Aligning Ethics with Medical Decision-Making: The Quest for Informed Patient Choice

Author:

Moulton Benjamin,King Jaime S.

Abstract

Medical practice should evolve alongside medical ethics. As our understanding of the ethical implications of physician-patient interactions becomes more nuanced, physicians should integrate those lessons into practice. As early as the 1930s, epidemiological studies began to identify that the rates of medical procedures varied significantly along geographic and socioeconomic lines. Dr. J. Alison Glover recognized that tonsillectomy rates in school children in certain school districts in England and Wales were in some cases eight times the rates of children in other districts, with the only significant predictive factors being the current chief medical officer in the area and the socioeconomic well-being of the child's parents. Unfortunately, Dr. Glover's work revealed that the increase in tonsillectomies did not improve the health of adolescent patients and appeared to be performed “as a routine prophylactic ritual for no particular reason and with no particular result.”

Publisher

Cambridge University Press (CUP)

Subject

Health Policy,General Medicine,Issues, ethics and legal aspects

Reference91 articles.

1. Understanding treatment decision making: Contexts, commonalities, complexities, and challenges

2. 33. For further discussion of these challenges, see infra Section II.

3. 19. By definition, paternalism is “the intentional overriding of one person's known preferences or actions by another person, where the person who overrides justifies the action by the goal of benefiting or avoiding harm to the person whose preferences or actions are overridden.” See Beauchamp, and Childress, , supra note 13, at 178.

4. 4. Id.

5. 64. A number of primary care practices have successfully adopted shared decision-making and the use of decision aids, including the University of North Carolina (UNC), Chapel Hill, NC; White River Junction VA, White River Junction, VT; Massachusetts General Hospital (MGH), Boston, MA; University of California Los Angeles (UCLA), Los Angeles, CA; University of California San Diego (UCSD), San Diego, CA; Maine Health – Portland, ME; Mercy Medical Center, Des Moines, IA; Stillwater Hospital, Stillwater, MN; Oregon Health Science, Portland, OR; Palo Alto Medical Center, Palo Alto, CA; and Dartmouth Hitchcock Medical Center (DHMC), Hanover, NH. In addition, specialty practices at the University of California, San Francisco (UCSF) and DHMC have also adopted shared decision-making and the use of decision aids.

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