Informed consent challenges
Ethical challenges associated with valid and informed consent to treatment and to the creation use and management of patient records, consent forms, and associate health information to support care and treatment.
Teaching of Beauchamp-Childress principlism to medical students remains one big advantage as these future physicians will apply informed consent in strengthening the relationships between them and their patients. Informed consent draws its roots from past reports of abuse of vulnerable people in the US. In order to solve this, the US Public Health Service established regulations concerning human rights and establishment of IRBs became a requirement in most institutions as a means of dealing with ethical issues (Zussman, 1997).
In medical ethics, both the actions of patients and the physician are of great concern, and in the last twenty years, medical practice issues including informed consent, have been widely discussed in various forums. Specifically, informed consent helps the physician understand the patient better and patients will be encouraged to keenly adhere to their treatments. However, the benefits of informed consent should not be overstated (Barbara, 2004).
First, in as much as it makes decision-making possible between physicians and patients, informed consent does not allow for autonomous choices in the absence of such choices. Most nursing institutions restrict patients’ choices in order to function as an organized institution. Rules that dictate patients’ behavior and routine have been put in place and this limits autonomy of the patients. Autonomy involves freedom of patients to making choices on moral positions, privacy, among others. The patient should command their own lives and autonomy should not be affected by external constraints. However, nursing institutions are faced with the dilemma of respecting autonomy at the expense of running their institution as an organized institution (Fisher, 2001).
Informed consent has also developed within a particular cultural context and so may not fit perfectly in certain cultures and societies. Critics have argued that informed consent has western bias and so some other non-western cultures where family-community consent prevails may not find this as a universal ideal. In some communities, preservation of their norms and values overrides individual autonomy. In other African cultures, the older family members are the ones in charge of making decisions regarding the patient. In others, married women cannot make important decisions and so this is a responsibility of their husbands. The Arab culture believes that decisions should be made collectively and not by individuals alone. The medical practitioners therefore face a challenge in handling these cultural norms in relation to informed consent. Today’s physician may therefore face challenges on application of informed consent since we live in a highly multicultural world (Gordon, 2011).
With respect to cultural diversity and tolerance, the question that emerges is why then should the western individual-consent be applied universally while other cultures too have their own norms such as family-community consent which may vary from those of western countries. In imposing this to conservative patients from non-Western cultures, physicians may be accused by patients of practicing Western imperialism on them (Gordon, 2011).
The concept of truth-telling also varies across cultures. Some communities have embraced only the positive thinking and any negative discussions are avoided even if they were the truth. Some such as the Navajos consider end-of-life discussions as a taboo. In China, positive thinking is highly embraced and so physicians will not tell their patients any bad news. On the other hand, some individual patients may personally choose not to be informed of any bad news about their medical conditions and progress. Others may decide to delegate such responsibilities of decision-making to their families. The physicians will therefore be faced with a challenge of balancing between respect of the patient’s autonomy and the patient’s desire for less information and decision-making authority.
In conclusion, informed consent is of great necessity in the medical field. However, it does not lack limitations which present physicians with ethical challenges. The main limitation which is incompatibility with all world cultures could however be addressed through the bioethicists understanding of the role of culture in ethics and then adopting an anthropological strategy in ethics. This will serve the purpose of bridging culture gaps hence giving physicians an easy time in applying informed consent in their practices.
Barbara, J. R. (2004). Unwittingly de-humanizing patients; rehabilitating informed consent.
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