Informed decision-making: Be empowered!
Informed decision-making: Be empowered!
July 3, 2023
Joy Stepinski, MSN, RN-BC
Ethics are a moral code that guides the conduct of healthcare professionals. There is a duty to the patient to avoid or minimize harm, as well as respect patient preferences [1]. The four fundamental principles of ethics include beneficence, nonmaleficence, justice, and autonomy. In addition to these are veracity (truth-telling) and confidentiality. These pillars keep the patient at the forefront of care.
Looking at these ethical principles in further detail, beneficence refers to acting for the benefit of the patient, as a form of altruism. Nonmaleficence is not harming the patient, and not causing pain and suffering. Justice means the fair, equitable, and appropriate treatment of each person. Finally, autonomy recognizes the patient’s self-determination.
Autonomy is at the core of decision-making. Patients who have decision-making capacity may decide on their treatment according to their values, goals, and life plan, regardless of whether their healthcare provider agrees or not [2]. “The ethical principle of autonomy protects this fundamental right” (p.189).
Historically the ability to consent to treatments was established through common law court decisions. For instance, in 1914, the judge in the case Schloendorff v. Society of New York Hospitals stated, “every human being of adult years and sound mind has a right to determine what will be done with his own body” (p. 189).
Self-determination is a major piece of both the medical and nursing codes of ethics. For example, Provision 1.4 of the Nursing Code of Ethics is titled “The Right to Self-Determination.” The provision states that self-determination shows respect for human dignity. Patients have the right to determine what will be done to their person. They also have the right to be given accurate and complete information in order to make an informed decision. Furthermore, the patient may accept, decline, or end a treatment without dishonesty, duress, or prejudice. The nurse must support the patient through their decision-making process [3].
The communication that patients have with their healthcare providers is essential. As the literature points out [4], often conversations involving informed consent are unidirectional with the physician disclosing risks and benefits. However, in order for a decision to be made, the patient must be more involved by asking questions, sharing goals, and taking time to weigh his or her options. With regard to informed consent, 80% of communication by healthcare professionals does not actually meet the criteria for the patient to make an informed decision [5].
There are many barriers for patients in a healthcare setting. Often people do not know their role in decision-making and do not have an understanding of questions to ask. The provider may not convey all the information and may not be aware of all the options. Medical lingo may be used, but not well-understood by the lay person. Patients may also feel rushed to decide or be overwhelmed. Additionally, the patient may desire to rely on their healthcare provider to make the choice.
As a patient, feeling empowered to seek knowledge about your condition is vital to make decisions. In this consumer culture where people spend time investigating the best product to purchase, consider doing the same type of research for your health. After all, your health has an even greater importance! Diet, medicine, and health-related decisions are yours to make. Some of these decisions may be the most important of your life. If feeling overwhelmed, take time to decide. Unless the situation is dire, urgent, or life-threatening, there is usually time to consider options.
When faced with a decision, develop a clear understanding of risks and benefits. Although reflecting upon risks may be very daunting, the most important consideration is that the treatment you choose aligns with the values and goals for your life. The following table lists components that the provider should use when presenting you with a choice.
Elements of informed decisions include that the healthcare provider [4]:
1. Encourage the patient to participate in decision-making.
2. Explain the clinical issue.
3. Share options, including the right to decline.
4. Discuss the benefits and the risks.
5. Reveal uncertainties, including that treatments may not help.
6. Assess how well the patient understands.
7. Ask the patient’s opinion.
Other strategies that you can use include the following. Ascertain the cause of the disease, not just treating to mask symptoms. Consider food as medicine and strive for an optimal diet to bolster your health. Often whole-food plant-based diets can help resolve health issues. Look for treatments that resolve the health problem quickly. Choose the least invasive option first because those often have the less potential for harm. Engage in treatments that have clear benefits, such as decreased mortality, as evidenced by high quality research. Ask to see the research your provider is using to present you with the decision. Avoid over-testing and over-treatment when possible.
Above all, we are truly the ones responsible for our own health and seeking information to decide! I am available for health consultations if needed.
References:
1. Varkey, B. (2021). Principles of clinical ethics and their application to practice. Medical principles and practice: International Journal of the Kuwait University, Health Science Centre, 30(1), 17–28. https://doi.org/10.1159/000509119
2. Rock, M. J., & Hoebeke, R. (2014). Informed consent: Whose duty to inform? MedSurg Nursing, 23(3), 189 – 191.
3. Code of ethics for nurses with interpretive statements. (2015). American Nurses Association.
4. Braddock, C. H., Edwards, K. A., Hansenberg, N. M., Laidley, T. L., Levinson, W. (1999). Informed decision making in outpatient practice: Time to get back to basics. JAMA, 282(24), 2313 – 2320.
5. Lewis, C. L., & Pignone, M. P. (2009). Promoting informed decision-making in a primary care practice by implementing decision aids. North Carolina Medical Journal, 70(2), 136–139.