Micro AETCOM(2.5,2.6,2.

7)

Q) Extent of patient autonomy

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Ans) Extent of Patient Autonomy

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Patient autonomy is the ethical principle that respects a patient’s right to make decisions
about their own healthcare. It is rooted in the belief that individuals have the capacity to
determine what is best for their own well-being. The extent of patient autonomy is
in uenced by the following factors:
1. Informed Consent: Patients must be provided with suf cient information about
their condition, treatment options, risks, and bene ts to make informed decisions.

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Without understanding, autonomy is incomplete.
2. Competence: A patient must have the mental capacity to make rational
decisions. In cases of impaired competence (e.g., minors, unconscious patients, or those
with severe mental illness), autonomy may be limited, and decisions may rely on legal
guardians or surrogate decision-makers.
3. Cultural and Social Context: In some cultures, family or community input is
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considered essential in decision-making, potentially in uencing the individual’s
autonomy.
4. Legal and Ethical Boundaries: While autonomy is fundamental, it is not
absolute. Decisions that endanger public health (e.g., refusal of quarantine) or harm
others may justify restrictions.
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5. Healthcare Provider’s Role: Physicians must balance respecting autonomy with
their duty to ensure bene cence (doing good) and non-male cence (avoiding harm). This
dynamic can sometimes challenge patient autonomy, especially when patients choose
treatments that are not evidence-based or refuse life-saving care.

In summary, patient autonomy is a cornerstone of ethical medical practice but operates

within limits de ned by competence, societal considerations, and the responsibilities of
healthcare providers.
Q) informed consent and informed refusal

Ans) Informed Consent and Informed Refusal in Medical Settings

Informed Consent and Informed Refusal are fundamental principles in medical ethics,
ensuring respect for patient autonomy.

Informed Consent
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Informed consent is the process by which a patient voluntarily agrees to a medical
procedure or treatment after being fully informed about:
1. Nature of the Procedure: Explanation of what the procedure entails.
2. Purpose: Why the procedure is being recommended.
3. Risks and Bene ts: Potential outcomes, side effects, and bene ts.
4. Alternatives: Other treatment options, including no treatment.
5. Right to Withdraw: Assurance that the patient can revoke consent at any time.

Consent can be written, verbal, or implied, but documentation is essential for medico-
legal purposes. It must be given freely, without coercion, and by a competent individual.

Informed Refusal
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Informed refusal occurs when a patient, after being fully informed about the medical
situation and consequences, decides to decline a recommended treatment or procedure.
Healthcare providers must:
1. Ensure Understanding: Con rm that the patient comprehends the risks of
refusal, including potential harm or worsening of the condition.
2. Respect Autonomy: Acknowledge the patient’s right to refuse care, even if the
decision may result in adverse outcomes.
3. Document Refusal: Record the patient’s decision and the details of the
discussion in the medical records.

Both informed consent and informed refusal emphasize the importance of open
communication and respect for the patient’s autonomy, ensuring ethical medical practice
and shared decision-making.
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Q) con ict between autonomy and bene cience

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Ans) Con ict Between Autonomy and Bene cence in Medical Settings

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The con ict between autonomy and bene cence arises when a patient’s right to make

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their own healthcare decisions (autonomy) clashes with the healthcare provider’s duty
to act in the patient’s best interest (bene cence).

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Key Areas of Con ict:
1. Refusal of Treatment: A patient may refuse life-saving treatment (e.g., blood
transfusion due to religious beliefs), challenging the physician’s responsibility to
preserve life.
2. Risky Decisions by Patients: Patients may choose harmful or non-evidence-
based treatments, which can con ict with the provider’s goal of ensuring optimal care.
3. Withholding Information: Physicians sometimes withhold information (e.g.,
poor prognosis) to protect the patient from distress, prioritizing bene cence over
autonomy, which may undermine informed decision-making.
4. Public Health vs Individual Rights: During infectious disease outbreaks,
mandatory isolation or vaccination may prioritize bene cence for society over an
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individual’s autonomy.

Resolution Strategies:
• Shared Decision-Making: Open discussions to balance respect for the
patient’s values with the physician’s professional judgment.
• Ethical Deliberation: Consulting ethics committees or guidelines for dif cult
decisions.
• Legal Considerations: Following legal frameworks to resolve disputes when
necessary.

In summary, the balance between autonomy and bene cence requires careful
navigation to uphold both patient rights and ethical medical care.
 Q) what must informed consent include?

Ans) What Must Informed Consent Include?

Informed consent is a process that ensures a patient voluntarily agrees to a

medical intervention after understanding its implications. To be valid, informed
consent must include the following key elements:

1. Nature of the Procedure

• A clear explanation of the proposed treatment, procedure, or intervention.

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2. Purpose
• The reason for the intervention and its intended bene ts.

3. Risks and Potential Complications

• Information about possible risks, side effects, and complications,
including their likelihood and severity.

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4. Alternatives
• Details about other treatment options, including their risks, bene ts, and
the possibility of choosing no treatment at all.

5. Expected Outcomes
• A realistic understanding of the likely results of the intervention, both
positive and negative.

6. Right to Refuse or Withdraw

• Assurance that the patient has the right to decline treatment or withdraw
consent at any point without facing undue pressure.

7. Assessment of Understanding
• The healthcare provider must ensure the patient comprehends the
information and can make an informed decision.

8. Voluntariness
• Consent must be given freely, without coercion or manipulation.

By including these elements, informed consent respects patient autonomy and

ensures ethical medical practice.
 Q) Elements in decision making: Competency vs Capacity

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Ans) Elements in Decision-Making: Competency vs. Capacity

Competency and capacity are critical concepts in medical decision-making, often

used to evaluate a patient’s ability to make informed healthcare choices.

1. Competency
• De nition: A legal determination made by a court regarding a person’s
overall ability to make decisions.
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• Scope: Broad and applies to all areas of life, not limited to healthcare
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decisions.
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• Authority: Only a judge can declare someone incompetent.
• Implications: If a person is deemed incompetent, a legal guardian or
surrogate is appointed to make decisions on their behalf.

2. Capacity
• De nition: A clinical assessment of a patient’s ability to understand,
appreciate, and make speci c decisions about their healthcare.
• Scope: Task-speci c and context-dependent (e.g., capacity to consent to
surgery).
• Assessment: Determined by healthcare providers based on:
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1. Ability to understand relevant information.
2. Ability to appreciate the consequences of their decisions.
3. Ability to reason and weigh options.
4. Ability to communicate a choice consistently.

Key Differences
• Competency is a legal status; capacity is a medical/clinical evaluation.
• Competency is static unless overturned by the court; capacity can uctuate
based on health, mental state, or context.

Understanding both ensures ethical and effective decision-making in medical

practice.
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Q) DNR(ethical, legal and social aspect)
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Ans) Do Not Resuscitate (DNR): De nition and Aspects

De nition:
A Do Not Resuscitate (DNR) order is a medical directive that instructs healthcare
providers not to perform cardiopulmonary resuscitation (CPR) if a patient’s heart stops
or they stop breathing. The goal is to respect the patient’s wishes and avoid
interventions that may prolong suffering or compromise quality of life.

Legal Aspects:
1. Documentation: A valid DNR order must be clearly documented, signed by
the physician, and based on informed consent from the patient or their legal surrogate.
2. Regional Variations: Laws governing DNR orders vary by jurisdiction, and
failure to follow them may result in legal consequences.
3. Advance Directives: DNRs are often part of advance care planning, where
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patients express their end-of-life preferences in legally binding documents.

Ethical Aspects:
1. Autonomy: Respects the patient’s right to make decisions about their care.
2. Bene cence vs. Non-Male cence: Balances the duty to act in the patient’s
best interest (e.g., reducing suffering) against the principle of avoiding harm through
invasive or unwanted interventions.
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3. Informed Consent: Requires thorough communication to ensure the patient
or their family understands the implications of a DNR order.
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Social Aspects:
1. Cultural Beliefs: Views on DNR orders are in uenced by cultural, religious,
and societal attitudes toward death and dying.
2. Family Dynamics: Families may struggle to accept or respect a patient’s
DNR preference, leading to con icts.
3. Awareness and Stigma: Lack of public understanding can result in stigma or
misconceptions about DNR orders as “giving up” rather than respecting dignity.

In conclusion, DNR orders require careful consideration of legal requirements, ethical

principles, and social sensitivities to ensure they align with patient preferences and
promote compassionate end-of-life care.
Q) Responsibilities of Patient and doctor in shared decision making

Ans) Responsibilities of Patient and Doctor in Shared Decision-Making

Shared decision-making (SDM) is a collaborative process in which patients and doctors

work together to make healthcare decisions that align with the patient’s preferences,
values, and clinical evidence.

Responsibilities of the Patient

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1. Active Participation:

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• Share their preferences, goals, and concerns openly.
• Engage in discussions about treatment options and outcomes.
2. Seek Clari cation:
• Ask questions to fully understand the risks, bene ts, and alternatives of
proposed treatments.
3. Provide Accurate Information:
• Share relevant details about their medical history, symptoms, and lifestyle to aid
decision-making.
4. Make an Informed Choice:
• Weigh options and communicate their decisions clearly after understanding the
implications.

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Responsibilities of the Doctor
1. Provide Evidence-Based Information:
• Explain the diagnosis, available treatment options, risks, bene ts, and outcomes
in a way the patient can understand.
2. Facilitate Understanding:
• Use plain language, visual aids, or interpreters as needed to ensure patient
comprehension.
3. Respect Patient Autonomy:
• Acknowledge and support the patient’s preferences, even if they differ from the
doctor’s recommendations.
4. Guide Without Coercion:
• Offer advice and recommendations without pressuring the patient, ensuring their
decision is voluntary.
5. Monitor and Support:
• Follow up to evaluate the outcomes of the decision and provide ongoing care.

In SDM, both patients and doctors share the responsibility of creating a partnership that
balances medical expertise with individual values for better healthcare outcomes.
Ans) Full and Reasonable Disclosure

Q)and
Full what is fulldisclosure
reasonable and reasonable disclosure?
is a critical component of informedExcpetion to fullensuring
consent in healthcare, disclosure
patients
are provided with suf cient information to make informed decisions about their treatment.

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Key Elements of Full and Reasonable Disclosure
1. Nature of the Procedure:
• Clear explanation of the medical intervention, including its purpose and process.
2. Risks and Bene ts:
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• Discussion of potential outcomes, including side effects, complications, and the likelihood of
success.
3. Alternatives:
• Presentation of other available treatment options, including no treatment, with their respective risks
and bene ts.
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4. Prognosis Without Treatment:
• Explanation of the expected course of the condition if no intervention is undertaken.
5. Uncertainties:
• Acknowledgment of any uncertainties or limitations in the medical knowledge or proposed
treatment.
6. Costs and Logistics:
• Information about nancial implications, recovery time, and other practical considerations when
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relevant.

Exceptions to Full Disclosure

While full disclosure is a cornerstone of informed consent, there are speci c situations where it may not be
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required or appropriate. These exceptions include:

1. Therapeutic Privilege
• De nition: The withholding of information when a physician believes that full disclosure would
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cause signi cant harm to the patient, such as severe emotional distress or a risk of suicide.
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• Ethical Considerations: This must be used cautiously and documented, ensuring it is in the
patient’s best interest.

2. Emergency Situations
• De nition: In emergencies where immediate treatment is required to save a life or prevent serious
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harm, and the patient is unable to provide consent.
• Rationale: Delay in providing treatment to obtain consent could jeopardize the patient’s well-being.

3. Incompetence
• De nition: When a patient lacks the capacity to understand and make decisions due to mental
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illness, cognitive impairment, or unconsciousness.
• Process: Decisions are then made by a legal surrogate or guardian.

4. Waiver by the Patient

• De nition: Patients may voluntarily choose not to receive detailed information about their condition
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or treatment.
• Requirement: The waiver must be explicit, and the physician should con rm that the patient fully
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understands the implications of their choice.

5. Public Health Concerns

• De nition: In cases of infectious diseases or other public health emergencies, full disclosure may
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be limited to prioritize the health and safety of the broader community.