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- African Traditional Medicine: Autonomy and Informed Consent | Peter Ikechukwu Osuji | Springer;
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A special order item has limited availability and the seller may source this title from another supplier. In this event, there may be a slight delay in shipping and possible variation in description. Our Day return guarantee still applies. Bookseller Completion Rate This reflects the percentage of orders the seller has received and filled. Advanced Book Search Browse by Subject. Make an Offer. Respect for autonomy is upheld in the Brazilian Code of Medical Ethics Chapter V, Article 31 , according to which it is prohibited to the doctor to "Disregard the right of the patient or his legal representative to freely decide on the performance of diagnostic or therapeutic practice, except in case of imminent danger of death".
With this article, the code of medical ethics emphasizes the obligation to respect patient autonomy 7. The practice of respect for patient autonomy is opposed to the traditional paternalistic model of care. In paternalism all decisions concerning the treatment are taken by the doctor alone. Between the two extremes represented by the total patient autonomy and the paternalistic model, there is the model of participative decision.
The participative model can be regarded as ideal from the ethical point of view, in which the doctor informs, advises and guides the patient, through encouragement, in making free and informed decisions 1 , 2. Thus, the adoption of the participatory model requires the involvement of both the physician and the patient, both being active agents in decision-making. Information sharing is a basic premise of participative relationship and making decisions together can only occur in an environment where there is sincerity and trust.
Both patient and physician must agree with the final decision 1 - 3 , 6. Studies show many benefits of adherence to this model: increased satisfaction, improved quality of life, increased confidence in the treatment and increased knowledge about the disease itself 6.
Encouraging the participation of the patients must be done according to their own individual characteristics. Expectations and desires of each patient are extremely peculiar and can vary widely according to their familial, cultural, social and religious characteristics 8 - Some individuals value the commercial aspect of the doctor-relationship patient and associate the right to participate to the fact that they are paying for the treatment.
Likewise, patients in the Unified Health System SUS may feel obliged to agree unconditionally because they believe that by disagreeing, they could lose their right to medical care. Experiences of previous hospitalizations may also influence the relationship and some patients feel afraid to pester the doctor with questions or even acknowledge their right to participate 6. The participation of patients, therefore, needs stimulation, through the establishment of trust and encouragement of exchange of information. The good doctor-patient relationship allows the identification of the needs of each patient and is critical to the success of any therapy.
Expectations of each individual must be identified and respected, including in cases of refusal of treatment 8 - The ultimate goal of the professional should be the preservation of the interests and welfare of the patient 1 , 2. The attitude of patients towards this ethical ideal of participation also varies between different countries. A US study conducted in with individuals from four distinct ethnic groups found significant differences in behavior between groups. American descendants of Koreans and Mexicans showed less tendency to believe that the patient should know the diagnosis when the prognosis is negative, stating that the responsibility should be delegated to a family.
The model focused on family responsibility was defended by the descendants of Koreans and Mexicans, in contrast to the patients of European and African origin, who preferred a model more focused to the patient himself. The variations in the pattern of preferences were also correlated with socioeconomic status. Patients of the same ethnic groups with higher levels of education and higher social classes had greater similarity to those of European and African origin, showing preference for model based on patient autonomy A study in China showed that the preferred model in the country is the protection of the patient through the omission of certain information.
Beschreibung des Verlags
The consent for surgical procedures should be obtained from the family. The family decides what information can be passed to the patient and what should be omitted In , Spanish patients underwent a questionnaire by Delgado et al. The data revealed that while the majority of the interviewees wished to be heard and informed by the doctor, the patients' autonomous participation was seen as an undesired increase in their accountability. More serious diseases are also associated with an even lower wish to participate The desire to have an active role in decisions related to treatment was higher among German and Swiss populations.
The Spanish population had the highest proportion of patients who desired a passive role in the relationship with the doctor In Brazil there is still a lack of studies that identify the pattern of preferences of our population regarding the role of the patient in treatment. A study on the understanding of informed consent, in terms of its readability, found differences between the various education and socioeconomic levels.
As discussed earlier, the informed consent IC is one of the tools that guarantee the full exercise of autonomy. The study then discusses the need to adapt the text to the characteristics of each patient in order to facilitate understanding, and discourages the use of standardized forms For the patients to exert their independence, no therapeutic procedure can be performed without consent; in theory, it can be obtained in a verbal or written manner.
Since every decision must be made consciously, the act of consent can be considered valid only if it is preceded by a clear explanation of the benefits and potential risks that each procedure offers. Thus, the duty to inform is an essential condition to validate the consent 1 , 2 , 18 - The definition of informed consent may be philosophically divided into five analytical components, namely: competence or ability of the patient, information, understanding, willingness and consent.
In other words, the consent must be given by a capable individual, who has received and understood the required information and that voluntarily authorizes the procedure 1 , 2 , It is necessary that the patient is capable of understanding and deciding, that the decision is voluntary and that the information was provided in a clear and appropriate manner. Learn more Check out. Citing Literature. Volume 7 , Issue 1 April Pages Related Information. Close Figure Viewer.
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