UNIT VI:
person has the right to be informed of what
APPLICATION OF BIOETHICAL PRIENCIPLES TO
THE CARE OF THE SICK AND AN ANALYSIS OF
THE BIOETHICAL ISSUE: INFORMED CONSENT
INTRODUCTION
Knowledge is useful if it results in a change in
behavior. Having learn the ethical principle, the
health provider is challenged to apply these
principles in his daily life and act accordingly.
FIDUCIARY RELATIONSHIP
The important avenue to your success as a
professional is to perfect the communication,
listening and interpretive skills required to
honor tenets of the doctrine of informed
consent. One of the legal cornerstones of our
current health care system. Whether engaging
with patient – or research subject basic
principle of respect for the patient undergird
informed consent. In fact, informed consent to
central health care decision- making.
“Maybe things would be better if ... we knew
what the hell he (the physician) was driving at,
and not in big words either” (the health of
Region Ville)
I. LEGAL AND ETHICAL PRINCIPLES IN
INFORMED CONSENT
A. Legal Principle
- Among the most important legal
concepts that have given rise to our
thinking about informed consent
are BATTERY, DISCLOSURE, and the
FIDUCIARY RELATIONSHIP.
BATTERY
➢ Is the act of offensive touching done
without the consent of the person being
touched however benign the motive or
effect of the touching.
The idea of DISCLOSURE conveys that a
will happen to him or her. There are
standards of disclosure:
a) A related idea is that the standard be
determine as “what a reasonable
physician” would disclose.
b) The standard will be shifted from the
health professional to what a
“reasonable patient” would want to
know
➢ Is in such a relationship, a person in
whom another person has placed a
special trust or confident, is required to
watch out for the best interest of the
other party.
➢ The physician-patient relationship was
ruled a fiduciary relationship in a case
on the basis of the “ignorance and
helplessness” of the patient regarding
his own physical condition.
➢ It is stated that physician violated his or
her legal duty by withholding
information necessary for a patient to
make rational decision-making
regarding care.
➢ In addition, the physician must disclose
“all the fact which materially affect the
patient’s rights and interest and the
risk, hazards and danger, if any (Purtillo,
1993)
B. Ethical Principle
- The governing ethical principle in
informed consent in the RIGHT TO
SELF-DETERMINATION or
AUTONOMY.
- When you think about moral rights
as someone else’s claim on you,
what is the claim on you as a health
professional when the situation is
one requiring informed consent?
AUTONOMY
➢ Is the moral right to choose and follow
one’s own plan of life. Autonomous
action and choice should not be
constrained by others.
➢ Human being should be treated with
dignity. They should be accepted as
responsible for their own action.
Destinies and should be allowed to
make decisions for themselves.
➢ Autonomy enhances a person’s
personnel worth. It protects a person
from being used by others.
➢ In health care, it helps develop a
mature therapeutic alliance between
the health professionals and the patient
(Purtilo, 1993)
VIOLATIONS AND NON-VIOLATION OF THE
PRINCIPLES OF AUTONOMY
A. The following actions are violations of
the principles of autonomy:
1. Actions performed that constrain a
person’s capacity to make a
decision.
2. Actions performed that constrain a
person’s capacity act according to
his decision.
B. The following situation are non-
violations of the principle of autonomy:
1. A person expresses his autonomous
wish to waive consent or delegate
authority to others.
2. Competence to give consent is
absent or reduce and the procedure
considered is necessary to save the
person’s life. By reasoning
paternalism (those who know best
decide)
3. Respecting a person’s autonomy
competes with other oral principles
or autonomy VS non-maleficence.
ROLE OF THE HEALTH PROFESSIONAL ON
AUTONOMY
The health professional should help the patient
make his autonomous choice and act on it by.
1. Providing him with the information
necessary to weigh risks and benefit,
2. Stating his convictions and clearly
explaining the reasons for his opinion,
3. Not exercising coercion, manipulation,
undue influence, or irrational
persuasion,
4. Respecting the patient’s autonomous
choice, and
5. Withdrawing from the case and helping
the patient find another health
professional who might be more
successful in these situations when the
health professional feels it is impossible
to help the patient
II. INFORMED CONSENT
Informed Consent is an ideal connected to the
principles of autonomy and respect for a
person, any procedure to be done on a person
may only be administered with his free and
informed consent. This gives valid permission
for others to act in certain specific ways.
Recognizing that every person is primarily
responsible for his own body, free and informed
consent was later introduced into care as a
means of protecting a patient’s personal
integrity and enhancing the patient’s active
roles in his own care.
In health care, INFORMED CONSENT is defined
as the willing and uncoerced acceptance of a
medical intervention by the patient after
adequate disclosure by the health professional
of the nature of the intervention, its expected
risks and benefits and alternative available.
 A. Informed Consent has Two Main
Functions:
1. Protective – to safeguard against
intrusion of integrity
2. Participative – to be involved in
medical decision-making
B. The elements of informed consent
There are two major elements of informed
consent: INFORMATION element involving
DISCLOSURE and COMPREHENSION of
information and CONSENT element involving
VOLUNTARINESS and COMPETENCE to consent.
1. INFORMATION ELEMENT
A. Disclosure of information
In order to make a decision, a person needs an
information based in which to weigh
risks/benefits in the light of one’s value and
goods, deliberate and make rational choice.
In health care, a patient has the right to obtain
this information. A health professional has duty
to give it to the patient. Although lists vary
regarding what information to disclose in
medicine, three general standards of adequate
disclosure govern what should hold:
1. The professional practice standard
which is based in the traditional
disclosure practice of the professional
community. What practicing physician
would generally accept as the necessary
information to disclosure?
2. The reasonable person standard which
is based on what a hypothetical
reasonable person would judge as
pertinent to the decision-making
process.
3. The subjective standard which is based
on what a particular patient needs to
know in general, necessary items to
disclose include
a. The patient’s current medical status
including the likely course of no
treatment;
b. The contemplated procedure or
medication.
c. Alternative available procedure or
medication,
d. Anticipated risks and benefits of
both
e. A statement offering the patient an
opportunity to ask further
questions,
f. In care of research, his right to
withdraw anytime, and
g. A professional opinion about the
alternative.
When disclosing in information, the health care
professional has a strong, oral obligation to be
truthful and honest. There may, however, be
certain situation wherein telling “part of the
truth” or the delay of telling the whole truth is
allowed.
1. THE PHYSICIAN’S THERAPEUTIC
PRINCIPLE
According to the doctrine of therapeutic
privilege, a physician may intentionally not
disclose information based in a sound medical
judgment that to divulge the information at the
precise time would be potentially harmful to
the patient.
2. RESEARCH
a. Randomized clinical trials – in
certain clinical trials, patient is
randomly assigned to one of the
several alternative treatment
categories some subject receives
experimental therapy such as new
drugs while others received
standard therapy. Such procedures
are blind, least in that the subject in
not informed and does not know
which treatment he receives.
 b. Research in psychosis – Deception
in research in permitted only if
three condition are fulfilled: (1) it is
essential to obtain the information
sought, (2) there is insubstantial risk
for the subject and (3) no other
moral principle is violated.
c. Placebo – This is the therapeutic
procedure which is objectively
without specific activity for the
condition being treated. In
deception placebo use, three
condition must be fulfilled (1) the
condition for which it is
administered must be known to
have a high respond rate of the
placebo, (2) alternative must offer
the greater evil and (3) the patient
must insist to be treated with a
prescription/medication
B. Comprehension of Information
Merely to give information is not sufficient. A
person must understand the information.
Often, information may be too technical or
complicated for a patient the health
professional must give clear and simple the
health professional must give clear and simple
explanation. Questions should be asked to
assess understanding. Written instruction of
printed materials adapted to subjective
competency should be provided.
2. CONSENT ELEMENT
A. Voluntariness
This means that a person can exercise his choice
free of coercion and other forms of controlling
influence by others whether this be force, fraud
deceit or overreaching. Voluntariness varies
with the forces exerted as well as the person’s
personal resistance.
B. Competence
This is the capacity to decide about a
recommended procedure, or about
participation in a research at the time and in the
context of the circumstances.
A patient is competent if and only if the person
can make decisions based on rational reasons.
He must be able to understand the procedure,
weigh its risks and benefits, and make decisions
in the light of such knowledge and his individual
values and goals. Whether a person chooses to
use or not to use, the information is not a
criterion for competence.
Although competence is reduced by illness.
Anxiety, pain and hospitalization, a health
professional must be cautious against too
rapidly judging a patient as incompetent.
Whether to agree or disagree with the
patient’s decision is not a basis for judging
competence.
C. Method of obtaining informed consent
1. A written consent. It is a consent form to be
filled up and signed by a patient as he checks in
for admission in the hospital.
2. Verbal consent. This occurs when the patient
verbally signifies willingness to undergo medical
treatment. This is usually made after a physician
has briefed the patient about the medical
process to be undertaken.
D. Types of Patients who need not Require
Informed Consent
1. Comatose or obtuned patients
2. Blind or illiterate patients
3. Undergo patients or those unable to
understand the circumstances
4. Patient with language barrier
In the principle, the patient’s immediate
relative, guardians or next of kin should be
informed when the patient in comatose, blind,
illiterate, underage or unstable to understand
the language of the physician.
In actual experience, however, the expediency
of the situation may be such that the physician
may not have time to consult the patient’s next
of kin and time is essential. An instant decision
of a matter of like and death and the physicians
delayed action may be fatal to a particular
patient.
E. Others Forms of Consent
1. Implied/presumed consent
a. By merely entering the physician-patient
relationship, consent (tacit, presumed) for the
customary diagnostic and therapeutic
procedures in common use is given.
b. This occur when consent to some general line
of action has been given.
2. Surrogate consent
a. When someone other than a patient decided
in behalf if the patient, a surrogate consent is
given. The surrogate is morally responsible for
the patient. (Alora.1992)
III. PATIENT’S RIGHT
Rights are necessary because every individual
life in a community of persons “no man is an
island” so the saying goes. Man is being-with-
others in the world. For the reason, human life
is more meaningful, and worth living only in the
presence and help of others, in communion
with others and for the benefits of others. This
holds true for all kinds of human relationships.
A patient, like the physician is an individual
human being endowed with reason and
freedom. As he enjoys natural and inalienable
rights such as the right of the life and the right
to privacy, among others.
A. Meaning of patient’s right
In the medical context, a patient’s rights mean
the oral and inviolable power vested in him as a
person to do, hold or demand something as his
own. By nature, every person enjoys a moral
and inviolable power to do, hold, enjoy and
exact those things proper to one’s whole being.
Every right in one individual involves a
corresponding duty in others to respect this
right and not to violate it. Duty, therefore, is the
correlative of right.
B. Types of patient’s rights
1. The right of self-determination (also known
as the principle of autonomy)
2. The right to informed consent
3. The right to informed decision
4. The right to informed choice
5. The right to informed treatment
C. Limitation of patient’s rights
1. A patient’s rights do not include the right to
be allowed to die
2. A patient is moribund condition does not
possess the necessary mental and emotional
stability to make an informed choice
3. A patient’s rights are no absolute
D. The right of the patient
The following are the 12 rights of the patients
as they are documented in American Hospital
Association (AHA) “Statement on apatient’s bill
of rights”
1. The patient has the right to considerate and
respectful care
2. The patient has the right to obtain from his
physician complete current information
concerning his diagnoses, treatment and
prognosis in terms of the patient con be
reasonable expected to understand.
3. The patient has the right to receive from his
physician information necessary to give
informed consent to prior to the start of any
procedure and/or treatment.
4. The patient has the right to refuse treatment
to the extent permitted by the law and to be
informed on the medical consequences of his
action.
5. The patient has the right to every
consideration if his privacy concerning his own
medical care program.
6. The patient has the right to expect that all
communication and records pertaining to his
care should be treated as confidential.
7. The patient has the right to expect that,
within its capacity, the hospital must provide a
reasonable response to his/her request for
services.
8. The patient has the right to obtain
information regarding any relationship of his
hospital to other health care and educational
institutions insofar as his care is concerned.
9. The patient has the right to be advised if the
hospital proposes to engage in or perform
human experimentations affecting his care pr
treatment. That patience has the right to refuse
to participate in such research project.
10. The patient has the right to expect
reasonable continuity of care.
11. The patient has the right to examine and
receive an explanation of the hospital bill
regarding of source of payment.
12. The patient has the right to know what
hospital rules and regulations apply to his
conduct as a patient. (Timbreza, 1994)
IV. PHYSICIAN/PATERNALISM
Mencius’s concept of human-heartedness or
the feeling of helpfulness and commiseration is
the point of discussion in this concept. “all men
have a mind which cannot bear to see the
suffering of others, Mencius said. These he
refers to the desire to help others, the feeling of
benevolence of good will, a sense of
compassion with the desire to help, to be of
service, to give assistance whenever it is
needed.
A. Definition
➢ From the latin pate “father” or paternus
“fatherly, PATERNALISM means the act
of being fatherly someone, as if the
later were one’s offspring. It consists in
acting like a father to a person for the
latter’s own good and interest. This is
keeping with the principle of non-
maleficence and with Mencius’s sense
of human-heartedness. It is argued that
a paternalistic act is believed and
intended to protect or advance that
interest of its recipient although such
an act may go against the latter’s own
immediate desire or may limit his
freedom of choice.
B. Types
1. As regards to the recipient’s welfare,
paternalism may be either pure or impure.
PURE paternalism justifies intervention into a
person’s life for the sole welfare of that person.
IMPURE paternalism justifies interference with
another person not only for that person’s
welfare but also for the welfare of another.
2. As regarding to the recipient’s defect and
safety, paternalism may be either restricted or
extended. RESTRICTED paternalism support
intervention which overrides an individual.
EXTENDED paternalism is one in which an
individual is restrained from doing something
because it is too risky or dangerous.
3. As regards to promotion of good and
prevention of harm, paternalism may be either
positive or negative.
4. As regards to the patient’s sense of values,
paternalism may be either soft or hard. In SOFT
paternalism, the patient’s values are used to
justify the intervention with his possible with
his possible action or decision. In HARD
paternalism, the patient’s values are not the
ones used to justify a paternalistic act.
Justification for personification paternalism
A. The recipient of the paternalistic act is sick
and consults the physician seeking medical
expertise and assistance.
B. The recipient of the paternalistic act has
some incapacity which prevent him from
making a decision.
C. To the best of one’s knowledge and training,
there is the probability of harm unless a
paternal decision is made
D. The probable benefit of paternal intervention
outweighs the probable risk of harm from non-
interference.
E. The physician has an obligation to act in the
best interest of the patient.

5. As regards to the recipient of the benefit,
paternalism may be either direct or indirect. In
DIRECT paternalism, the individual who should
receive the supposed benefit is the one whose
values are overridden or disregarded for his
own good. In INDIRECT paternalism, a particular
individual will be benefited if one person is
restrained from doing something.
F. The patient, upon consulting the physician,
voluntarily transfers part of his autonomy to the
latter based on faith in the physician.
Justification for state paternalism
1. To improve the good quality of medical
education.
2. To upgrade a high standard of medical care.

3. To control drug addiction, other drug abuses,

C. Medical Context or the spread of AIDS and other related
diseases.
In the application of paternalism in the medical
context, personal and state paternalism are
identified.

1. PERSONAL paternalism is one in which an

individual decided on the basis of one’s best
knowledge of what is good for another person.

2. STATE paternalism refers to the control

exerted by the legislature, an agency or other
governmental bodies over particular kinds of
practices and procedures in medicine.