The Experts below are selected from a list of 216 Experts worldwide ranked by ideXlab platform
Tracey Evans Chan - One of the best experts on this subject based on the ideXlab platform.
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Regulating the placebo effect in clinical practice.
Medical law review, 2014Co-Authors: Tracey Evans ChanAbstract:Recent research and ethical analysis have forced a clinical and ethical reappraisal of the utility of placebos in medical practice. The main concern of ethics and law is that using placebos in health care involves deception, which is antithetical to patient autonomy and trust in the physician-patient relationship. This article reviews the various, more nuanced scientific conceptions of the placebo effect, and evaluates the ethical and legal objections to deploying placebos in clinical practice. It argues that the placebo effect may be legitimately accommodated on the basis that it does not engage the requirement for material or quasi-fiduciary disclosures of information, and may also be justified by Therapeutic Privilege. In addition, this reconceptualisation of the placebo effect offers a new justification for Therapeutic Privilege in these contexts. Notwithstanding this, using the placebo effect in clinical practice raises regulatory issues that will require special regulatory supervision.
Mark A. Rothstein - One of the best experts on this subject based on the ideXlab platform.
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Autonomy and Paternalism in Health Policy
Social Science Research Network, 2014Co-Authors: Mark A. RothsteinAbstract:In the United States the delivery of health care traditionally has been hierarchical and strictly controlled by physicians. Physicians typically provided patients with little information about their diagnosis, prognosis, and treatment plan; patients were expected to follow their physicians’ orders and ask no questions. Beginning in the 1970s, with the widespread adoption of the doctrine of informed consent to treatment, the physician-patient relationship began to be more collaborative, although the extent of the change has been subject to debate. At a minimum, physicians began to give patients more information and asked them to consent to recommended treatment, the Therapeutic Privilege to withhold information from patients lost support and eventually was repudiated, and physicians embraced – at least in theory – a more patient-centered conception of health care.
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Autonomy and Paternalism in Health Policy: Currents in Contemporary Bioethics
The Journal of law medicine & ethics : a journal of the American Society of Law Medicine & Ethics, 2014Co-Authors: Mark A. RothsteinAbstract:In the United States the delivery of health care traditionally has been hierarchical and strictly controlled by physicians. Physicians typically provided patients with little information about their diagnosis, prognosis, and treatment plan; patients were expected to follow their physicians’ orders and ask no questions. Beginning in the 1970s, with the widespread adoption of the doctrine of informed consent to treatment, the physician-patient relationship began to be more collaborative, although the extent of the change has been subject to debate. At a minimum, physicians began to give patients more information and asked them to consent to recommended treatment, the Therapeutic Privilege to withhold information from patients lost support and eventually was repudiated, and physicians embraced — at least in theory — a more patient-centered conception of health care.More recently, health care and health promotion activities have moved beyond clinical encounters and the strict confines of physician-patient interactions.
Jane Greenlaw - One of the best experts on this subject based on the ideXlab platform.
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Talk about not talking.
Archives of internal medicine, 1993Co-Authors: Jane GreenlawAbstract:ANY CONTEMPORARY discussion of medical treatment decisions necessarily requires consideration of the doctrine of informed consent. Its introduction into the doctor-patient relationship caused some stirs and generated considerable misunderstanding. Consider, for example, a 1977 letter to the editors of The New England Journal of Medicine . 1 The authors described two cases in which they speculated that heart attacks were caused by [ill]e infliction of unwanted medical information. Blaming [ill]e informed consent principle and their fear of being sued, [ill]e authors lamented that "legal reasons" were forcing them persist with a potentially frightening dissertation," even [ill]n their patients said "I don't want to know" or "Don't [ill]me." 1 Thankfully, understanding of the informed con[ill]t doctrine has evolved to a higher plane, including cor[ill]tion of the two misconceptions evident in that letter. [ill]w it is accepted that there is a Therapeutic Privilege [ill]mitting nondisclosure when the doctor believes the [ill]rmation will be
Sylvester C. Chima - One of the best experts on this subject based on the ideXlab platform.
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Respect for Autonomy as a Prima Facie Right: Overriding Patients' Autonomy in Medical Practice
Social Science Research Network, 2009Co-Authors: Sylvester C. ChimaAbstract:Prima facie, every competent adult has the right to decide whether to consent or refuse any medical treatment, even if such refusal could lead to death. However, this right to respect for autonomy is a rebuttable right, which could be overridden where there is temporary or permanent mental incapacity, such as due to unconsciousness, infancy, or mental retardation. On these occasions, an individual’s right to informed consent could be overridden based on the doctrines of best interests, necessity, Therapeutic Privilege, or as a matter of public policy. In view of ongoing controversies and contemporary ethical dilemmas surrounding the withdrawal of life sustaining nutrition and hydration from patients in a persistent vegetative state (PVS), compulsory immunization of children, and detention of mental health patients. The quarantine and treatment of patients with infectious diseases, such as extremely drug resistant tuberculosis (X-DR TB), or during routine management of unconscious patients in medical emergencies. It is imperative that physicians and healthcare users are aware of those circumstances, where a patient’s right to respect for autonomy may be ethically and legally overridden, without descending down the ‘slippery slopes’ of medical paternalism. This essay analyzes the relevant case law and ethical principles, to find instances where an individual’s right to respect for autonomy may be considered to have only a prima facie standing and could be overridden when in conflict with other equally compelling moral considerations.
Alastair V. Campbell - One of the best experts on this subject based on the ideXlab platform.
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How should the 'Privilege' in Therapeutic Privilege be conceived when considering the decision-making process for patients with borderline capacity?
Journal of medical ethics, 2020Co-Authors: Sumytra Menon, Alastair V. Campbell, Vikki Entwistle, Johannes J. M. Van DeldenAbstract:Therapeutic Privilege (TP) is a defence that may be available to doctors who fail to disclose to the patient relevant information when seeking informed consent for treatment if they have a reasonable belief that providing that information would likely cause the patient concerned serious physical or mental harm. In a landmark judgement, the Singapore Court of Appeal introduced a novel interpretation of TP, identifying circumstances in which it might be used with patients who did not strictly lack capacity but might be inclined to refuse recommended treatments. In this paper, we explore the conceptual and practical challenges of this novel interpretation of TP. We propose that more emphasis should be placed on forms of shared and supported decision-making that foster the autonomy of patients with compromised mental capacity while being mindful of the need to safeguard their well-being. The kind of Privilege that doctors might need to invoke is one of time and supportive expertise to ensure a flexible, responsive approach calibrated to the individual patients' needs. The provision of such service would extinguish the need for the novel TP proposed by the Singapore Court of Appeal.
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P39 Collusion, advance care planning and Therapeutic Privilege – paternalism via the back door?
Poster Presentations, 2019Co-Authors: Sumytra Menon, J.j.m. Van Delden, Alastair V. CampbellAbstract:Collusion in the healthcare setting occurs when a patient’s loved ones seek healthcare professionals’ cooperation in hiding or moderating the disclosure of a serious illness from the patient with capacity to make their own healthcare decisions. Collusion more commonly occurs in patients who are older, perceived as vulnerable and in need of protection from the harsh truth. When collusion occurs, the patient is excluded from the decision-making process, their autonomy is suspended, and advance care planning is not even an option. Collusion may be justifiable if the doctor exercises Therapeutic Privilege and withholds diagnostic and/or prognostic information from the patient because of concerns that the patient may be seriously harmed physically or psychologically, if informed. The highest court in Singapore in the recent case of Hii Chi Kok v Lucien London Ooi expanded the concept of Therapeutic Privilege. The court endorsed the view that Therapeutic Privilege should not be abused by doctors to prevent patients with mental capacity from deciding for themselves just because the doctors think their choice is not in their best interests. However, it seemed to leave the door open for the possibility of triggering the Therapeutic Privilege if the patient is impaired in their decision-making capabilities, although still possessing mental capacity, and refuses low-risk beneficial treatment because they misunderstand the rationale treatment for it, even with appropriate assistance. Are there limits to an individual refusing beneficial treatment? Is this compatible with respecting an individual’s right to make an unwise decision? Where should the line be drawn?
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p39 collusion advance care planning and Therapeutic Privilege paternalism via the back door
BMJ, 2019Co-Authors: Sumytra Menon, J.j.m. Van Delden, Alastair V. CampbellAbstract:Collusion in the healthcare setting occurs when a patient’s loved ones seek healthcare professionals’ cooperation in hiding or moderating the disclosure of a serious illness from the patient with capacity to make their own healthcare decisions. Collusion more commonly occurs in patients who are older, perceived as vulnerable and in need of protection from the harsh truth. When collusion occurs, the patient is excluded from the decision-making process, their autonomy is suspended, and advance care planning is not even an option. Collusion may be justifiable if the doctor exercises Therapeutic Privilege and withholds diagnostic and/or prognostic information from the patient because of concerns that the patient may be seriously harmed physically or psychologically, if informed. The highest court in Singapore in the recent case of Hii Chi Kok v Lucien London Ooi expanded the concept of Therapeutic Privilege. The court endorsed the view that Therapeutic Privilege should not be abused by doctors to prevent patients with mental capacity from deciding for themselves just because the doctors think their choice is not in their best interests. However, it seemed to leave the door open for the possibility of triggering the Therapeutic Privilege if the patient is impaired in their decision-making capabilities, although still possessing mental capacity, and refuses low-risk beneficial treatment because they misunderstand the rationale treatment for it, even with appropriate assistance. Are there limits to an individual refusing beneficial treatment? Is this compatible with respecting an individual’s right to make an unwise decision? Where should the line be drawn?