Proxy Consent

Deciding for Others

 Principle of Informed
Consent
Elements:
1. Information
• concerns the purpose of the procedure, the risks
and benefits that are anticipated, the alternative
procedures and the hoped for results
• never be withheld
2. Comprehension
• material must be adapted to the subject's
capacities
• If the patient cannot comprehend, then some
third party, usually a family member but
sometimes one appointed by the court, should
be asked to act in the patient's best interest
3. Freedom to choose
• understands the situation clearly and that no coercion
nor undue influence is exercised
 Introduction
 Whenever possible, informed consent
on the part of the subject is ethically
and legally necessary
 Sometimes, however, the subject is
not able to give consent
“Hmm…I think I’ll go
for option A. That
means your getting
me a new bag,
right?”
 Definition
 not a subspecies of informed consent
 a substitute for informed consent and
is sought when acquiring informed
consent is impossible
 should be made in view of the good
of the individual patient
 Basic Conditions
 the patient or research subject
cannot offer informed consent
 the person offering the consent
ought to determine what the
incompetent person would have
decided were he or she able to make
the ethical decision
 Special Considerations
 person given the right to make such a
judgment for another should be one who
knows the person well and who has a
loving concern for the well-being of the
person for whom the judgment is made
 if the person who has the right to make
this decision decides something which
does not seem to be in accord with the
good of the patient, other responsible
people may challenge the decision of
the proxy and even bring the matter
before the civil authority
A baby does not exist for society…
it is society that exists for the
individual, for the baby.
INFORMED
CONSENT
NEONATAL CARE UNIT
 Principle
 The objectives of the doctors are to:
 Provide health care for infants and
children at the request of the parents
 care for infants as agents of the
community or society
 Philosophy
 indicates that decision making
concerning medical therapy for
infants and children is a collaborative
process
 both parents and medical team have
an ethical responsibility to strive for
the overall well-being of the infant or
child
 Implications
• Both medical personnel and parents should be concerned
with the overall well-being of the child; not only with the
possibility of keeping the child alive
• involves more than mere physiological function.
• medical personnel must consider social and
economic factors as they assess well being
• Questions that must be considered:
 does this therapy impose more burden than
benefit upon the patient or?
 will this therapy be effective or ineffective insofar
as the overall well-being of the patient is concerned ?
 Implications
1. States and cities (society) should give
high priority to the health and well-being
of their children.
• Question: is enough attention and funding
devoted by society to the health needs of
children?
• We are lacking:

primary preventative services
 follow-up rehabilitation
 chronic care services
 Implications
1. In our pragmatic society the notion of
protecting and enhancing the life of weak
and debilitated infants might become
unpopular
• As ethically-minded doctors, we must
follow a different path
"No society whether family, village or state,
is really strong if it will not carry its
weak and even its weakest members.
They belong to it no less than the
strong, and the quiet work of their
maintenance and care which might seem
useless on a superficial level, is perhaps
more effective than labor, culture, or
productivity in knitting it closely and
securely together. On the other hand, a
community which regards and treats its
weak members as a hindrance or even
proceeds to their extermination is on the
verge of collapse."
 In other words…
PROTECT ME OR ELSE!!!!
 Addressing Neonatal
Issues
 Consider the goals of specific monitoring,
diagnostic tests, therapies, or research
protocols that are administered.
 Center the goals of care on the patient
and the family.
 The patient is treated, but the family must
live with the long-term consequences of
the daily decisions made in caring for the
baby.
 What will be “good” for the
baby?
 A concept of the good must be refined to reflect
the peculiarities of the patients, their conditions,
the available treatment alternatives, the values
placed upon those alternatives by relevant
parties, the likely outcomes of treatment or
nontreatment, and the influences of external
considerations.
 Goods that are pursued include health,
prevention or elimination of disease or morbidity
(including iatrogenic sequelae of treatment),
relief of unnecessary pain or suffering, and the
prolongation of life.