The Limits of Medical Consent

Sunday, October 27, 2019

First Aired:

Sunday, May 7, 2017

What Is It

In our healthcare system, parents normally make medical decisions for their kids because, we think, children are not competent to make such decisions for themselves. Similarly, we permit doctors to violate or defer consent for mentally incompetent adults. But where do we draw the line for what constitutes ‘incompetence’? Should severely depressed patients, for example, have the right to decide for themselves whether or not they want treatment? What makes a patient so incompetent, they should be precluded from making their own decisions? Ken and guest host Laura Maguire consent to talk to Jodi Halpern from the UC Berkeley School of Public Health, author of From Detached Concern to Empathy: Humanizing Medical Practice.

Listening Notes

Ken and Laura begin the show with the question: who gets to decide your medical decisions other than you? That is, when should patients’ medical decisions be made for them? Children and the physically incapacitated (e.g. the comatose, the unconscious) are perhaps the easy cases—we are comfortable when others make decisions for them. But what about adults who are depressed, grief-stricken, or otherwise psychologically incapacitated? What does ‘psychologically incapacitated’ even mean?

The philosophers invite Jodi Halpern, professor of bioethics at the University of Berkeley, to the show. Ken asks Halpern to flesh out what medical consent is and why the medical field is committed to it. They explore the importance of consent as a method of clarifying a patient’s values. But Halpern suggests that certain emotional and mental attitudes can get in the way of understanding one’s own principles. Still, Laura wonders why we think that any mental state could hinder a person's autonomy. For example, shouldn't we equally respect the decisions that a person who has undergone trauma and a patient who is a bad decision maker make?

In the last segment, Ken and Laura ask Halpern how she thinks that our current medical practices should change. The philosophers discuss “advanced directives" -- questionnaires that are meant to discern a patient’s values. Finally, Halpern argues that doctors should be more empathetic to and engaged with their patients. She explains how this practice would mitigate the ethical challenges of medical consent.

Roving Philosophical Reporter (Seek to 7:28): Liza Veale documents the story of a doctor who receives a significant number of requests from emotionally troubled people who want to end their lives. The rights of patients and doctors are considered.
Sixty Second Philosopher (Seek to 45:18): Ian Shoales discusses the advent of advertisements for prescription drugs on television and how patients are now empowered to choose the drugs they use.

Transcript

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Guest

Jodi Halpern, Professor of Bioethics and Medical Humanities, University of California Berkeley

Bonus Content

Research By

Mohit Mookim

Comments (11)

Harold G. Neuman

Monday, October 7, 2019 -- 12:06 PM

The matter of ethics

The matter of ethics certainly plays strongly in this issue. There is one phrase used in your intro above which left me wondering as to intent: "...They explore the importance of consent as a method of clarifying a patient's values..." That fragment left me wondering as to who it was who is receiving the clarification? If the patient is distraught over the real and imminent threat of death, need he (or she) consent to an honest clarification of what is believed? Perhaps, in the term, be it long or short, it does not truly matter to the patient, and may, in fact matter more to loved ones affected by the reality of human mortality. Medical consent is a loaded phrase, seems to me, and, not only should it have limited application, perhaps it might be better having no application at all. Compare it to, say, abortion and all the social turmoil that patient-practitioner relationship has spawned. I believe we should all have the right to decide how we will die when there is clearly no choice in the matter. Nor does it seem relevant or particularly helpful to have one's values clarified. Many of us are compelled to live on other people's terms. To me, it is the height of insult not to be permitted to die on one's own.

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