Information management in physician-patient interactions: towards a new approach
Thesis (PhD)--Stellenbosch University, 2019.
ENGLISH ABSTRACT: This dissertation argues that a set of guidelines rooted in a particular African ethics, and specifically, a combination of Ubuntu and the Yoruba concept of oot , can usefully supplement current medical ethics codes and guidelines, and be of assistance in addressing ethical challenges around unsolicited information in a variety of clinical contexts, thereby contributing towards theoretical diversity, enhancing health professional/patient communication, and justifying loss of value in the event of an ethical dilemma. Unsolicited information raises unique challenges for health professionals in the clinical context. For example, withholding information about misattributed paternity accidentally discovered in testing for organ compatibility may be seen by a patient as a violation of his right to know. On the other hand, disclosure when a patient has not requested such information (and where establishing paternity is not the purpose of the patient‟s clinical interaction with the physician) may be taken by the patient as a violation of his right „not to know‟. My examination of existing regulations and studies reveals that there is a lack of adequate guidance for managing ethical issues around unsolicited information. In the absence of such guidance, contradictory and ethically challenging proposals have been made. Some scholars propose, for example, that the decision to reveal or withhold information should be at the discretion of the physician, but this puts the physician in an omniscient position over the patient whose informational preferences should also count. Principlism has also been suggested as an approach for managing such information, but it is often challenging to decide which principle should take priority when principles conflict. Moreover, principlism does not focus adequately on significant elements of human experience, as well as important background information about the patient, which may complicate a harm/benefit analysis of non/disclosure of unsolicited information within the clinical setting. This point is especially true of Africa, where important cultural inclinations such as an African communalistic outlook on life will complicate how a patient receives, for example, information about misattributed paternity. This dissertation will use philosophical reflection and qualitative research methodology to argue that African moral theory contains an under-emphasized value for addressing these ethical challenges around unsolicited information. Specifically, it proposes guidelines, rooted in an African ethics which I defend, that do not only rely on the health professional‟s discretion but that also foster the patient‟s shared decision-making capacity. I am optimistic that if this alternative model is incorporated into current medical ethics codes and curricula, it will significantly enhance ethical decision-making around unsolicited information in the clinical context, as well as health professional/patient communication in general.