Browsing by Author "Potgieter, Helet Elizabeth"

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    Authenticity of informed consent in anaesthesia : ethical reflection on the dilemma of informed consent in anaesthesia
    (Stellenbosch : Stellenbosch University., 2020-03) Potgieter, Helet Elizabeth; De Roubaix, Malcolm; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Philosophy.
    ENGLISH ABSTRACT: Informed consent is the process by which the treating health care provider discloses appropriate information to a competent patient so that the patient may make a voluntary choice to accept or refuse treatment (Appelbaum 2007: 1834). Health Care Professionals should obtain informed consent from the patient before proceeding with the proposed treatment. Therefore, the anaesthesiologist should obtain informed consent from the patient before proceeding with the anaesthetic. The requirement of informed consent implies that certain pre-requisites should be met. The patient should be competent to understand the information given to him/her. The patient should be adequately informed and thereby be able to decide, without being influenced, and should also have the right to refuse the treatment. These requirements of obtaining informed consent prompted this investigation into the authenticity of informed consent in anaesthesia and the ethical dilemma faced by the anaesthesiologist. In order to examine this dilemma in anaesthesia the thesis firstly investigates the origin and establishment of informed consent, both in biomedical ethics and in the law. It starts by investigating the concept of autonomy and the development of respect for autonomy as the basic premise for the development of the informed consent process and elucidates the move away from the paternalistic approach in medicine to the current patient centred approach. To expound the unique nature of informed consent consultation in the peri-operative environment, anaesthesia as a speciality is examined. This investigation into the history and origin of anaesthesia leads to an acknowledgment of the unique moral status of the anaesthetised patient. The patient transits from the patient-as-person to the-patient-as-body while undergoing anaesthesia, as was alluded to by the first users of anaesthesia who experienced this transition firsthand. This unique moral status questions the validity of consent in this exceptional environment. The unique ethical dilemma the anaesthetists faces in the peri-operative setting is further investigated, keeping in mind the requirements for informed consent as stipulated in bioethical literature as well as in legal and regulatory guidelines. The guidance of current thought leaders in informed consent, as well as bioethical principles as published in bioethical literature are used as tools to examine the dilemma of informed consent in anaesthesia. In an attempt to find ethical solutions to this dilemma, ethical alternatives to informed consent in anaesthesiology are investigated. Phronesis and the ethics of responsibility, virtue ethics as well as medical professionalism offers some solutions to the ethical dilemma, and if promulgated could alter the construct of informed consent in anaesthesiology as it currently exists. The unique moral status that being anaesthetised infers upon a patient also has interesting potential implications for altering the construct of anaesthetic informed consent. Lastly practical solutions to satisfy the responsibilities that current legal, regulatory and bioethical guidelines place on the anaesthesiologist are investigated. Ultimately the reality of the difficulties in obtaining authentic informed consent in anaesthesia remains a dilemma in its current form and one looks forward to future development in the bioethical and legal fields to be able to develop an authentic anaesthetic informed consent consultation.