Therapeutic privilege and consciousness PDF

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Therapeutic privilege and consciouness...

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Therapeutic privilege and consciousness’s objection o Therapeutic privilege  Therapeutic privilege - Exists to protect a patient - The withholding of information from a patient - Should only be used by a doctor when in a patient’s best interests - Was commonly used in the past - Patient feedback indicated that despite diagnosis or prognosis, the patient preference was that they be told the truth  Autonomy - Self determination  Free to self-make own decisions without interference or control from others - Self-determination requires a true appreciation of circumstances - Practitioners should not withhold the truth or lie to a patient  Beneficence - The practitioner must act to do good or remove harm from a patient  Non-maleficence - The practitioner must refrain from taking action that could cause harm to a patient  Justice - A patient should receive that which they need or deserve as a person  However - In some limited situations an exception can arise - A doctor may choose to not disclose information to a patient that is believed to be detrimental to the patient’s best interests - But practitioners should note, information should not be withheld except in very limited circumstance  Exclusions to disclosure of information 1. The doctor judge’s on reasonable grounds that the patient’s physical or mental health might be seriously harmed by the information; or 2. The patient expressly directs the doctor to make the decisions, and does not want the offered information  Despite therapeutic privilege

TOPIC - The doctor should still give basic information about the illness and the proposed intervention - To widen the application of therapeutic privilege beyond the two given circumstances runs counter to the general duty to inform  Withholding truth - To avoid harm to the patient or others - Or with the prior consent of the patient - Is also known as benevolent deception  Paternalism - One problem with using therapeutic privilege is the risk of paternalism - Interference with, or limitation of, a person’s right to autonomy o Consciousness objection  Conscientious objection - Exists to protect a practitioner  Conscience - “Conscience is the most fundamental of all moral duties- the duty to unite one’s powers of reason, emotion and will into an integrated moral whole based upon one’s most fundamental moral principle and identity (Sulmasy, 2008)”.  Nurses - “Nurses have a right to refuse to participate in procedures which would violate their reasoned moral conscience (i.e. conscientious objection). In doing so, they must take all reasonable steps to ensure that quality of care and patient safety is not compromised”.  Right to raise conscientious objection - Respect for properly formed conscience is fundamental to the concept of tolerance in a society - A repressive society grants only limited room for conscientious differences in belief - A tolerant society finds a mean between repression and licentiousness (‘anything goes’).  Practitioners should take note that - Conscientious judgements can sometimes be wrongconscience is not infallible - This may happen as a result of faulty reasoning, ignorance of facts or rules, emotional imbalance, etc.

TOPIC  One’s conscience - A well-formed conscience is committed to morality itself and is a final arbiter - Conscience assists us in judging whether, or not, the act one has either already done or intends to do would violate a moral commitment  Respect for conscience - Conscientious persons can disagree: need for humility and tolerance - However, forcing a person to violate their own conscience is objectionable  Responsibilities of the conscientious objector 1. Ensure that the objection is a moral objection- not simply that you don’t want to do the work 2. Let the nurse in charge of the ward know that you are refusing to participate and on what sounds (good reasons) 3. Ensure that someone else will perform the task for you 4. Document your objection and refusal o Ethical decision-making  Use of Giving Voice to Values - GVV- focuses on ACTION- but emphasise that we can choose to act on our values, assuming that we are aware of and can articulate our values - Conscientious decision-making  Respects the distinction between reasons and rationalisations from one person to another  Recognises that emotional motivations are significant in the process of rational decision-making and in deciding how to act...