Center for Biomedical Ethics

ETHICS INSTRUCTION IN THE THIRD YEAR CLERKSHIPS

MEDICINE CLERKSHIP

Session 1 : Informed Consent - Physicians should seek consent before providing diagnostic tests or treatment because capable adults have the right to choose or refuse recommended diagnostic tests or treatment. This includes the right to forego (not start or stop) life-sustaining treatment such as cardiopulmonary resuscitation, mechanical ventilation, dialysis, antibiotics, and artificial nutrition and hydration, even if this decision results in the patient's death. This right is grounded in the ethical principle of respect for patient autonomy and protected by the legal doctrine of informed consent. The elements of consent include (1) disclosure, (2) capacity, and (3) voluntariness.

Session 2 : Advance Directives - Advance directives are usually written documents designed to allow competent patients the opportunity to guide future health care decisions in the event that they are unable to participate directly in medical decision making. The major argument for the use of instructive directives, such as a living will, is that it allows an individual to participate indirectly in future medical care decisions even if they lack the decision-making capacity, i.e., they become unable to make informed decisions. Instructive directives may extend individual autonomy and help ensure that future care is consistent with previous desires.

Session 3: Medical Error - Adverse events and medical errors are not uncommon. Ethics, professional policy and the law, as well as the relevant empirical literature, suggest that timely and candid disclosure should be standard practice. Candor about error may lessen, rather than increase, the medical legal liability of the health care professionals and may help to alleviate the patient's concerns.