Question

1. Explain how the doctrine of informed consent is related to the principle of patient autonomy.
   MUST correctly describes elements of doctrine and principle of autonomy, and MUST shows relationship between the two

Answer 1

Doctrine of informed consent

A duty imposed on a doctor to explain the risks of recommended procedures to a patient before a patient determines whether or not he or she should go forward with the procedure.

Patient autonomy: The right of patients to make decisions about their medical care without their health care provider trying to influence the decision. Patient autonomy does allow for health care providers to educate the patient but does not allow the health care provider to make the decision for the patient.

Patient can not take decision without the diagnosis of his/Her disease condition and information about the treatment or procedure.

The benefits and complications of treatment must be explain to the patient after that the patient can decide about the treatment.(Patient is free to take decision about the procedure) so, Doctrine of informed consent is related the principle of patient autonomy.

An adult patient has complete autonomy over his body when he can consent to any form of’ medical treatment without fear of being vetoed by someone else. Any procedure done without consent would amount to battery and assault. However, complete patient autonomy gets restricted in certain circumstances. For example, despite accepting the notion of complete patient autonomy, courts all over the world are reluctant to legally accept active euthanasia

Informed consent: Informed consent, in the medical field, is the procedure whereby a patient consents to or refuses (informed refusal) a medical intervention based on the information provided by a health care worker regarding the nature and potential consequences of the proposed treatment regimen.

The elements of informed consent include: disclosure of information, competence, understanding, voluntariness and decisionmaking. A doctor provides information to a competent patient, who after understanding the information, makes a valid decision.

Basic Principles of Medical EthicsBasic Principles of Medical Ethics-

• Autonomy

          Requires that the patient have autonomy of thought, intention, and action when making decisions regarding health care procedures. Therefore, the decision-making process must be free of coercion or coaxing. In order for a patient to
          make a fully informed decision, she/he must understand all risks and benefits of the procedure and the likelihood of
          success. Because ARTs are highly technical and may involve high emotions, it is difficult to expect patients to be
          operating under fully-informed consent.

• Justice
• 
  
• The idea that the burdens and benefits of new or experimental treatments must be distributed equally among all groups in
  society. Requires that procedures uphold the spirit of existing laws and are fair to all players involved. The health care provider must consider four main areas when evaluating justice: fair distribution of scarce resources, competing needs, rights and obligations, and potential conflicts with established legislation. Reproductive technologies create ethical dilemmas because treatment is not equally available to all people.
  
• Beneficence
• 
  
• Requires that the procedure be provided with the intent of doing good for the patient involved. Demands that health care providers develop and maintain skills and knowledge, continually update training, consider individual circumstances of all patients, and strive for net benefit.
  
• Non-maleficence
• 
  
• Requires that a procedure does not harm the patient involved or others in society. Infertility specialists operate under the assumption that they are doing no harm or at least minimizing harm by pursuing the greater good. However, because
  assistive reproductive technologies have limited success rates uncertain overall outcomes, the emotional state of the patient may be impacted negatively. In some cases, it is difficult for doctors to successfully apply the do no harm principle.

Relationship

Autonomy as a principle of ethics assumes a certain level of respect for persons and their ability to take actions. It includes issues of informed consent, confidentiality of information, truth telling and promise keeping. The principles of Privacy and Confidentiality are intimately related to Autonomy as disclosure and dissemination of a person‘s intimate information and thoughts destroys this important Ethical and Moral Principle. The patient, in fear of the dissemination of his intimate secrets, would never confide in the doctor and this will lead to a number of problems in future both to the doctor and to the patient. The consent given by the patient should be voluntarily, free, fair, uninhibited, clear, direct and personal; without any fear, force, fraud, misrepresentation of facts, threat of physical injury or death, etc. The information given by the physician to the patient must include the disease condition, nature and consequences of the treatment procedure/ examination, alternatives, prognosis, etc. The disclosure so made should be complete, honest and truthful and should be made prior to implementation of the procedure.