Download Heatlh Care Ethics and Philosophies Revised

Philosophy and Ethics
HS20-HC1 Analyze how Western, Indigenous, traditional,
complementary and alternative approaches to health care contribute to
a holistic perspective (e.g., mental, emotional, physical and spiritual) of
health.
Indicators!
• a. Identify how humanity’s beliefs about health, wellness, illness, disease, and treatment have changed over time. (STSE)
• b. Discuss the importance of and difficulties in defining terms such as Western, Indigenous, traditional, complementary, and
alternative approaches to health care within a current global context. (K, A, S, STSE)
• c. Assess how health, wellness, illness, disease, and treatment (e.g., Circle of Life disharmony of body energies, being symptom
free, and healthy lifestyle choices) are addressed in Western, Indigenous, traditional, complementary, and alternative approaches
to health care. (K, A, STSE)
• d. Investigate the intended results of using natural products (e.g., herbs, vitamins, minerals, probiotics, and essential oils) and
mind and body practices (e.g., acupuncture, various massage therapies, yoga, spinal manipulation, relaxation techniques,
meditation, and movement therapies) and other complementary and/or alternative approaches to health care. (K, A, STSE)
• e. Examine the significance of rituals, place based ceremonies, plants, and traditional herbs in Indigenous and traditional
approaches to health care. (K, A, STSE)
• f. Describe the role of clinical based studies (e.g., randomized, blind, double-blind, and placebo) in understanding Western
approaches to health care. (STSE)
• g. Provide examples of ways in which one or more of the approaches to health care might be implemented together to support the
health and wellbeing of an individual. (K, A, STSE)
Opening Video – Medicine Men Go Wild – The Hot
Zone – Bayaka
Indicator: compare Western medicine to other cultures’ medicine.
• Watch the video/documentary https://www.youtube.com/watch?v=5KVLsiLeTN8
Note: You will see an infected monkey getting cooked and chopped up.
And a baby cut with a razor to try to help with an infection.
• Complete the associated question-sheet.
• Key Questions/Takeaways –
What is natural selection and how is it at work?
What are the similarities and differences between Western Medicine and
other forms of medicine?
Western versus Alternative Medicine (Types of
Medicine)
How has Western medicine developed over time?
• Western (conventional) medicine historically
• Holistic health –
• Complimentary medicine –
• Alternative medicine –
Western versus Alternative Medicine (Types of
Medicine)
How has Western medicine developed over time?
• Western (conventional) medicine historically
Doctors (Health Care Providers) use drugs, surgery, or radiation to treat
symptoms, injury, disease and illness.
• Holistic health – health includes not just illnesses of the body, but of the
mind and soul (well-being physically, mentally, emotionally, and spiritually).
• Complimentary medicine – a combination of conventional
and alternative medicine!
• Alternative medicine – a medical treatment that may not
be scientifically tested or proven.
Western versus Alternative Medicine
How has Western medicine developed over time?
• Western medicine historically just focused on treating the illness of the
patient and didn’t look at holistic health.
• Holistic health involves overall well-being of an individual physically,
emotionally, mentally, and spiritually.
• Complimentary medicine is using conventional medicine (pills, surgeries,
etc.) and alternative medicine (yoga, naturopath, chiropractor).
Alternative medicine has become more common in recent history (last 50
years).
Traditional (alternative) Medicine Meditation
•What cultures meditate?
•What are the benefits?
Traditional (alternative) Medicine Meditation
•What cultures meditate?
East Indian Religions (Hinduism, Buddhist, Judaism and
Christianity) – meditation is now a global practice – not
culture-specific
•What are the benefits?
Decreases tension, boosts immune
system, lowers blood pressure,
reduce anxiety attacks.
Traditional Medicine - Meditation
• What cultures meditate?
Pre-historic but mostly attributed to Hindu and
Eastern Asia!
• What are the benefits?
lower blood pressure, improved blood circulation,
lower heart rate, less perspiration, slower respiratory
rate, less anxiety, lower blood cortisol levels, more
feelings of well-being, less stress, deeper relaxation
Traditional Medicine - Meditation
• How to:
- Sit or lie comfortably.
- Close your eyes.
- Make no effort to control the breath; simply breathe naturally.
- Focus your attention on the breath and on how the body moves
with each inhalation and exhalation. Notice the movement of
your body as you breathe. Observe your chest, shoulders, rib
cage and belly. Make no effort to control your breath; simply
focus your attention. If your mind wanders, simply return your
focus back to your breath. Maintain this meditation practice for
2–3 minutes to start, and then try it for longer periods.
• Let’s try! There are others online!
http://marc.ucla.edu/body.cfm?id=22
Importance of Terminology
Discuss the importance of and difficulties in defining terms such as Western, Indigenous, traditional,
complementary, and alternative approaches to health care within a current global context. (K, A, S, STSE)
• Western Medicine
• Indigenous Medicine
• Traditional Medicine
• Complementary and Alternative
Differentiating Between Forms of Medicine
Discuss the importance of and difficulties in defining terms such as Western, Indigenous, traditional,
complementary, and alternative approaches to health care within a current global context. (K, A, S, STSE)
• Western Medicine - the science and practice of the diagnosis, treatment, and
prevention of disease through experimental study and testing. This is typically done through
medications and surgery. What we consider conventional medicine.
• Indigenous Medicine/Traditional Medicine - sum total of the knowledge,
skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether
explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or
treatment of physical and mental illness.
All the ideas and practices of a particular group as it relates to well-being.
• Complementary and Alternative - the combination of the practices and
methods of alternative medicine with conventional medicine.
Complimentary and Alternative Medicine
(CAM)
What is CAM
• Allopathy –
• Complementary medicine –
• Alternative medicine –
• Complete the Complimentary and Alternative Medicine Handout
Correct – hand in.
Complimentary and Alternative Medicine
(CAM)
What is CAM
A group of practices and products that are not a strict part of conventional
medicine
• Allopathy – conventional medicine or common and usual practice of medicine
• Complementary medicine – alternative medicine used with conventional
medicine
• Alternative medicine – used instead of conventional medicine
• Complete the Complimentary and Alternative Medicine Handout
Correct – hand in.
Holistic
• Should have heard it in health before… what does it mean?
• Overall ___________ and _____________ between all of your different
___________ of health.
 _______
 Socioemotional
 _______
 Spiritual
• This means… __ ____ _______, ____ ____ ________.
• Important to remember that this involves the most complete form of
health and needs to be considered beyond simply treating a condition with
a pill… this is what CAM keeps in mind.
Holistic
• Overall balance and well-being between all of your different dimensions of
health.
 Physical
 Socioemotional
 Mental
 Spiritual
• This means… If one suffers, all can suffer
• Important to remember that this involves the most complete form of
health and needs to be considered beyond simply treating a condition with
a pill… this is what CAM keeps in mind.
Clinical-Based Studies
• Randomized –
Problem/Limitations
• Blind –
Problem/Limitations
Clinical-Based Studies
• Double-Blind –
Problem/Limitations
• Placebo –
Problem/Limitations
Examples and Definitions
• Randomized – completely random sample – everyone take a card from the
deck at random… whoever draws a heart is who I will test. BUT there may
be some rules to the randomness.
• Blind – “information about the test is kept from the participant until after
the test.” – Here… take this pill *watches and observes what happens*.
• Double-Blind – “an experiment or clinical trial in which neither the
subjects nor the researchers know which subjects are receiving the
active medication, treatment, etc., and which are not: a technique for
eliminating subjective bias from the test results.” –
• Placebo - a harmless pill, medicine, or procedure prescribed more for the
psychological benefit to the patient than for any physiological effect. Used
as a control for testing new drugs. – ‘Here, take this pill to help with your
headache’ *expects nothing to happen.* If something does, it may not be
the pill.
Clinical Based Studies – Problems and Limitations
Describe the role of clinical based studies (e.g., randomized, blind, double-blind, and placebo) in understanding
Western approaches to health care. (STSE)
Problems and possible limitations of Clinical Based Studies (Importance)
• Randomized – requires some rules/details in order to pick a specific group to make
results more credible/reliable. If I was testing a hair drug on males, and in my random
sample only get men with certain similar characteristics (brown hair), it can impact
the reliability of the testing… What if this drug perhaps work better on men with
brown hair than dark?
• Blind – still can be subject to personal bias as the tester is aware of what may be
occurring in the test.
• Double-Blind – may be more expensive and time-consuming to prepare the testers
and tested for the experiment. As well, when they are not informed of the intended
results, it can cause concerns regarding allergy or safety regarding the well-being of
participants – if you warn of allergies, could that influence bias?
• Placebo – simply measures or eliminates the possibility of a drug’s psychological
effects… however, when used in combination with other steps can include data on
the effectiveness of the pill as well.
Health Studies
Describe the role of clinical based studies (e.g., randomized, blind, double-blind, and placebo) in
understanding Western approaches to health care. (STSE)
Clinical Based Studies
What are you testing for and why? What is your prediction and why?
• Randomized –
• Blind –
• Double-Blind –
• Placebo –
Come up with a test to perform on your classmates for one of these. Not
drug-based, but come up with something to test in the class. Small groups
(3 or less).
• Importance: Conventional medicine needs clinical based studies to
become widely used and distributed to meet the health needs of people.
Scientific Method Reminder
• Hypothesis/Prediction –
• Independent variable –
• Dependent variable –
• Control group –
• Data Collection –
• Model data (making a graph) –
• Analyze results/draw conclusion –
Scientific Method Reminder
• Hypothesis/Prediction – if we do ______, then _____ should happen
because of ___________.
• Independent variable – what you change.
• Dependent variable – what happens as a result of the change.
• Control group – group that isn’t given the drug (but may have the
same environment and conditions as the other group).
• Data Collection – collect your data
• Model data (making a graph) – Put data into a visual.
• Analyze results/draw conclusion – what does the data say? Did it
work? Why or why not?
Examples of Tests
• Hand in assignment – share one with class… if you are struggling just
look up some examples. Collect results from one that you can test the
class on.
• Be sure to look at potential problems with each of these methods.
• “Come up with a test to perform on your classmates on each of these.
Not drug based, but come up with something to test in the class.
Small groups – write down your plan for each.”
Phase of Clinical Research
• Clinical trials involving new drugs are commonly classified into four
phases. Each phase of the drug approval process is treated as a
separate clinical trial. The drug-development process will normally
proceed through all four phases over many years. If the drug
successfully passes through Phases I, II, and III, it will usually be
approved by the national regulatory authority for use in the general
population. Phase IV are 'post-approval' studies.
Phase of Clinical Research
• Pre-Clinical
• Phase 0
• Phase 1
• Phase 2
• Phase 3
• Phase 4
Vocabulary
Pharmacodynamics
Pharmacokinetics
Phases of Clinical Research
• Pre-Clinical – observe (drug) on animal or human cells in a test tube.
• Phase 0 – humans are given the test but in amounts below what
would actually be given in order to observe results… this may also
reduce the negative effects.
• Phase 1 – human-testing – testing safety, pharmacokinetics (what a body
does to a drug), pharmacodynamics (what a drug does to the body), and how food
absorption affects the drug. “Helps determine safety and dosage”
• Phase 2 – usually when a new drug fails – this is when it is observed if
the drug actually works - how much should be given and how well it
works at those doses. “Evaluate effectiveness, look for side effects”
Pre-Clinical
Chart of Phases and Timelines
Phase 1!
Phases of Clinical Research
• Phase 3 - the most expensive, time-consuming and difficult trials to
design and run – Can involve up to 3000 people and different
institutions (hospitals for example) done randomly. “Pre-marketing
phase” – actually given to consumers and data is collected.
(Can take a minimum of 3 years)
IF GOOD IT’S DISTRIBUTED! YAAAAAY!
• Phase IV (4) – Post-marketing surveillance. Constant monitoring of
the drug, if problems appear, drug production will be ceased. This can
last over 10 years!
How long does it take?
• Approximately 12 to 18 years (but not always), often costing over $1
billion
• Some can get fast-tracked – Phase 0 helps with this.
Importance –
It is important to understand the extended length of time it takes for
a drug that may be very beneficial for individuals to actually make it
through testing and into normal/regular consumer use.
Phases of Clinical Research
• Importance:
It can take up to twenty years for a drug to be tested and proven safe.
And close to 10 years for it simply to be put on the market. So when
you hear about new drugs to cure diseases (like Cancer or HIV), it may
not come into mainstream usage for awhile to ensure it’s safety.
Quiz Friday
Matching (match term to definition) -
What are the six phases of clinical testing?
What are the four different ways of clinical based tests?
What does pharmacokinetic and pharmacodynamic mean?
Cultural Beliefs
Read over the cultural beliefs! Then record the following on looseleaf!
• Something I found interesting about __________ (culture) was…
__________________ because __________________.
• Something I did/didn’t agree with about __________ (culture) was…
__________________ because _________________.
• Summarize a simple way to describe one particular culture’s
worldview on medicine.
Overall Worldviews of Groups
Cutltural Group
Belief (Summarized) – interesting treatments
South African
Illnesses are caused by the supernatural – can be healed by regaining harmony
through herbal medicines. Balance of body, spirit and mind!
Asian
Harmony and balance with nature - Yin and Yang (Cold and Hot). There are
medicines. Disgrace associated with sickness – supernatural forces cause it.
European
Good health is a personal responsibility. Cured by medications and immunizations.
Hispanic
Health is good luck and a reward from God. Bad luck = bad health = punishment.
Express pain verbally.
Middle Eastern
THE EVIL EYE! Cleanliness is important to health – males are dominant in health and
health care. Can’t examine female patients. Tolerating pain is a sign of strength.
First Nations
Health is harmony between man and nature. Holistic health. Herbs and other means
of medication.
Different parts of the world practice different means of medicine. Using parts from all of them
may provide the most complete health care service to everyone.
Natural Products – Intended Use
Investigate the intended results of using natural products (e.g., herbs, vitamins, minerals, probiotics, and essential oils) and
mind and body practices (e.g., acupuncture, various massage therapies, yoga, spinal manipulation, relaxation techniques,
meditation, and movement therapies) and other complementary and/or alternative approaches to health care. (K, A, STSE)
What are the intended results of (pick one and look it up)…
• Herbs – any plant with leaves, seeds or flowers used for medicine,
flavour or food. Example Aloe and Chamomile
• Vitamins – essential for normal growth and nutrition. Organic
compounds. In pill form – does it work?
• Minerals – solid, inorganic substance that the body needs to function.
• Probiotics – microorganism introduced into the body for beneficial
qualities, typically aiding with digestion.
• Essential Oils – oils obtained from plants by distillation. They can help
with sickness, moods, and other health concerns. Do they work? For
some maybe.
Your thoughts on these treatments…
immunizations, chemotherapy, radiation, vitamin supplements, physical
activity, nutrition and prayer
• Pick one of the above and answer briefly what they involve as it
pertains to health.
• Does the evidence support this practice (does it work)? Are there
guaranteed benefits? Are there side effects? Is it a western practice?
• Think of another belief we covered, would they accept this given their
beliefs and perspectives?
Your thoughts on these treatments…
immunizations, chemotherapy, radiation, vitamin supplements, physical
activity, nutrition and prayer
• Pick one of the above and answer briefly what they involve as it pertains to
health.
Immunizations – injections of a weak form of a virus to get the body to learn
how to fight it.
• Does the evidence support this practice (does it work)? Are there guaranteed
benefits? Are there side effects? Is it a western practice?
Assuming no allergies – evidence supports it! Tiredness and fatigue (fighting
off infection). In Western countries typically vaccine rates are high and disease
rates are low.
• Think of another belief we covered, would they accept this given their beliefs
and perspectives?
Hispanic – may not agree because their methods are pain free and alternative
forms of medicine.
Your thoughts on these treatments…
immunizations, chemotherapy, radiation, vitamin supplements, physical
activity, nutrition and prayer
• Pick one of the above and answer briefly what they involve as it pertains to
health.
Chemotherapy – two forms: directly into blood or vein. Chemical that kills
cancer cells – can prevent or reduce spreading of cancer.
• Does the evidence support this practice (does it work)? Are there
guaranteed benefits? Are there side effects? Is it a western practice?
Proven to work, will kill cancer cells. Poisons your body (every system) –
lose weight, get sick. Yes to Western practice.
• Think of another belief we covered, would they accept this given their
beliefs and perspectives?
Jewish – no blood donation. “Obligation to preserve life takes precedence
over a person’s decision with their body” – may not agree.
European – would accept this, it is a medication to help treat the illness.
Hispanic – against beliefs, but some may still use it.
Your thoughts on these treatments…
immunizations, chemotherapy, radiation, vitamin supplements, physical
activity, nutrition and prayer
• Pick one of the above and answer briefly what they involve as it pertains to
health.
Physical activity – bodily movement produced by skeletal muscles requiring
energy.
• Does the evidence support this practice (does it work)? Are there
guaranteed benefits? Are there side effects? Is it a western practice?
It helps, evidence supports it! Reduces blood pressure amongst other
things! Side effect – possible injury. It is a western practice!
• Think of another belief we covered, would they accept this given their
beliefs and perspectives?
All beliefs would practice this.
Your thoughts on these treatments…
immunizations, chemotherapy, radiation, vitamin supplements, physical
activity, nutrition and prayer
• Pick one of the above and answer briefly what they involve as it
pertains to health.
• Does the evidence support this practice (does it work)? Are there
guaranteed benefits? Are there side effects? Is it a western practice?
• Think of another belief we covered, would they accept this given their
beliefs and perspectives?
Mind and Body Practices – Intended Use
Investigate the intended results of using natural products (e.g., herbs, vitamins, minerals, probiotics, and essential oils) and
mind and body practices (e.g., acupuncture, various massage therapies, yoga, spinal manipulation, relaxation techniques,
meditation, and movement therapies) and other complementary and/or alternative approaches to health care. (K, A, STSE)
What are the intended results of…
• Acupuncture
• Massage Therapy
• Yoga
• Spinal Manipulation
• Relaxation Techniques
• Meditating
• Movement Therapies
Philosophy and Ethics
HS20-HC2 Examine how personal and societal beliefs impact ethical
decisions regarding health care.
Indicators
•
a. Pose questions about ethical dilemmas within health care. (K, S, A, STSE)
•
b. Understand the core ethical questions to be considered when making health care decisions:
What can be done for the patient? (intervention technologies)
Does the patient understand the options? (informed consent)
What does the patient want? (autonomy)
What are the benefits? (beneficence)
Will it harm the patient? (non-maleficence)
Are the patient’s requests fair and able to be satisfied? (justice)
Are the costs involved fair to society? (economic consequences) (K)
•
c. Analyze a health care issue (e.g., case study, interview and current events) with respect to the core ethical questions. (K,A, S, STSE)
•
d. Contrast how procedures to prevent illness, such as immunizations, vitamin supplements, physical activity, nutrition and prayer, might be viewed
from the perspective of Western, Indigenous, traditional, complementary, and alternative approaches to health care. (K, A)
•
e. Examine ethical considerations related to various treatments (e.g., chemotherapy, radiation, acupuncture, sweat lodge, blood transfusions, and
hirudotherapy) that might be prescribed in Western, Indigenous, traditional, complementary, and alternative approaches to health care.
•
f. Examine individual, community and cultural beliefs regarding issues related to life and death such as home birthing, blood transfusions,
contraception, abortions, organ donation, autopsies, euthanasia, cremation and burials. (K, A, STSE)
•
g. Discuss ethical considerations and perspectives related to issues such as the use of cadavers in professional studies, dissection and raising animals
for the purpose of dissection, and public exhibits of plastinated organs and bodies, all of which could provide increased scientific understanding of
human anatomy. (A, STSE)
•
h. Understand a patient’s rights in Saskatchewan and in Canada with regards to health care decisions such as developing an advance care directive,
refusal of treatment, informed consent, and the role of a proxy or substitute decision-maker. (K)
•
i. Discuss ethical considerations (e.g., personal beliefs, informed consent, the roles of institutional review boards and regulatory agencies) of why an
individual may choose to participate in a clinical study of a new biomedical intervention (e.g., vaccine, drug, treatment, device, or process). (STSE)
•
j. Debate a decision related to ethics in health care from the viewpoint of individuals who hold different belief systems. (K, A, S, STSE)
Making a Health Care Decision
• Several core ethical questions (CEQ) guide health care providers in
making decisions.
• In addition to these questions, there are 7 additional steps to
resolving ethical dilemmas that relate to health decision making.
• Why? Health care providers will be faced with tough life/death
decisions and it helps to have a set of guidelines to follow in making a
decision of that magnitude and being confident in it.
Making Health Care Decisions
CORE ETHICAL QUESTIONS
• a. (intervention technologies)
• b. (informed consent)
• c. (autonomy)
• d. (beneficence)
• e. (non-maleficence)
• f. (justice)
• g. (economic consequences)
Making Health Care Decisions
CORE ETHICAL QUESTIONS
• a. What can be done for the patient? (intervention technologies)
• b. Does the patient understand the options? (informed consent)
• c. What does the patient want? (autonomy)
• d. What are the benefits? (beneficence)
• e. Will it harm the patient? (non-maleficence)
• f. Are the patient’s requests fair and able to be satisfied? (justice)
• g. Are the costs involved fair to society? (economic consequences)
Making Health Care Decisions
7-Steps to Resolving Ethical Dilemmas
• Recognize that a case raises an important ethical problem.
• Identify the problem that needs to be solved.
• Determine reasonable alternative courses of action.
• Consider each option in relation to the fundamental ethical
principles.
Making Health Care Decisions
7-Steps to Resolving Ethical Dilemmas
• Recognize that a case raises an important ethical problem. Ethical
problems arise when there is a conflict of values and when there are
different ways of proceeding. It is important to be as knowledgeable
as possible about the case.
• Identify the problem that needs to be solved. Once the problem is
precisely identified, you will be better able to decide what resources
you need to handle the problem.
• Determine reasonable alternative courses of action. These options
don’t need to include everything, but they should be clearly distinct.
• Consider each option in relation to the fundamental ethical
principles. None of these principles is always paramount, but in
certain situations, one may trump another (benefits may outweigh
the harm).
Making Health Care Decisions
7-Steps to Resolving Ethical Dilemmas
• Decide of a resolution to the problem.
• Consider your position critically.
• Are there circumstances under which you would advocate a different course
of action? Could your decision be formulated into a general principle?
• Consider your emotions, conscience and the opinion of others.
• Would you make the same choice if your decision were made public?
• Do the right thing!
Making Health Care Decisions
7-Steps to Resolving Ethical Dilemmas
• Decide of a resolution to the problem. Your conclusion may be
disputed, so you should be able to say why you think it is the best
one.
• Consider your position critically.
• Are there circumstances under which you would advocate a different course
of action? Could your decision be formulated into a general principle?
• Consider your emotions, conscience and the opinion of others.
• Would you make the same choice if your decision were made public?
• Do the right thing!
Rights of an SK Individual
Understand a patient’s rights in Saskatchewan and in Canada with regards to health care decisions such as developing an
advance care directive, refusal of treatment, informed consent, and the role of a proxy or substitute decision-maker.
• Advance Care Directive –
• Refusal of Treatment –
• Role of a proxy or substitute decision-maker (cover more in-depth soon)
• Informed Consent (cover more in-depth soon)
There is an associated activity for each of the following
Rights of an SK Individual
Understand a patient’s rights in Saskatchewan and in Canada with regards to health care decisions such as developing an
advance care directive, refusal of treatment, informed consent, and the role of a proxy or substitute decision-maker.
• Advance Care Directive - is a legal document in which a person specifies
what actions should be taken for their health if they are no longer able to make
decisions for themselves because of illness or incapacity. (Ex. Will)
• Refusal of Treatment – individuals have the right to refuse treatment when
they are able to make a decision to do so.
• Role of a proxy or substitute decision-maker
• Informed Consent - a process for getting permission before
conducting a healthcare intervention on a person. Ex. Massage
Therapy, sign here.
There is an associated activity for each of the following
Role of Substitute Decision-Maker (SDM)
• http://www.hss.gov.yk.ca/pdf/substitute_dm_brochure.pdf
• How is it chosen – what is the order of individuals who could be responsible?
• Who can be one? What is the minimum criteria?
Role of Substitute Decision-Maker (SDM)
• http://www.hss.gov.yk.ca/pdf/substitute_dm_brochure.pdf
• How is it chosen – what is the order of individuals who could be responsible?
Guardian  Proxy (Advance Directive)  Spouse  Child  Parent  Grandparent
 Brother or Sister  Other relative  close friend  last resort – care providers
• Who can be one?
Over 19 years of age… unless they are spouse or parent.
Contact in last 12 months and;
No court orders or conflicts preventing this.
Role of Substitute Decision-Maker (SDM)
Things to be aware of in this role…
• The person’s current wishes;
• Whether the person’s condition or well-being is likely to improve, worsen or stay the
same if the person receives the care;
• Whether the person’s condition or well-being is likely to improve, worsen or stay the
same if the person does not receive the care;
• Whether the benefits of the care will outweigh the risks or negative consequences;
• Whether a less restrictive or less intrusive form of available care would have greater
benefits or less negative consequences;
SDM - Duties
Duties
• Consult with the person to the extent reasonable, given their condition;
• Consult with any friend or relative who asks to assist if the substitute decision-maker does not know the
person’s values or wishes;
• Follow the wishes expressed by the person when they were still capable and after they turned 16 years
of age unless:
• It is impossible to follow the wish; OR • The substitute decision-maker believes that because of
changes in knowledge, technology or practice, the person would no longer act on the wish;
• Use the person’s wish as guidance where it does not clearly anticipate the specific circumstances that
exist;
• Make a decision based on the person’s values and beliefs if the substitute decisionmaker does not know
the person’s wishes;
• Make a decision based on what is in the person’s best interests if the substitute decision-maker does
not know the person’s values and beliefs or wishes;
SDM - Decisions to Make
Decisions to make…
• Health care (e.g. medical treatment, dental care, diagnostic procedures)
• Admission to a care facility (e.g. nursing home, group home for adults with
cognitive disabilities)
• Personal assistance services (e.g. home care, personal care in a care facility)
SDM - Importance and Takeaways
• Select someone to represent you who really knows you and your
wants OR select someone whose opinion you trust even if you
sometimes don’t agree with it.
• Ultimately they are making decisions for you when you are incapable
to do so… this includes “pulling the plug”.
SDM – Who would you actually pick?
Mr. P’s answer
• I would pick my father. He is the most similar to me in terms of life-outlook
(science-focused) and has similar beliefs about death.
• Donate organs… anything to science. Plant tree from remains.
• If there’s legitimate hope (>1%) for even just my brain to recover, give it a short
amount of time (<month) or until it becomes a financial burden on others – if I
have kids, ensure their needs are met first and foremost and financial needs for
my health do not jeopardize their futures. Or if my brain can be frozen to be
implanted in a robot… go for it.
• No funeral/memorial needed. Have a party or something! I think once I’m dead
I’m dead so regardless of what you do it don’t matter, do what you got to do for
you, not me… if chosen to cremate and selecting somewhere meaningful will
make you feel better, spread my ashes somewhere near the Base, on the prairies
or on the hockey arena.
• Avoid religion if memorial-based, but offer services to those who are.
Role Play
• Pick someone in our class to be your SDM. Talk with them for 5
minutes about each of your health desires should anything bad
happen to you.
• You will read the story on the next slide, they will decide your future
and write it down including their rationale.
• They will then share it with you and we will see if they did what you
would have wished.
SDM
• What I would choose for myself:
• What I would choose for my partner(s):
Story
• They were in a car accident. Severe damage to the body. Permanent
paralysis from the waist down, waste-above will work. Possible sightloss but no apparent damage to vocal cords and no apparent brain
damage. However, they have been in a coma for the past month. Life
support has helped. Doctors say that IF they come out of a coma
naturally in the next 2 months they would retain brain function… or
they could induce you try to come out of a coma immediately with a
50% success/mortality rate. Decision?
Keep in mind what you think the wishes of this person are.
Scientific Studies • John Oliver (uses some foul language and inappropriate comments)…
But!
Good reminder for our projects at the end of the year and scientific
studies.
https://youtu.be/0Rnq1NpHdmw?t=15m1s
Remember – no results, are still results!
Informed Consent
• Be sure to grab the hand out!
Informed Consent to Treatment
• Throughout Canada, before health care professionals may treat a
client, he or she requires the informed consent of the client. The
health care professional must determine whether the person is
capable of giving consent to treatment.
• The individual’s capacity to give consent can change. One day they
may be capable, the next, incapable. If a person becomes incapable
(unable to understand the nature of an intervention), the issue of
consent must be readdressed.
• Consent MUST be both Informed and Voluntary.
Informed Consent
Informed Consent is based on the patient understanding:
1) the treatment or procedure
2) the nature and purpose of the proposed treatment
3) risks, side effects, benefits and expected outcomes
4) implications of refusing recommended treatment
5) be made aware of alternatives (if any) to the proposed treatment so they
understand their choices
*Health care professionals have an obligation to use language that is at an
appropriate level and to discuss the information when the client is not
stressed or unhappy (may require second explanations of the intervention
when the client is in a calm frame of mind)
Voluntary Consent:
• Clients must NOT feel compelled to make a decision for fear of criticism, nor
must they feel pressured toward any particular decision by the information
provider or anyone else.
*At times only a fine line exists between coercing (i.e., bullying) and making a
recommendation especially when the health care professional feels strongly that the client
should consent to a treatment, and the client is leaning toward refusing it.
• *According to the Supreme Court of Canada, it is the basic right of every
capable person to decide which medical interventions he or she will accept or
refuse. It shows respect for the client and the person’s right to autonomy; it
also improves client compliance with treatment regimes.
• *Every province has its own legislation regarding informed consent. Health
care providers are encouraged to obtain written consent for all medical
services even minor medical services like immunizations.
Types of Consent:
• Written Consent:
• Major medical interventions require signed, written consent as confirmation that the
appropriate process for obtaining consent was followed and that the client has agreed to the
intervention.
• Client must understand the intervention along with the risks and benefits
• Most forms must be signed by the client, dated and witnessed (the definition of a witness
varies in different areas)
• For minor or major surgeries, physicians or a registered nurse will usually witness the consent
• The witness must be sure the client understands what they are signing. If there is doubt, there
must be further explanation and clarification.
• Most hospitals have a list of volunteer interpreters should the need arise, but interpreters who
can deliver health-related information clearly and accurately are not always available. Often
family members translate and what is presumed to be “informed consent” may not be.
Types of Consent:
• Oral Consent:
• Given by spoken word over the phone or in person and is as equally binding as
written consent
• At times, someone other than the client offers consent to surgery
• Two people must validate that consent has been given
• Written consent is still preferred for complex treatments
Types of Consent:
• Implied Consent:
• Consent assumed by the client’s actions, such as seeking out the care of a health
care professional or failure to resist or protest.
• More and more health care professionals are requesting written consent even for
treatments within a health clinic (e.g., receiving immunizations at the clinic).
• By allowing themselves to be admitted into a hospital, clients imply their consent
to certain interventions (e.g., allowing the nurse to give them a bath or take vital
signs). However, where possible oral consent should be obtained. “Is it okay if I
change your dressing in a little while?” *Refusal to treatment are recorded on
health records with reasons for refusal provided by the client*
Who Can Give Consent
• The person receiving medical care most often gives consent for treatment
• If the person is incapable of providing consent (e.g., is unconscious or not
mentally competent), the person’s legal representative or next of kin assumes the
responsibility.
• The person who has power of attorney (A legal document naming a specific person
or persons to act on behalf of another in matters concerning personal care,
personal estate or both) may take on this duty.
• If no power of attorney is present, most provinces and territories will allow a
spouse (legal or common law) or another family member to legally provide
consent. In some locations, there is a designated order depending on the
availability of particular relatives – typically, a spouse will have control before a
mother and father who have control before a sibling, then aunts and uncles and
so on.
• In most regions, there is no specific age defining a minor (a person under the age of majority in a
particular province or territory) when it comes to providing independent consent to treatment or
to requesting treatment without a parent’s knowledge.
• As long as the minor fully understands the treatment (along with risks and benefits), he or
she can make an informed decision about accepting or rejecting treatment, and health care
professionals MUST respect his or her wishes.
• When a minor’s consent is accepted, the minor is referred to as a mature minor. Frequently,
a minor’s consent to treatment is made along with the parents.
• Emancipated minors – those married, living on their own, or showing independence from
parents in some way – may also consent to medical care.
• When required, either parent with legal custody of the minor (or legally appointed guardian)
can provide consent to treatment.
• **In the view of the courts, if the children are too young to hold and express beliefs or
understand the consequences of receiving or not receiving treatment, courts will uphold
requests made to intervene on the child’s behalf.
Case Studies – Making an Ethical Decision
• Let’s try it out given the case studies I have for you!
Given your own case (whichever you’d like) –
come up with a…
• Small groups – 3-5
• Summary of the case (3 sentences).
• How it connects to each of the “core ethical questions” - CEQs (2 marks
each)?
• What the question was? (1 mark)
• What your decision would have been (2 marks)?
CEQs
• Autonomy – ability to think/decide freely for the patient. Are they in a
position to make an informed decision.
• Beneficence and Non-Maleficence What is best for the patient? Are
these presented to them? – Act in a manner that does bring further harm.
• Justice – Are measures taken by Health Care provider within reason? Does
it take into account scarcity of resources? (Is it a proper use of resources?)