Models of the Doctor-Patient Relationship and the Ethics Committee: Part One

Models of the doctor-patient relationship determine which value will predominate in the interaction of the parties. That value then significantly colors and even sometimers alters the nature of the ethical discussion. For example, if an institution predominately prides it-self on its competitive posture, ethical issues arising therein will necessarily be colored by entrepreurial rather than deontological ethics. By contrast, a physician who underlines patient decision making will tend to place autonomy first above all other principles, casting that relationship in a libertarian tone.

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Decision-Making of Older Patients in Context of the Doctor-Patient Relationship: A Typology Ranging from “Self-Determined” to “Doctor-Trusting” Patients

International Journal of Family Medicine ◽

10.1155/2013/478498 ◽

2013 ◽

Vol 2013 ◽

pp. 1-10 ◽

Cited By ~ 14

Author(s):

Jennifer Wrede-Sach ◽

Isabel Voigt ◽

Heike Diederichs-Egidi ◽

Eva Hummers-Pradier ◽

Marie-Luise Dierks ◽

...

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Information Seeking ◽

Older Patients ◽

Self Determination ◽

Shared Decision ◽

Patient Relationship ◽

Doctor Patient Relationship ◽

Good Doctor ◽

Patient Decision Making

Background. This qualitative study aims to gain insight into the perceptions and experiences of older patients with regard to sharing health care decisions with their general practitioners. Patients and Methods. Thirty-four general practice patients (≥70 years) were asked about their preferences and experiences concerning shared decision making with their doctors using qualitative semistructured interviews. All interviews were analysed according to principles of content analysis. The resulting categories were then arranged into a classification grid to develop a typology of preferences for participating in decision-making processes. Results. Older patients generally preferred to make decisions concerning everyday life rather than medical decisions, which they preferred to leave to their doctors. We characterised eight different patient types based on four interdependent positions (self-determination, adherence, information seeking, and trust). Experiences of a good doctor-patient relationship were associated with trust, reliance on the doctor for information and decision making, and adherence. Conclusion. Owing to the varied patient decision-making types, it is not easy for doctors to anticipate the desired level of patient involvement. However, the decision matter and the self-determination of patients provide good starting points in preparing the ground for shared decision making. A good relationship with the doctor facilitates satisfying decision-making experiences.

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Ethical issues in invasive mechanical ventilation for amyotrophic lateral sclerosis

Nursing Ethics ◽

10.1177/0969733009350945 ◽

2010 ◽

Vol 17 (1) ◽

pp. 51-63 ◽

Cited By ~ 11

Author(s):

Yuko Hirano ◽

Yoshihiko Yamazaki

Keyword(s):

Decision Making ◽

Amyotrophic Lateral Sclerosis ◽

Ethical Issues ◽

Invasive Mechanical Ventilation ◽

Patient Decision Making ◽

Nursing Advocacy ◽

Patient Decision ◽

Decision Making Factors ◽

Herth Hope Index ◽

Lateral Sclerosis

Currently in Japan, discontinuing an invasive mechanical ventilator (IMV) is illegal; therefore IMV-related decision making is a crucial issue. This study examined IMV decision-making factors and psychological conflict in 50 patients with amyotrophic lateral sclerosis. The Herth Hope Index was used for the assessment of pre- and post-IMV conflict. Interviews identified some decision-making factors: patient’s decision, patient’s and family’s mutual decision, family’s decision, and emergency-induced without patient’s or family’s consent. Participants who experienced no IMV-related regret received sufficient prior IMV education from physicians and nurses, and time for reflection and family consultation. Their hope was similar to their pre-onset levels. Patients who received no prior IMV education accepted treatment as a natural progression. Their hope levels were lower than pre-onset. Those who received only a brief prior IMV explanation rejected the ventilator, experiencing regret if they were given an emergency IMV. Their hope levels were among the lowest. However, some of these patients managed to overcome their regret through being helped by nurses. Sufficient physician explanation and nursing advocacy for autonomous patient decision making are critical for improving hope in this patient group.

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Ethical issues related to the COVID-19 pandemic in patients with cancer: experience and organisations in a French comprehensive cancer centre

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2020-002504 ◽

2020 ◽

pp. bmjspcare-2020-002504

Author(s):

François Blot ◽

Sarah N Dumont ◽

Laurence Vigouret-Viant ◽

Nelly Verotte ◽

Julien Rossignol ◽

...

Keyword(s):

Decision Making ◽

Critical Care ◽

Ethical Issues ◽

Ethical Dilemmas ◽

Real Life ◽

The Elderly ◽

Ethics Committee ◽

Resource Scarcity ◽

Patients With Cancer ◽

Deontological Ethics

BackgroundThe COVID-19 pandemic has aggressively reached the most vulnerable, not only the elderly but also patients with chronic conditions such as cancer. In this study, we present the outlines of ethical thinking and the measures implemented to try to respect our basic values of care, in the specific environment of an oncology hospital.MethodsOur ethics committee created an ethical watch system based on 24/7 shifts to assist practitioners in their daily decisions. We discuss the challenges faced by patients with cancer during the pandemic, such as access to critical care and ethical dilemmas in the context of resource scarcity, as well as the issue of isolation of patients. We also debate the restrictions in access to oncology care in a health context strongly ‘prioritised’ against COVID-19.ResultsIn all areas of an ethical dilemma, either for sorting out access to critical care or for the dramatic consequences of prolonged isolation of patients, our common thread was our attempt to protect, whenever possible, the principles of deontological ethics by strictly resisting utilitarian pressure. Respecting democratic health decision-making processes is a cornerstone of ethically relevant decisions, including in the context of a sanitary crisis.ConclusionThe role of an ethics committee related to real-life situations includes not only a reflexive perspective in respect of fundamental principles, but also the help to enlighten and resolve ethical dilemmas in complex clinical situations. This ethical watch team assists physicians in decision-making, promoting the supportive and palliative dimension of care with a holistic approach.

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