扬州大学：《医学伦理学》课程教学课件（PPT讲稿）Chapter 2 THE UNDERLYING PRINCIPLES OF ETHICAL PATIENT CARE（Basic Principles）

CHAPTER2THE UNDERLYNGSOFETHICALPRINCIPLESPATIENTCARE

CHAPTER 2 THE UNDERLYING PRINCIPLES OF ETHICAL PATIENT CARE

BASICPRINCIPLES1)Beneficence2)Non-Maleficenceautonomy3)RespectforAutonomyjustice4)Justice5) Principle of Veracitybeneficencenof6) Principle of Respect formaleficenceDignityDruarsinscom

BASIC PRINCIPLES 1) Beneficence 2) Non-Maleficence 3) Respect for Autonomy 4) Justice 5) Principle of Veracity 6) Principle of Respect for Dignity

THEPRINCIPLEOFBENEFICENCEMedical practitioners shouldact inthe bestinterestsofthepatientMore specifically,they should prevent harmremove harm,and promotegoodforthepatient

THE PRINCIPLE OF BENEFICENCE Medical practitioners should act in the best interests of the patient. More specifically, they should prevent harm, remove harm, and promote good for the patient

THEPRINCIPLEOFNON-MALEFICENCEThe principle of"Non-Maleficence"requires an intention toavoidneedlessharm orinjurythat can arisethroughactsofcommissionoromission

THE PRINCIPLE OF NON-MALEFICENCE

Problem:medical interventionsrisksbenefits: ldentification of harms for individual patients andspecific medical interventionsPrinciple of Beneficence and thePrincipleofNon-Maleficence will often need to be appliedtogether

Problem: • Identification of harms for individual patients and specific medical interventions medical interventions risks benefits • Principle of Beneficence and the Principle of Non-Maleficence will often need to be applied together

THEPRINCIPLEOFRESPECTFORAUTONOMYCapablepatientsmustbe allowedto acceptorrefuserecommendedmedicalinterventions"Autonomy" is defined as the capacity forself-determination or the capacity to makeone'sowndecisions

THE PRINCIPLE OF RESPECT FOR AUTONOMY Capable patients must be allowed to accept or refuse recommended medical interventions. “Autonomy” is defined as the capacity for self-determination or the capacity to make one’s own decisions

AUTONOMYCapacity involves the ability to make andcommunicate health care decisions.Respect forpatient autonomy reguires that those with thiscapacity be permitted to accept or refuse treatmentalternatives recommended by their physiciansVoluntaryinformedconsent·Capable patients must be provided with full, relevant.and truthful information about recommendedtreatments and any reasonable alternatives, includingexpected benefits, potential risks, and the results ofrefusing treatment altogether.They must understandthis information and make a voluntary decisionwithout coercion or undue influence

Capacity involves the ability to make and communicate health care decisions. Respect for patient autonomy requires that those with this capacity be permitted to accept or refuse treatment alternatives recommended by their physicians. Voluntary informed consent •Capable patients must be provided with full, relevant, and truthful information about recommended treatments and any reasonable alternatives, including expected benefits, potential risks, and the results of refusing treatment altogether. They must understand this information and make a voluntary decision without coercion or undue influence. AUTONOMY

AUTONOMYInformedConsentDisclosureCOMPreHeNSiONunderstandwhat/read

AUTONOMY

caseFor example, you inform a patient about the risksand benefits of bone marrow transplantation forchronic myelogenous leukemia. You fully informthe patient about the risk of transplantation,including the possibility of developing graftversus host disease. After the transplantation thepatient develops graft versus host disease, whichis hard to control. The patient learns that there isan alternative treatment called imatinib (gleevec);which does not include the risk of graft versushost disease, but which will not cure theleukemia. The patient files suit against you. Whatwill be the most likely outcome of the suit?

For example, you inform a patient about the risks and benefits of bone marrow transplantation for chronic myelogenous leukemia. You fully inform the patient about the risk of transplantation, including the possibility of developing graft versus host disease. After the transplantation the patient develops graft versus host disease, which is hard to control. The patient learns that there is an alternative treatment called imatinib (gleevec), which does not include the risk of graft versus host disease, but which will not cure the leukemia. The patient files suit against you. What will be the most likely outcome of the suit? case

caseMr. M. consents to a procedure on his left ear. Afterthe patient is anesthetized, Dr. W. discovers that theright ear is in greater need of surgery. What shouldthe surgeon do?a. Perform the procedure on the right ear if it is clearthat it is more necessaryb. Wake the patient up and seek consent for a differentprocedure.c. Seek a second opinion from another surgeon andproceed with the more necessary procedure.d. Perform the procedure on both ears

case Mr. M. consents to a procedure on his left ear. After the patient is anesthetized, Dr. W. discovers that the right ear is in greater need of surgery. What should the surgeon do? a. Perform the procedure on the right ear if it is clear that it is more necessary. b. Wake the patient up and seek consent for a different procedure. c. Seek a second opinion from another surgeon and proceed with the more necessary procedure. d. Perform the procedure on both ears