The role of authentic choices in medical consent [PhD Thesis]

The role of authentic choices in medical consent [PhD Thesis]
Alexander Villafranca
University of Manitoba Electronic Thesis, 23 December 2019
Open Access
Abstract
This dissertation investigates whether the “authenticity” of a patient’s choice (i.e. its correspondence with important markers of the patient’s identity), should be part of a model of valid medical consent. This research question was addressed across three manuscripts using philosophical and empirical methods. Manuscript one is a philosophical manuscript defending my thesis that the standard model of valid consent may be improved by including the “authenticity” of a patient’s choice as an additive condition, thereby forming what I call the “authenticity-informed model of valid consent”. In this manuscript, I present seven procedural practices stemming from this new model. I argue that these practices should be considered for inclusion in the existing procedural recommendations of the Canadian Medical Protective Association (CMPA), which draw heavily from the standard model. The new practices could help physicians to i) more accurately evaluate the decisional capacity of patients; ii) more accurately evaluate the autonomy of patient choices, and iii) better support the psychological and physical well-being of patients. I also created vignettes to assess empirically whether the end goal of promoting authentic and autonomous patient choices would have instrumental value above choices that are solely autonomous. In manuscript two, I introduce the use of pretesting to evaluate and enhance the rigor of vignettes studies used in empirical ethics research. This manuscript includes an illustrative example of how data collected through a respondent debriefing procedure can be used to measure numerous desirable vignette characteristics. Manuscript three uses the vignettes to evaluate the instrumental value of shifting from a choice that is solely autonomous to one that is both authentic and autonomous in a single, but consequential, clinical scenario. This study confirms that shifting from a solely autonomous choice to an authentic and autonomous choice can substantially decrease anticipated decisional regret and increase both anticipated decisional satisfaction and compliance with postoperative instructions. In conclusion, there are plausible reasons to believe that adding authenticity may improve the standard model of valid consent and its associated procedural practices. Consequently, consideration should be given to modifying the procedural recommendations of the CMPA to reflect the addition of authenticity.

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