The Use Of Therapeutic Privilege On Medical Professionals And Their Patients

This research paper is being submitted on December 8, 2011, for Mara Pehkonen’s M230 Medical Law and Ethics Course.

Clearly, confidentiality is essential to the healing process. However, though it may appear to be a relatively easy concept, its application in the therapeutic atmosphere has proven to be quite complex (Younggren & Harris, p. 589). One issue that causes confusion for many professionals pertains to the differences between confidentiality and legal privilege. Quite often, ethical obligations overlap with the legal requirements. Frequently, the practitioner is not well informed about these particular limits on confidentiality and this lack of knowledge can place both the client and the helping professional at risk (Younggren & Harris, p.590, 598).

According to sense two, legal or institutional effectiveness takes precedence. In other words, a subject’s consent is limited to the scope of the rules of the institution. Faden and Beauchamp illustrate that even if a patient autonomously gives her consent, it does not follow that effective consent is given if the requirements of the institution are not met. Consequently, the authors propose that sense one and sense two should both contribute in defining informed consent. Using Jay Katz’s argument, Faden and Beauchamp argue that sense two should satisfy sense one for there to be some type of balance between the two.

Informed consent is the basis for all legal and moral aspects of a patient’s autonomy. Implied consent is when you and your physician interact in which the consent is assumed, such as in a physical exam by your doctor. Written consent is a more extensive form in which it mostly applies when there is testing or experiments involved over a period of time. The long process is making sure the patient properly understands the risk and benefits that could possible happen during and after the treatment. As a physician, he must respect the patient’s autonomy. For a patient to be an autonomous agent, he must have legitimate moral values. The patient has all the rights to his medical health and conditions that arise. When considering informed

Sule stated that, “The Patient Bill of Right adopted by American Hospitals Association states that ‘a patient possesses the right to be informed of the medical consequences of his or her actions and decisions and refuse treatment to the extent permitted by the law’. However, this is true only if the patient is in position to understand the consequences of his treatment. Incompetent, senile patients neither have the correct judgment regarding which treatment is appropriate for them, nor are they in a state of understanding the implications of their treatment. In such case, their willingness to grant or deny consent cannot dictate the course of treatment.” Problem with the Act is being able to find that the patient component enough to make such a call. Another issue that Sule stated was on confidentiality and autonomy. According to Sule, “This is another ethical issue erupting from the conflict of patient's rights and professional ethics in nursing job and profession. The Patient Bill of Right makes it mandatory for the medical practitioners to reveal the form and extent of the ailment along with the course of treatment to be undertaken by the practitioners. However, this law of autonomy clashes with the nursing ethic that the professional should maintain high degree of confidentiality regarding the patient's health and treatment.” This can cause conflicting issues in the NP’s

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)

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?

Patient informed consent refers to the situation where the patient is fully informed on the consequences of their health care decision after which the patient gives the decision. For there to be informed consent, there are five elements that must be discussed. The first is the nature of the patient's decision then the applicable alternatives to the proposed intervention. Third are the risks, benefits and uncertainties associated with each of the alternatives. Fourth is the assessment of the patient's understanding and last is the acceptance of the intervention or an alternative by the patient. Before the patient's consent is considered to be valid, the patient's competency to make the decision must be addressed. The criteria for evaluating the patient's competency is clearly stated in section 3 of the 2005 Mental Capacity Act which states that provided the person is able to understand, retain and use information provided and to communicate their decision in any way such as talking or sign language, they are competent to make a decision. If a patient is treated against their refusal to consent, it amounts to the tort of battery or can also be considered the crime of assault. In addition to this, laws that touch on human rights reinforce the importance of the protection of the physical integrity of the individual in terms of their right to respect of their private life. Therefore, refusal of medical treatment is a human right.

De Bord, J. (2014). ETHICS IN MEDICINE University of Washington School of Medicine. Retrieved from https://depts.washington.edu/bioethx/topics/consent.html

The idea of a privilege to reject treatment was based on fundamental rights to security, break even with assurance under the law, and due process. At the end of the day, automatically hospitalized patients still have a privilege to choose what happens to their bodies. The privilege of a patient to reject treatment depends on five sacred insurances the eighth amendment's assurance against merciless and abnormal discipline the first alteration's assurance of free discourse (opportunity of thought/thoughts) the first revision's assurance of flexibility of religion the all the more extensively translated appropriate to protection the fourteenth amendment's insurance of freedom (the privilege to be free from unjustified interruptions on

It is best demonstrated when patients signs for proposed treatment once they feel fully informed and completely understand what a treatment or procedure entails. The idea of informed consent is based on the principle of autonomy and respect of self-determination. In this paper I am going to present different perspectives of informed consent by different institutions that why it is important to treatment procedure.

The patient has the right to voice grievances and suggest changes in service or staff without fear of restraint or discrimination.

In our day today lives we make complex decisions, continually weighing up the risks and benefits of our actions. However in the hospital environment, the Doctor knows best attitude has prevailed for many years, patients deemed unable to be involved in decisions regarding treatment. Development in law relating to consent has been slow, based on paternalistic approach and therapeutic privilege to decide treatment choice for patients. Whilst health care practice moved towards informed consent, the law lagged behind. In 2015 informed consent has finally been recognised in Law. The author will describe the changing attitude in the law of consent from 1950’s to present day and how these changes affected nurses duty to obtain consent from patients

“Respect for human beings involves giving due scope to peoples capacity to make their own decisions. In the research context, this normally requires that participation be the result of a choice made by the participants” (NHMR, 2007, p.3).  Freegard 2012 (p.60), states that “respecting the rights of others,” includes a responsibility for Health professionals “to let others know about their rights” and that this forms the basis of an informed consent.

The general awareness among patients on their rights during a medical procedure often conflict with the morals of the healthcare industry. Many times healthcare professionals are caught between