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Evidence, influences, and patient autonomy: utilizing the ecological model to maximize justice and autonomous choice in the legal doctrine of informed consent

Burns, Amanda Paige (2013) Evidence, influences, and patient autonomy: utilizing the ecological model to maximize justice and autonomous choice in the legal doctrine of informed consent. Master Essay, University of Pittsburgh.

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Abstract

This essay evaluates the current legal doctrine of informed consent and its ability to promote the rights of self-determination and autonomous choice. At the time that the doctrine was developed, American courts determined that the doctrine need not incorporate a requirement that a patient understand disclosed information, a determination largely based on the assumption that the vast majority of patients would be able to understand a reasonable disclosure. By analyzing the current body of research regarding patient health literacy, this paper seeks to establish that, contrary to the doctrine’s presumption of understanding, only a small minority of patients are capable of understanding and utilizing disclosed medical information in a way that allows them to make truly autonomous decisions. Furthermore, this paper will show that, in addition to failing to promote self-determination, the doctrine’s failure to require reasonable patient understanding results in tangible harm to the many patients who have limited health literacy, thus resulting in an unjust medical system that disadvantages a large group of patients, many of whom are already vulnerable to poor health outcomes due to other systemic and environmental influences. Recognizing these failures, this paper proposes that patient self-determination should be viewed as an individual behavior that is best promoted by a public health intervention that recognizes the complicated web of influences, of which informed consent law is but one, that effect a patient’s ability to understand medical information and make truly autonomous medical decisions. This paper will use the ecological model to identify these influences and suggest policy changes, including a revision of the legal doctrine of informed consent, that are most likely to promote patient autonomous choice in light of the complex web of influences that currently hinder patient autonomous choice.


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Details

Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Burns, Amanda Paige
Contributors:
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairBjerke, Elizabethschmidte@pitt.eduSCHMIDTEUNSPECIFIED
Committee MemberMeisel, Alanmeisel@pitt.eduMEISELUNSPECIFIED
Date: 2 March 2013
Date Type: Submission
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Publisher: University of Pittsburgh
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Health Policy & Management
School of Law > Law
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: Yes
Date Deposited: 07 May 2015 13:34
Last Modified: 30 Oct 2018 13:57
URI: http://d-scholarship.pitt.edu/id/eprint/18663

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