Year: 2010
Type: dissertation
Abstract: This study involves a critically evaluation of evidence-based patient choice as partnership model in clinical decision making.It pays attention to the emergence of the concept of autonomy in modern moral philosophy and in particular to the pivotal contributions of Immanuel Kant and John Stuart Mill in this regard.Against this background, it elaborates on the ethical principle of respect for autonomy, informed consent as paradigm for patient autonomy in clinical decision making, the conflicts that arise between the ethical concepts of autonomy and beneficence, the dominance of paternalism in clinical decision making, the challenges posed to the dominance of paternalism, the resulting emergence of the concept of partnership in clinical decision making and evidence-based patient choice as partnership model in clinical decision making.Moreover, it provides an exposition of the context, nature and practice of evidence-based patient choice and of the four key decision making skills required from health care professionals to involve patients in clinical decision making, namely shared decision making, risk communication, decision analysis, and the use of decision aids.Against this background, it critically evaluates the effectiveness of evidence-based patient choice as partnership model in clinical decision making by judging it in terms of the ethical concept of patient autonomy as reflected in the informed consent elements of competence, disclosure, understanding and voluntariness and indicates that none of the key skills of evidence-based patient choice can be regarded as completely adequate in honouring the principle of respect for autonomy in clinical decision making and that consequently each of these four key skills leave evidence-based patient choice with a challenge that needs to be addressed from another angle in order to establish and maintain the ethical principle of respect for autonomy.In response to these challenges, the study makes three recommendations for the transformation of evidence-based patient choice to a therapeutic alliance health care, namely to review and further develop the philosophical foundations of evidence-based patient choice, to consider the continental philosophical perspectives of Edmund Husserl, Jean-Paul Sartre, Maurice Merleau-Ponty and Jürgen Habermas on the evidence-based patient choice challenges of the separate worlds of doctor and patient, the constitution of meaning in illness and the dangers of abstractions and informational manipulation in health care and to transform the practice of evidence-based patient choice to a therapeutic alliance in health care by individualising the provision of information by embedding it in the human processes of sense making, knowledge creation and decision making through which information is transformed into insight, knowledge and action.
Author: W. Moore
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2132868405