HEALTH CARE ETHICS – NCM108

Asynchronous Research Activity

Serrano, Alyssa Marie C.

SN#: 19-1527

BSN-2
Informed Consent and Its Principles
An informed consent is a process by which health care providers, like physicians and nurses,
educate and explains to the patient/client about the risks, benefits, and other alternatives for
such procedure or intervention. This is to help the health care providers as well as the
patient/client in decision making.

According to Menendez, shared decision making is at the foundation of a mutually respectful

relationship between a health care provider and a patient. Before surgery, the informed
consent process serves as the practical application of mutual participation and respect for the
patient's autonomy. In addition, the patient's legal right to participate in decisions about
his/her medical care is supported by oversight regulations such as the Patient Rights
Condition of Participation. The method of providing for informed consent for surgery may
vary among different surgeons and even among different patients of the same
surgeon. Traditionally, the process includes an oral discussion between the surgeon and the
patient, followed by the patient signing a document affirming his/her consent. The use of oral
communication and written documents remains common. Videos and computer software are
also used to disclose important information needed to obtain a valid informed consent. Any
delivery method may be used as long as it necessitates providing patients with the (a)
indications, (b) risks, (c) benefits, and (d) alternatives about a planned surgery.

According to Wagner, informed consent is based on the moral and legal premise of patient
autonomy: You as the patient have the right to make decisions about your own health and
medical conditions. There are 4 principles of informed consent:

• You must have the capacity (or ability) to make the decision.

• The medical provider must disclose information on the treatment, test, or procedure in
question, including the expected benefits and risks, and the likelihood (or probability)
that the benefits and risks will occur.

• You must comprehend the relevant information.

• You must voluntarily grant consent, without coercion or duress.

The process of informed consent is giving the patient the autonomy to make decision regarding
his/her condition with the help and guidance of the health care provider by giving thorough
explanation, considering ethical, legal and patient-centered when it comes to decision making.

Right to Refuse on Treatment

Upon educating the patient/client regarding the informed consent, and explaining the risks,
benefits, and alternatives for the procedure or treatment needed, every patient has their right to
refuse as part of their autonomy. Its either surgical or medication, patients have the right to
refuse when it comes to their health conditions.

According to Menendez, a competent patient's right to refuse a recommended treatment is an

important principle in the informed consent process. Respect for patient autonomy and self-
determination requires that decisions to consent to or refuse treatment originate freely from the
patient as an autonomous agent. Not only must consent be freely given, but it may also be freely
withdrawn at any time. With some exceptions, even patients with mental illness are usually
considered competent to refuse treatment at any point in the informed consent process. The
granting of autonomy to refuse consent to a recommended treatment requires health care
providers to accept the free choice of each person even if that choice seems inappropriate,
foolish, or hazardous. Refusal of surgical intervention is possible after an appropriate informed
consent discussion. It does not mean the surgeon did not provide adequate information during the
process. The patient may find alternatives to surgery equally attractive to having an operation. In
addition, refusal to consent is not itself evidence of the patient's incapacity to make health care
decisions.

In a case scenario, where a firefighter was badly burned, almost 85 percent of his body, after the
doctor explained to him his condition and what will happen to him if ever, he agreed to the
treatment, the client refuses to have life-sustaining treatment and asked the doctor to let him die.
With the case of the firefighter, as health care provider they must respect the patient’s decision in
refusing the life-sustaining treatment, but they also need to consider the patient’s capacity in
decision-making. According to Cooper, one of the greatest dilemmas for emergency physicians
occurs when a patient refuses medical treatment that is necessary to sustain life and health. When
patients in need explicitly refuse life-sustaining emergency treatment, the physician must choose
between the undesirable options of forgoing beneficial treatment and forcing treatment on a
competent but unwilling patient, both of which have potential ethical and legal consequences.
The “emergency privilege” does not permit physicians to treat competent patients with
emergency conditions who refuse treatment; but how does one assess an injured patient’s
decision-making capacity?

Decision-making capacity (DMC) exists along a continuum, referring to the ability of a patient to
make a specific decision at a specific time; it is not a global determination. “Medical decision-
making capacity is present when the patient is able to understand information about the medical
condition and its consequences, to reason and deliberate about the various choices, to make a
choice consistent with his or her values and goals, to communicate this choice to the physician,
and to maintain this choice consistently over time”.

Withholding and Withdrawing Treatment

In decision making especially in an intensive care unit (ICU), withholding treatment is the
decision not to make further therapeutic interventions – and withdrawing is the decision of the
removal of a therapy that has been started in an attempt to sustain life but is not, or no longer,
effective. Essentially, a decision to limit life-sustaining therapy can take one of two forms:
withholding or withdrawing. Withdrawal of therapy is relatively easily defined as the removal of
a therapy that was started in an attempt to sustain life but has become futile and is just
prolonging the dying process. Withdrawal usually concerns therapies such as mechanical
ventilation and administration of vasoactive agents. Withholding therapy, on the other hand,
concerns the concept of no therapeutic escalation. Perhaps the most frequent example of this is
the do not resuscitate (DNR) order (or DNAR – do not attempt to resuscitate). Withholding
resuscitation efforts will almost inevitably result in death from a cardiac arrest should one occur.
(Vincent, 2005).

According to Reichlin, A general rationale is presented for withholding and withdrawing medical
treatment in end-of-life situations, and an argument is offered for the moral irrelevance of the
distinction, both in the context of pharmaceutical treatments, such as chemotherapy in cancer,
and in the context of life-sustaining treatments, such as the artificial ventilator in lateral
amyotrophic sclerosis. It is argued that this practice is not equivalent to sanctioning voluntary
active euthanasia and that it is not likely to favor it.

Pharmacology Ethics

The profession, particularly community pharmacy, sits at the intersection between health and
retail, as the profits are gained from making sales of medications. This introduces a number of
ethical complications and a strong need for guidelines to base decisions on that are centered on
moral obligations and virtues.

Ethical Principles

The code of conduct to guide decision-making for pharmacist and maintain ethical integrity
varies according to the country and professional body that creates the guidelines. However, the
ethical principles are similar and can be separated into five main categories: the responsibility for
the consumer, the community, the profession, the business and the wider healthcare team.

The ethical responsibilities of a pharmacist that relate to the consumer include:

• To recognize the consumer’s health and wellbeing as their first priority, and utilize
knowledge and provide compassionate care in an appropriate and professional manner.

• To respect the consumer’s autonomy and rights and assist them in making informed
decisions about their health. This should include respecting the dignity, privacy,
confidentiality, individuality and choice of the consumer.

The ethical responsibilities of a pharmacist that relate to the community include:

• To maintain the reputation and trust that the public has placed on the profession and
refrain from abusing this trust and respect.

• To acknowledge their place in the wider community, including their professional role and
responsibilities to control and supply pharmaceutical goods for optimal health outcomes.
The ethical responsibilities of a pharmacist that relate to the profession include:

• To commit to the development and enhancement of the profession by becoming involved

in activities such as training staff, teaching, being a preceptor or mentor for students,
interns or colleagues, participating in initiatives to develop the profession and
demonstrate positive leadership.
• To keep up-to-date with knowledge of pharmacy practice with lifelong learning and self-
development to maintain professional competence and personal health to continue
practicing.
• To practice only when their professional independence, judgment and integrity remains
upheld, and manage situations with a conflict of interest appropriately.

The ethical responsibilities of a pharmacist that relate to business practices include:

• To conduct the business practices of pharmacy in an ethical and professional manner with
the consumer’s best interest in mind and due respect to colleagues and the reputation of
the profession.

The ethical responsibilities of a pharmacist that relate to other health professionals include:

• To work in cooperation and collaboration with other healthcare professionals to achieve

the optimal health outcomes for consumers. (Smith, 2019)

Research Ethics

According to WHO (World Health Organization), research ethics govern the standards of
conduct for scientific researchers. It is important to adhere to ethical principles in order to protect
the dignity, rights and welfare of research participants.

In doing research, there are ethical considerations that should apply before proceeding the
research. Not that long ago, academicians were often cautious about airing the ethical dilemmas
they faced in their research and academic work, but that environment is changing today.
Researchers face an array of ethical requirements: They must meet professional, institutional and
federal standards for conducting research with human participants (Smith, 2003).
Ethics in medical research deals with the conflicts of interest across various levels. Guidelines
have been proposed for standardized ethical practice throughout the globe. The four fundamental
principles of ethics which are being underscored are autonomy, non-maleficence, beneficence,
and justice. It deals with the choices made by both clinicians and patients and the duties and
obligations of clinicians to their patients. Medical ethics also deals with the choices made by
society, the distribution of resources, and access to health care, and the dilemmas arising from
them. The challenge to international research ethics is to apply universal ethical principles to
biomedical research in a multicultural world with a multiplicity of health-care systems and
considerable variation in standards of health care. It laid down 10 clear principles to be followed
by researchers and made voluntary consent essential, allowed subjects to withdraw from the
experimentation at any time, banned experiments that could result in major injury or death of the
subjects, and made mandatory to have preclinical data before experimenting on humans.
(Avasthi, Ghosh, Sarkar, & Grover, 2013).
References:

Avasthi, A., Ghosh, A., Sarkar, S., & Grover, S. (2013, January). Ethics in medical research:
General principles with special reference to psychiatry research. Retrieved March 20,
2021, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3574464/#:~:text=Ethics%20in%20medic
al%20research%20deals,maleficence%2C%20beneficence%2C%20and%20justice.

Cooper, S. (2010, June 01). Taking no for an answer: Refusal of life-sustaining treatment.
Retrieved March 20, 2021, from https://journalofethics.ama-assn.org/article/taking-no-
answer-refusal-life-sustaining-treatment/2010-06

Menendez, J., RN, MSHL, CPHRM. (n.d.). Informed Consent: Essential Legal and Ethical
Principles for Nurses. Retrieved March 20, 2021, from
https://www.nursingcenter.com/ce_articleprint?an=00128488-201310000-00004

Reichlin, M. (2014, July 16). On the ethics of withholding and withdrawing medical treatment.
Retrieved March 20, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4107538/

Smith, D. (2003, January). Five principles for research ethics. Retrieved March 20, 2021, from
https://www.apa.org/monitor/jan03/principles

Smith, Y. (2019, February 27). Ethics in pharmacy. Retrieved March 20, 2021, from
https://www.news-medical.net/health/Ethics-in-Pharmacy.aspx

Vincent, J. (2005, March 04). Withdrawing may be preferable to withholding. Retrieved March
20, 2021, from
https://ccforum.biomedcentral.com/articles/10.1186/cc3486#:~:text=Such%20decisions%2
0can%20essentially%20take,to%20make%20further%20therapeutic%20interventions.

Wagner, R. A., MD. (2020, September 11). What is informed consent in Healthcare? 4
PRINCIPLES, important & laws. Retrieved March 20, 2021, from
https://www.emedicinehealth.com/informed_consent/article_em.htm

W.H.O. (n.d.). Ensuring ethical standards and procedures for research with human beings.
Retrieved March 20, 2021, from https://www.who.int/activities/ensuring-ethical-standards-
and-procedures-for-research-with-human-
beings#:~:text=Research%20ethics%20govern%20the%20standards,and%20welfare%20of
%20research%20participants.