The Pros And Cons Of Shared Decision-Making

The placebo effect has been affecting people for hundreds of years. In the 1940s sugar pills were sold in doctors’ catalogs specifically for the purpose of prescribing them to psychiatric patients. Today, over 60% of doctors admit to prescribing placebos to their patients, although there is an unwritten rule among doctors in the United States that placebos should no longer be given to patients. Some even do it on a regular basis because they believe the effect a fake drug has on the brain is more effective for its price than the real medication or treatment. In the documentary, Placebo: Cracking the Code, viewers see a few different perspective of the placebo effect. They hear from doctors, patients, and researchers to more fully understand the ins and outs of the placebo effect. These different viewpoints serve as an effective way to bring light the producers’ purpose: to show just helpful and sometimes harmful placebo drugs can be.

During my assessment I used the “Seven principles of good prescribing” to aid my decision making (National Prescribing Centre (NPC) 1999). This structured framework allows the prescriber to assess all appropriate factors and problems and make an informed decision whether to issue a prescription or discuss other options with the patient Humphries (2002). Examples of these options would be offering advice about their condition/problem or informing them that the treatment/items they require would be cheaper over the counter, thus making optimum use of the NHS budget, Prescription Pricing Authority (PPA) (2003).

Although the authors agree with Katz on his view of sense one and sense two, they reason that his model of shared decision making is nothing like informed consent. Shared decision making is when the doctor and the patient reach a conclusion that satisfies them both, but the authors do not agree with this notion because it violates the idea of informed consent by involving the doctor’s opinion. In sense one, the second condition states there should be no manipulation or coercion in true informed consent, and shared decision making does not recognize

The definition of exploitation is the use of utilization, mostly in regards of profit. Nowadays, there are many pharmaceutical companies that have a vested interest in profit rather than caring for patients. This false façade will be promoted through randomized clinical trials where data can be easily fabricated. This brings into question whether this is ethical or not – so epistemic information must be examined. However, conducting these randomized clinical trials will bring into detail the method of informed consent and its purpose within equipoise. Miller argues that equipoise is incoherent in terms of its methods as well as the appearance of the step process appearing very deceptive. As for informed consent, there are times where patients

Rarely any physician intends to harm patients when he or she provides treatment to them. Patients see physicians and specialists in full faith that they will get help with a condition. What complicates the patient-doctor relationship is that the outcome of each patient’s treatment is different because of individual health conditions and the course of treatment chosen by the doctor. Problems arise when a patient is not satisfied with care provided by the doctor or in extreme cases when a patient dies. Since most of the time it is hard to clearly determine whether the outcome was solely a result of the course of treatment chosen by the doctor or whether other factors played a role too, quite often patients take their

"Children, young people, their parents or legal guardians, and health care professionals in all settings make decisions about medicines based on sound information about risk and benefit. They have access to safe and effective medicines that are prescribed on the basis of the best available evidence" (Caldwell, 2013).

Another issue with the implementation of Informed consent arises when the patient waives the right to Informed consent and leaves the right to make the decision on the physician. Though legally correct, this can cause psychological stress for the physician especially when the decision is about a life threatening medical condition. Moreover, this also makes the patient vulnerable to abuse. (Manthous, DeGirolamo, 2003)

Autonomy includes three primary conditions: (1) liberty (independence from controlling influences), (2) agency (capacity for intentional action), and (3) understanding (through informed consent) (Beauchamp & Childress, 2009, p. 100). According to Beauchamp & Childress (2009) to respect autonomous agents, one must acknowledge their right to hold views, to make choices, and to take actions based on their personal values and beliefs (p. 103). Respect for autonomy implies thaturges caregivers to respect theassist a patient in achieving? Heed? the autonomous choices of their patients. From there, patients can act intentionally and with full understanding when evaluating medical treatment modalities. Autonomy also includes a set of rules, one of which requires that providers honor patient decision-making rights by providing the truth, also known as veracity (Beauchamp & Childress, 2009, p. 103). In this case, several facets of the principle of respecting autonomy, specifically veracity, informed

Every patient has a right to decide on their own course of treatment and freely consent to that treatment. In order to make an educated decision they must be provided with the proper information to make an informed choice (Opinion 8.08 - Informed Consent, 2006). It is the physician’s legal and ethical obligation to provide this information when making their recommendation on treatment. The choices given must be in accordance with good medical practice (Opinion 8.08 - Informed Consent, 2006). The informed consent is the legal policy, either written or verbal, that gives full disclosure of all the information including potential risks that is applicable to the patient’s condition and treatment being offered (Kazmier, 2008).

I must be aware, as the patient’s advocate, of the choice of each individual patient regarding his or her medical management or, as in this case, the withholding of treatment.

Imagine going to the doctor and being given medication to heal your pain. Now how would you feel if after taking the medication and feeling better you came to find out you were given a placebo? This may sound upsetting to some, however, “ a recent survey of U.S. internists and rheumatologists found that some 50% regular prescribe placebos.” A placebo is defined as a false treatment without any significant chemical properties or active ingredient. The use of placebos as a primary form of treatment with any pathology is not happening anytime soon, but their positive impact and usefulness in the medical field is becoming hard to deny. In the article, “The Magic of the Placebo”, author David Bjerklie attempts to explain the growing change in

Patient's decision-making is influenced by several factors. Patients may change their decisions, from accepting or refusing treatment depending on the available treatment options. The capacity of the individual to make informed medical decisions can differ as the patient's status changes cognitively, emotionally, and/or physically and as the proposed treatment interventions change. Treatment refusal is a common situation faced by clinicians. Patients do not usually refuse the medical advice if the advice is of good intention. When patients refuse an advice, it indicates some underlying reasons related to the patients or family, factors associated with the physician as well as social and organizational issues.

The author believes that biomedical research is the way of better understanding medicine and without randomized clinical trials the field of medicine will have insufficient information. He argues that randomized clinical trials are the most scientifically sound and ethically correct means of evaluating new therapies. The belief of a physician being unethical when running randomized clinical trials is rejected by this article because previous trials on patients can have a better outcome on future patients. This article stresses that randomized clinical trials must be carefully designed that has an intended purpose of gathering data to improve the wellbeing of patients. If the patient is to endure a clinical trial he/she must be properly informed of the risks of the trial and the health of the patient should be high priority. Overall this article explains the importance of randomized clinical trials and debunks the idea of randomized clinical trials as being unethical. This article uses a utilitarian point of view and gives reasons why these trials can be in the best interests for both the patient and society.

Shared decision making should involve both health professionals and patients in discussions about their care. “While health professionals hold the expert clinical and technical knowledge, patients are experts about their own lives and treatment objectives, and also what is important to them when making decisions. (Lally, Macphail, Palmer, Blair and Thomsom, 2011).

Pearson (2013) clarifies “clinical decision making is essential to every aspect of care delivered to a patient” (p. 214). It is the ability to blend information and make decisions that will later be implemented in the situation. Evidence-based decision making involves choosing from a variety of possibilities and combining the knowledge through research and the scientific evaluation of one’s practice. The purpose of this paper is to analyze my decision of administering ativan by advocating for the patient and anticipating her change prior to confirming signs; which provided a therapeutic response.