2. Charity: This term is the modern equivalent of Hippocrates` concept of „do no harm.” In practice, the ethical issue addressed examines the risk-benefit balance of the proposed medical treatment while 1) maximizing the benefits to the patient and 2) minimizing harm or discomfort. This includes both making decisions in the best interests of the patient and taking positive steps to prevent or eliminate patient harm. What is beneficial for the patient is very personal and multifaceted and involves taking into account the patient`s medical prognosis as well as several subjective factors such as care goals, quality of life, financial considerations, family contribution, etc. 3. Fairness: The general philosophy of this principle requires the practitioner to ensure a fair and equitable distribution of medical resources, regardless of demographics, insurance status, socioeconomic status, intellectual disability, etc. It should be remembered that „medical paternalism” (defined here as „the policy of restricting the freedom and responsibility of patients against their will and defended by claiming that the person who intervened is better off or protected from harm”) is not at the service of these ethical principles. Coercion in the course of action that the provider deems best does not respect the patient`s autonomy or does not support the principle of charity. To truly translate these principles into daily practice, you need to take the time to communicate your findings and recommendations to the patient, actively listen to their questions and concerns, and make a joint decision. Ultimately, this decision may not align with what the provider thinks is best.
Supporting this decision, if any, is part of the practice of respecting patient autonomy. A complete understanding of a person`s mental state, or at least as complete as the patient`s clinical condition allows, is essential to accurately determine their ability to make medical decisions. This review provides the basis on which an argument for or against a patient`s performance can be built. It is believed that all adults have sufficient capacity to decide on their own medical treatment, unless there is significant evidence to suggest otherwise. The jurisdictional components identified by a judge are listed below. Note the similarity with the 4 components of medical decision-making capacity. It is the legal body that oversees the implementation of the Mental Capacity Act (2005). Based on this mental state review, it would be reasonable and appropriate to determine that this patient is incapable of making informed or logical medical decisions.
Of the four capacity criteria listed above, he demonstrated none. A patient who does not have decision-making capacity cannot refuse or consent to treatment [7]. Once this lack of capacity has been determined and documented, the medical provider is legally authorized to perform sedation, restraint, venipuncture, and other tests or treatments deemed appropriate. If no communication barriers or reversible causes of incapacity for work are identified, the next step is a capacity assessment with a rapid and informal clinical interview. This process can help determine if the patient has all four elements of capacity. Table 2 provides questions to assess these four elements.3 When assessing a patient`s responses to these questions, keep in mind that patients do not need to make the „right” choice. They only need to demonstrate a rational review of the relevant information to make their decision.10 A high burden of proof is necessary to limit autonomy. Thus, if the assessment shows that the patient`s understanding and reasoning are reasonable, this usually determines capacity, even if someone else in the patient`s situation might make a different decision.11 TABLE 2. For example, a person who refuses to receive a blood transfusion because it goes against their religious beliefs would not be considered incapable.