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Questions and Answers
The paternalistic model of doctor-patient relationship promotes patient autonomy.
The paternalistic model of doctor-patient relationship promotes patient autonomy.
False
The collaborative model allows for discussion and development of patient values in medical decision-making.
The collaborative model allows for discussion and development of patient values in medical decision-making.
True
The informative model provides patients with options based solely on the physician's beliefs.
The informative model provides patients with options based solely on the physician's beliefs.
False
In the interpretive model, the physician helps clarify the patient's values when they are unclear or confused.
In the interpretive model, the physician helps clarify the patient's values when they are unclear or confused.
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Cultural and religious beliefs have no impact on the doctor-patient relationship.
Cultural and religious beliefs have no impact on the doctor-patient relationship.
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An 8-year-old girl who has had a tonsillectomy can be discharged immediately if there are no complications.
An 8-year-old girl who has had a tonsillectomy can be discharged immediately if there are no complications.
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A physician should always order unnecessary tests to avoid potential malpractice lawsuits.
A physician should always order unnecessary tests to avoid potential malpractice lawsuits.
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The modern version of Hippocrates' Oath emphasizes the importance of avoiding overtreatment.
The modern version of Hippocrates' Oath emphasizes the importance of avoiding overtreatment.
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According to Rachel Naomi Remen, comfort with uncertainty is an important skill for physicians.
According to Rachel Naomi Remen, comfort with uncertainty is an important skill for physicians.
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A CT scan is always necessary for evaluating lower back pain.
A CT scan is always necessary for evaluating lower back pain.
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The Hippocratic oath promotes the idea of non-maleficence and beneficence.
The Hippocratic oath promotes the idea of non-maleficence and beneficence.
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Paternalism in medicine refers to a partnership model between doctors and patients.
Paternalism in medicine refers to a partnership model between doctors and patients.
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Artificial limbs are considered an advance in regenerative medicine.
Artificial limbs are considered an advance in regenerative medicine.
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Immunisation is unrelated to advancements in genetics.
Immunisation is unrelated to advancements in genetics.
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The concept of confidentiality is highlighted in the Hippocratic oath.
The concept of confidentiality is highlighted in the Hippocratic oath.
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The Nuremberg Trials were focused on advancing medical technology.
The Nuremberg Trials were focused on advancing medical technology.
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The relationship between a doctor and patient is characterized by a power differential.
The relationship between a doctor and patient is characterized by a power differential.
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Bioethics emerged from the need to address scandals in the medical profession.
Bioethics emerged from the need to address scandals in the medical profession.
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Beneficence refers to the ethical obligation to act for the harm of patients.
Beneficence refers to the ethical obligation to act for the harm of patients.
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Paternalism involves always honoring a patient's preferences regardless of the situation.
Paternalism involves always honoring a patient's preferences regardless of the situation.
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The principle of nonmaleficence means to 'do no harm'.
The principle of nonmaleficence means to 'do no harm'.
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Negligence can be classified as intentional malpractice.
Negligence can be classified as intentional malpractice.
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The strengths of the four principles include their universal appeal and ability to avoid moral relativism.
The strengths of the four principles include their universal appeal and ability to avoid moral relativism.
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One of the weaknesses of the four principles is that they capture the complexity of real life.
One of the weaknesses of the four principles is that they capture the complexity of real life.
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Distributive justice includes the allocation of scarce treatment for patients.
Distributive justice includes the allocation of scarce treatment for patients.
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Nudging involves imposing decisions on individuals.
Nudging involves imposing decisions on individuals.
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The principle of respect for autonomy is considered to overlook community values and cultural autonomy.
The principle of respect for autonomy is considered to overlook community values and cultural autonomy.
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Humans exhibit 'bounded rationality', leading them to sometimes make decisions contrary to their best interests.
Humans exhibit 'bounded rationality', leading them to sometimes make decisions contrary to their best interests.
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The most effective nudging message for organ donation was 'Please donate if you can.'
The most effective nudging message for organ donation was 'Please donate if you can.'
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It is essential for doctors to listen effectively to their patients.
It is essential for doctors to listen effectively to their patients.
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The four principles of biomedical ethics include Justice, Nonmaleficence, Respect for Autonomy, and Charisma.
The four principles of biomedical ethics include Justice, Nonmaleficence, Respect for Autonomy, and Charisma.
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Patients have the right to self-determination in their treatment decisions.
Patients have the right to self-determination in their treatment decisions.
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Doctors are obligated to keep a patient's medical information confidential.
Doctors are obligated to keep a patient's medical information confidential.
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Nudging should be coercive in order to be effective.
Nudging should be coercive in order to be effective.
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An elective tonsillectomy requires overnight hospitalization for observation if there are no complications.
An elective tonsillectomy requires overnight hospitalization for observation if there are no complications.
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It is ethically permissible for a physician to order unnecessary tests to prevent a malpractice lawsuit.
It is ethically permissible for a physician to order unnecessary tests to prevent a malpractice lawsuit.
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A patient experiencing lower back pain should always receive a CT scan for evaluation.
A patient experiencing lower back pain should always receive a CT scan for evaluation.
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The modern version of Hippocrates’ Oath emphasizes the importance of combining warmth and sympathy with medical science.
The modern version of Hippocrates’ Oath emphasizes the importance of combining warmth and sympathy with medical science.
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Dr.Banerjee had a duty of care towards the three night watchmen who drank arsenic-laced tea.
Dr.Banerjee had a duty of care towards the three night watchmen who drank arsenic-laced tea.
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The duty of care begins only when a doctor physically examines a patient.
The duty of care begins only when a doctor physically examines a patient.
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Rachel Naomi Remen advocates that physicians should be uncomfortable with uncertainty in medical situations.
Rachel Naomi Remen advocates that physicians should be uncomfortable with uncertainty in medical situations.
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Engaging in critical reflection helps doctors improve their professional behavior towards patients.
Engaging in critical reflection helps doctors improve their professional behavior towards patients.
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Patients living with chronic diseases do not face any significant challenges.
Patients living with chronic diseases do not face any significant challenges.
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Evidence-based medicine (EBM) is unrelated to the clinical care of individual patients.
Evidence-based medicine (EBM) is unrelated to the clinical care of individual patients.
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Social and cultural influences can impact how patients access the healthcare system.
Social and cultural influences can impact how patients access the healthcare system.
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The principles of therapeutics do not concern any ethical issues.
The principles of therapeutics do not concern any ethical issues.
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High-quality communication is essential for successful patient-physician relationships.
High-quality communication is essential for successful patient-physician relationships.
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Beneficence refers to the ethical principle of acting for the benefit of patients.
Beneficence refers to the ethical principle of acting for the benefit of patients.
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Confidentiality is not considered an important aspect of patient care.
Confidentiality is not considered an important aspect of patient care.
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The principle of non-maleficence is summarized as 'do good' for patients.
The principle of non-maleficence is summarized as 'do good' for patients.
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Justice in medical ethics involves fair distribution of medical resources.
Justice in medical ethics involves fair distribution of medical resources.
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Informed consent is a component of patient autonomy.
Informed consent is a component of patient autonomy.
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Beneficence is the ethical obligation to act for the benefit of patients.
Beneficence is the ethical obligation to act for the benefit of patients.
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Paternalism refers to the complete disregard of a patient's best interests in medical decisions.
Paternalism refers to the complete disregard of a patient's best interests in medical decisions.
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The principle of nonmaleficence is summarized by the phrase 'Do harm'.
The principle of nonmaleficence is summarized by the phrase 'Do harm'.
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Negligence is considered unintentional harm occurring due to a lack of due care.
Negligence is considered unintentional harm occurring due to a lack of due care.
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Distributive justice involves ensuring equal access to all types of healthcare without consideration of resource limitations.
Distributive justice involves ensuring equal access to all types of healthcare without consideration of resource limitations.
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A significant weakness of the four principles is their ability to capture the complexity of real-life ethical situations.
A significant weakness of the four principles is their ability to capture the complexity of real-life ethical situations.
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The process of informed consent requires a patient to be provided with all necessary information for decision-making.
The process of informed consent requires a patient to be provided with all necessary information for decision-making.
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Manipulation of information is not a form of paternalism.
Manipulation of information is not a form of paternalism.
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Nudging is a method that imposes decisions on individuals.
Nudging is a method that imposes decisions on individuals.
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Humans having 'bounded rationality' means they can sometimes make decisions against their best interests.
Humans having 'bounded rationality' means they can sometimes make decisions against their best interests.
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The principle of beneficence refers to the obligation to do harm to patients.
The principle of beneficence refers to the obligation to do harm to patients.
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Patients have the right to self-determination but may still be encouraged toward better choices.
Patients have the right to self-determination but may still be encouraged toward better choices.
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The most successful organ donation message was 'Would you accept an organ if you needed one, if so please help others'.
The most successful organ donation message was 'Would you accept an organ if you needed one, if so please help others'.
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The principle of nonmaleficence means to actively promote patient harm.
The principle of nonmaleficence means to actively promote patient harm.
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Listening is a critical aspect of the doctor-patient relationship, as important as prescriptions.
Listening is a critical aspect of the doctor-patient relationship, as important as prescriptions.
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Choice architecture can help nudge individuals toward decisions that align with their best interests in healthcare.
Choice architecture can help nudge individuals toward decisions that align with their best interests in healthcare.
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Dr.Banerjee's decision to advise the night watchmen to go home did not constitute a breach of his duty of care.
Dr.Banerjee's decision to advise the night watchmen to go home did not constitute a breach of his duty of care.
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Patients with chronic diseases encounter significant challenges in their management and care.
Patients with chronic diseases encounter significant challenges in their management and care.
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The principle of respect for autonomy may conflict with the ethical standards in multicultural patient care.
The principle of respect for autonomy may conflict with the ethical standards in multicultural patient care.
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Basic competence in physical examination is irrelevant to high-quality communication with patients.
Basic competence in physical examination is irrelevant to high-quality communication with patients.
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Evidence-based medicine (EBM) plays a critical role in the personalized care of individual patients.
Evidence-based medicine (EBM) plays a critical role in the personalized care of individual patients.
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Confidentiality does not hold significant importance in the doctor-patient relationship.
Confidentiality does not hold significant importance in the doctor-patient relationship.
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Good therapeutic principles are exclusively clinical and do not involve any ethical considerations.
Good therapeutic principles are exclusively clinical and do not involve any ethical considerations.
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The four principles of biomedical ethics include Justice, Nonmaleficence, Respect for Autonomy, and Charisma.
The four principles of biomedical ethics include Justice, Nonmaleficence, Respect for Autonomy, and Charisma.
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The paternalistic model of doctor-patient relationship allows for patient involvement in decision-making.
The paternalistic model of doctor-patient relationship allows for patient involvement in decision-making.
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Cultural and religious beliefs can influence the decisions made in the collaborative model of doctor-patient relationships.
Cultural and religious beliefs can influence the decisions made in the collaborative model of doctor-patient relationships.
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In the informative model, the physician provides options based solely on their own beliefs about treatment.
In the informative model, the physician provides options based solely on their own beliefs about treatment.
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All doctor-patient relationships fall strictly into one of the four designated models without overlap.
All doctor-patient relationships fall strictly into one of the four designated models without overlap.
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The interpretive model is designed for situations when a patient's values are clear and well-defined.
The interpretive model is designed for situations when a patient's values are clear and well-defined.
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Paternalism in medicine refers to the intentional promotion of patient autonomy.
Paternalism in medicine refers to the intentional promotion of patient autonomy.
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The principle of nonmaleficence is often summarized as 'do not harm'.
The principle of nonmaleficence is often summarized as 'do not harm'.
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Negligence can be distinguished from malpractice by its intentional nature.
Negligence can be distinguished from malpractice by its intentional nature.
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The concept of distributive justice includes the allocation of medical resources based on need.
The concept of distributive justice includes the allocation of medical resources based on need.
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Weaknesses of the four principles of bioethics include their complexity and cultural specificity.
Weaknesses of the four principles of bioethics include their complexity and cultural specificity.
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Beneficence means acting for the benefit of patients, regardless of their preferences.
Beneficence means acting for the benefit of patients, regardless of their preferences.
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Nudging involves coercively imposing decisions on individuals.
Nudging involves coercively imposing decisions on individuals.
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The principle of paternalism can involve tactics such as manipulation and coercion.
The principle of paternalism can involve tactics such as manipulation and coercion.
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The principle of beneficence requires a doctor to act for the benefit of patients.
The principle of beneficence requires a doctor to act for the benefit of patients.
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Humans exhibit 'bounded rationality' which suggests they always make rational decisions.
Humans exhibit 'bounded rationality' which suggests they always make rational decisions.
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Due care refers to the absence of negligence and professional malpractice.
Due care refers to the absence of negligence and professional malpractice.
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Patients have the right to self-determination and to make their own medical choices.
Patients have the right to self-determination and to make their own medical choices.
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The success of the nudging message for organ donation was 'Would you accept an organ if you needed one, if so please help others'.
The success of the nudging message for organ donation was 'Would you accept an organ if you needed one, if so please help others'.
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The four principles of biomedical ethics include Justice, Nonmaleficence, Respect for Autonomy, and Responsibility.
The four principles of biomedical ethics include Justice, Nonmaleficence, Respect for Autonomy, and Responsibility.
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Doctor's obligations to maintain patient confidentiality do not include any rights for the patient.
Doctor's obligations to maintain patient confidentiality do not include any rights for the patient.
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The principle of nonmaleficence is often summarized as 'do no harm'.
The principle of nonmaleficence is often summarized as 'do no harm'.
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The principle of beneficence emphasizes acting to benefit patients rather than merely avoiding harm.
The principle of beneficence emphasizes acting to benefit patients rather than merely avoiding harm.
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The act of respecting patient confidentiality is not considered a central ethical principle in medical ethics.
The act of respecting patient confidentiality is not considered a central ethical principle in medical ethics.
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The ethical principle of autonomy allows patients complete freedom without any guidance or input from healthcare providers.
The ethical principle of autonomy allows patients complete freedom without any guidance or input from healthcare providers.
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Nudging in healthcare aims to subtly guide patients towards healthier choices without restricting their freedom of choice.
Nudging in healthcare aims to subtly guide patients towards healthier choices without restricting their freedom of choice.
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The ethical principle of justice relates solely to the distribution of healthcare resources based on individual merit.
The ethical principle of justice relates solely to the distribution of healthcare resources based on individual merit.
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Study Notes
Most Trusted Profession
- Survey conducted in 2017 by MRBI
- Medical/Scientific advances in the 20th century include: antibiotics, cell research, cardiac resuscitation, intensive care units, organ transplants, gene therapy, immunisation, life expectancy, assisted reproduction, artificial limbs, and regenerative medicine.
What Changed?
- Historical context: Nuremberg Trials/Nazi Doctors, universal human rights, scandals by Beecher and Pappworth, the Information Highway
- Shift from a paternalistic model to a partnership model in medicine
Hippocratic Oath & Its relevance
- 5th Century BCE
- Key principles: beneficence/non-maleficence, equal respect for all, confidentiality
Doctor-Patient Relationship
- Unique human relationship
- Difference from other relationships: power differential created by the Doctor's competence and knowledge, versus the patient's vulnerability
- Illness vs Disease: illness is the patient's subjective experience, while disease is the objective medical condition
Models of Doctor-Patient Relationship
- Paternalistic Model: Physician makes decisions for the patient, without their consent
- Informative Model: Physician provides information and patient makes decisions
- Interpretive Model: Physician clarifies patient's values and supports their autonomy
- Collaborative Model: Physician supports patient's autonomy by encouraging them to make informed decisions
Nudging
- Encourages individuals to make healthy choices without coercing them
- Transparent, defensible, and allows for refusal of the best option
- Emerged from psychology, sociology, and economics
- Humans make decisions that are not always in their best interest, hence the need for nudging
Nudging & Health example
- Organ donation
- Most effective message: "would you accept an organ if you needed one, if so please help others"
Doctor-Patient Relationship: Listening
- Conversations are as important as prescriptions
- Study by Beckman & Frankel: average time before a doctor interrupts a patient is 18 seconds
Four Principles of Biomedical Ethics
- Govern clinical research and medicine regarding human persons.
-
- Respect for Autonomy
-
- Nonmaleficence
-
- Beneficence
-
- Justice
Respect for Autonomy
- Doctor's Obligations: maintain confidentiality, presume patient's capacity, provide information for informed consent, obtain consent before treatment
- Patient's Rights: confidentiality of medical information, self-determination, informed decision-making, consent/refusal of treatment
Beneficence vs Paternalism
- Beneficence: Ethical obligation to act for the patient's benefit
- Paternalism: Overriding patient's preferences through manipulation, non-disclosure, deception, lying, coercion
Nonmaleficence
- "Do no harm"
- Due Care: Sufficient and appropriate care to avoid harm
- Absence of Due Care: Negligence, Professional Malpractice
Distributive Justice
- Types of Allocation:
- Partitioning of the comprehensive social budget
- Allocation within the health budget
- Allocation within the healthcare budget
- Allocation of scarce treatment for patients
Strengths of the Four Principles
- Culturally neutral
- Universal appeal
- Common language for moral discussions
- Avoid moral imperialism and relativism
Weaknesses of the Four Principles
- They are simply names and may not fulfill their claimed purpose
- Fail to capture the complexity of real life
- Make ethical debate boring
- Western principles, may not respect community values and cultural autonomy
What Would You Do? Case Studies
- 8 year-old girl needs elective tonsillectomy, parents insist on hospital stay
- Patient demands CT scan for lower back pain, despite doctor's belief the pain is muscular
Modern Version of Hippocrates' Oath
- Emphasize avoiding overtreatment and therapeutic nihilism
- Recognize the art and warmth of medicine
Introduction
- The text is a lecture about the four principles of biomedical ethics and their application to the doctor-patient relationship
- The principles were introduced in 1979 by Beauchamp and Childress and were revisited in 2013
- The text also discusses "Nudging" and how it can be used to encourage better health choices
Four Principles
- The four principles of biomedical ethics are
- Respect for Autonomy
- Nonmaleficence
- Beneficence
- Justice
- The text describes the doctor's obligations and patient rights within each principle
-
Respect for Autonomy: This principle focuses on the patient's right to make their own decisions about their health, including the right to confidentiality and informed consent.
- This principle is sometimes at odds with paternalism, where the doctor overrides the patient's preferences in the name of the patient's best interest
-
Nonmaleficence: This principle refers to the obligation to do no harm.
- It applies to both intentional and unintentional harm, as well as neglect and malpractice
- Beneficence: This principle involves the doctor's ethical obligation to act in the patient’s best interest
-
Justice: This principle dictates fair and equitable distribution of healthcare resources.
- There are several levels of allocation:
- The comprehensive social budget (including all public spending)
- Within the health budget
- Within the health care budget
- Scarce treatment for individual patients
- There are several levels of allocation:
Nudging
- Nudging is a concept that encourages people to make choices in their best interests without limiting their freedom of choice
- It is based on research in psychology, sociology, and economics, understanding that humans sometimes make decisions that are not in their best interest
- Nudging uses choice architecture to guide people towards making a preferred decision
- An example of nudging is organ donation, where the most successful message uses the wording: "would you accept an organ if you needed one, if so please help others"
The Doctor-Patient Relationship
- Communication is key in doctor-patient relationships
- Research shows that doctors frequently interrupt patients, emphasizing the importance of listening
- The text encourages doctors to remember that conversations are as important as prescriptions
Ethical Assessment in IPCP
- Students will need to reflect on a patient encounter, considering one of the ethical principles for their portfolio
- Examples of principles that could be used include:
- Consent
- Confidentiality
- Autonomy
- Beneficence
- Non-maleficence
- Justice
Modern Oath of Hippocrates
- The text highlights key themes in the modern version of the Hippocrates Oath
- Avoid overtreatment and therapeutic nihilism
- Remember the art and science of medicine
- Respect the privacy of the patient
- Remember that doctors treat a sick human being, not a disease.
Doctor-Patient Relationship
- Shift from paternalistic model to collaborative care
- Paternalistic model: Doctor makes decisions for competent patients without consent
- Collaborative Model: Shared decision-making based on patient autonomy
- Cultural influences can affect decisions: Families or senior members can request treatment/non-treatment, disclosure/non-disclosure
Types of Doctor-Patient Relationships
- Paternalistic: Doctor promotes patient's well-being independently of patient's preferences
- Informative: Doctor provides information and implements the patient's chosen intervention
- Interpretive: Doctor clarifies patient's values and supports autonomy through advice
- Collaborative: Doctor discusses and develops patient's values, nudging towards the best course of action
Nudging
- Framing information to encourage choices in patients' best interests while preserving freedom
- Must be transparent, defensible, and not coercive
- Emerged from psychology, sociology, and economics
- Accounts for "bounded rationality", where individuals make decisions contrary to their best interests
- Choice architecture (designing decision-making contexts differently) can nudge people to make better choices
Doctor-Patient Communication
- Listening is crucial for effective care. Doctors interrupt patients frequently
- Conversations are as important as prescriptions
The Four Principles of Biomedical Ethics
- Respect for Autonomy: Doctor's obligation to maintain patient confidentiality, presume patient's capacity to consent/refuse, provide all necessary information for informed consent
- Beneficence: Doctor's obligation to act in the patient's best interest
-
Nonmaleficence: "Do no harm"
- Due care: Sufficient and appropriate care to avoid harm
- Absence of due care: Negligence (intentional or unintentional) and professional malpractice
- Justice: Fair distribution of resources. Types of allocation: partitioning comprehensive social budgets, allocating within health budgets, allocating within healthcare budgets, allocating scarce treatments for patients
Strengths and Weaknesses of the Four Principles
- Strengths: Culturally neutral, universal appeal, enable common moral language, avoid moral imperialism and relativism
- Weaknesses: Only a collection of names, fail to capture the complexity of real life, make debate less nuanced, may prioritize Western principles over community values
Ethics Assessment in IPCP
- Portfolios will include reflection on a patient encounter, considering an ethical principle
- Examples: Consent, confidentiality, autonomy, beneficence, non-maleficence, justice
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Description
Explore the evolution of the doctor-patient relationship from historical contexts such as the Nuremberg Trials to modern ethical principles exemplified in the Hippocratic Oath. This quiz will cover key medical advances and the shift towards patient partnership in healthcare.
