Virtual Mentor. August 2009, Volume 11, Number 8: 565-647.Full Issue PDF

August 2009 Contents

Problematizing the Principle of Autonomy

Ethics Poll

The Food and Drug Administration exempts some emergency room research from the requirement of informed consent if, (1) the patient has a life-threatening illness or injury and is not able to give informed consent, (2) the research has definite benefit for society, (3) the research has potential benefit for the patient, (4) the investigators carry out public disclosure and community consultation and offer the community the opportunity to opt out. Do you think emergency room research should be allowed to proceed under these provisions?
Yes.
No.

Some claim that the informed-consent process "backfires." These critics argue that, without the formal consent process to protect them, physicians would actually be more thorough in their discussion of the risks and benefits of medical interventions and more diligent in ensuring that patients understood exactly what they were consenting to or refusing. Do you agree with this critique?
Yes.
No.

Many of the laws, regulations, and ethical guidelines that govern informed consent and patient decision making in the U.S. derive from our nation's emphasis on individual liberty and rights. Often, however, hospitals and health care teams encounter competent patients or their self-selected surrogates who value the well-being of family, community, country, or soul above the individual rights of the patient When this happens, U.S. hospital policies and health care teams:
Should uphold the importance of individual rights because respect for the individual person is the best way to ensure that we "do no harm."
Should act in accord with the values of the patients or their surrogates if they believe that those values are in the long-term interest of the patient.
Should always act in accord with the values of the patients or their surrogates; doing so shows true respect for individual liberty.
Leave themselves open to malpractice action if they act in accord with the values of patients or their surrogates and harm comes to the patient.

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From the Editor

Clinical Responsibility in the Age of Patient Autonomy
Barbara Chubak
Full Text | PDF
Virtual Mentor. 2009; 11:567-570.

Educating for Professionalism

Clinical Cases

Deciding for Others: Limitations of Advance Directives, Substituted Judgment, and Best Interest
Commentary by Ryan E. Lawrence and Daniel J. Brauner
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Virtual Mentor. 2009; 11:571-581.

Dilemmas in End-of-Life Decision Making for the Medical Tourist Patient
Commentary by Malika Haque and Hafzah Mueenuddin
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Virtual Mentor. 2009; 11:582-588.

Communicating Risk of Infertility to Adolescents Prior to Chemotherapy
Commentary by John Hutter and James L. Klosky
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Virtual Mentor. 2009; 11:589-597.

OnCall

Patient Autonomy and Physician Responsibility
Commentary by Patrick C. Beeman and Ryan C. VanWoerkom
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Virtual Mentor. 2009; 11:598-602.

Medical Education

Tethered to the Diving Bell: Beyond Vulnerability to Autonomy
Denise M. Dudzinski
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Virtual Mentor. 2009; 11:603-606.

Teaching Physician Decision Making in a Technical Age
David Segal and Richard L. Fernandez
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Virtual Mentor. 2009; 11:607-610.

Journal Discussion

The Belmont Report’s Misleading Conception of Autonomy
Sigurdur Kristinsson
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Virtual Mentor. 2009; 11:611-616.

Clinical Pearl

Prognosis and Therapy after Cardiac Arrest-Induced Coma
Megan Alcauskas
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Virtual Mentor. 2009; 11:617-620.

Law, Policy, and Society

Health Law

Donors Retain No Rights to Donated Tissue
Kristin E. Schleiter
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Virtual Mentor. 2009; 11:621-625.

Policy Forum

Autonomy and Exception from Informed-Consent Research
Catriona Macardle and Rachel Stanley
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Virtual Mentor. 2009; 11:626-630.

Medicine and Society

How Autonomous Is Medical Decision Making?
Andrew Fagan
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Virtual Mentor. 2009; 11:631-635.

Resources

Suggested Readings and Resources
PDF
Virtual Mentor. 2009; 11:636-644.

About the Contributors
Full Text | PDF
Virtual Mentor. 2009; 11:645-647.