medicine. Paternalism is the substitution of one individual’s judgment (in this instance being a public health professional) in place of another’s decision-making abilities, for the purpose of promoting that individual’s welfare. The new relationship between healthcare providers and a patient is treated as a type of contract that is invalid without the patient’s consent (Showalter, 2004). As Dr. Jane Orient explained, since the Nuremburg Trials consent has been treated as an absolute necessity before any and all medical procedures. She believes that 3rd party encroachments, in this case the government, on the doctor-patient relationship are both dangerous and undemocratic. She claims that they put the doctor in a situation of having to harm their patient and therefore break their Hippocratic Oath to follow public health policy. Dr. Orient also discusses how this medical model is reminiscent of a Socialist State, one that would disvalue the individual in order to

The physician–patient relationship is the quintessential fiduciary relationship because of the vast disparity in knowledge about disease and treatment between the clinician and the typical lay patient. The consequence of this disparity is that the physician has a moral (and ultimately a legal) responsibility to utilize that manifestly superior knowledge exclusively for the benefit of the patient. (Rich, 2005, p. 393)

They did not see morality as part of the medical equation.” What Maslin means is that doctors, rather medical students, care about science and finding cures more than the person they are treating. Not only are people’s lives at stake, but their sense of freedom of living their lives the way they want to. Doctors are just now beginning to realize that their patients are human. Meaning that if someone dies, their family will resent the doctor because they feel like all doctors care about is the next treatment and what the next course of action is.

In the medical field, healthcare professionals need to always look into both major and minor aspects including advancement of medical sciences and technology. The process of selecting, hiring and management in a health care environment should involve the basic hiring criteria, and including knowledge in areas that could be irrelevant with critical thinking and patient needs. In health care, professionals deal with situations and dilemmas that are not usually experienced by general public. This includes the necessity of taking into consideration, the common good of all patients, hence the branch of medical ethics called applied ethics, meaning that it deals with the field of practical application of moral standards that is beneficiary for the patients (Bonnie F. Fregmen, 2012).