How should the ‘privilege’ in therapeutic privilege be conceived when considering the decision-making process for patients with borderline capacity?

Abstract

Therapeutic privilege (TP) is a defence that may be available to doctors who fail to disclose to the patient relevant information when seeking informed consent for treatment if they have a reasonable belief that providing that information would likely cause the patient concerned serious physical or mental harm. In a landmark judgement, the Singapore Court of Appeal introduced a novel interpretation of TP, identifying circumstances in which it might be used with patients who did not strictly lack capacity but might be inclined to refuse recommended treatments. In this paper, we explore the conceptual and practical challenges of this novel interpretation of TP. We propose that more emphasis should be placed on forms of shared and supported decision-making that foster the autonomy of patients with compromised mental capacity while being mindful of the need to safeguard their well-being. The kind of privilege that doctors might need to invoke is one of time and supportive expertise to ensure a flexible, responsive approach calibrated to the individual patients’ needs. The provision of such service would extinguish the need for the novel TP proposed by the Singapore Court of Appeal.

Perilaku Profesional Tenaga Medis terhadap Tanggung Jawab Etik dan Transaksi Terapeutik dalam Menjalankan Kewenangan Klinis

“…Jenis hak istimewa yang perlu diberikan oleh seorang dokter adalah waktu dan keahlian yang mendukung untuk memastikan pendekatan yang fleksibel dan responsif yang disesuaikan dengan kebutuhan masing-masing pasien. 13 Informan 5 menilai pasien diam ketika diberi penjelasan, sebaliknya selalu bertanya padahal sudah diberi penjelasan berulang kali. Dalam menjalankan transaksi terapeutik dibutuhkan komunikasi yang efektif antara dokter dengan pasien, sehingga akan muncul kepercayaan pasien kepada dokter.…”

Supported Decision Making With People at the Margins of Autonomy

“…Additionally, there is growing interest in, and commitment to, supported decision making among courts, legislatures, legal practitioners, legal academics, and advocacy groups in the United States and abroad (Arstein-Kerslake et al 2017;Davidson et al 2015;Glen 2012;Kohn, Blumenthal, and Campbell 2012;Wright 2019). Yet, little work has been done within bioethics to consider the value and challenges of supported decision making for people with dynamic impairments ( but see recent work in Menon et al 2020;Wright 2020 ). Here, we argue that, while there is a role for guardianship and similar surrogate decision-making frameworks, supported decision making will often be more appropriate for individuals with dynamic impairments, particularly persons with MCI, estimated to be 15% of the U.S. older adult population (Petersen et al 2010).…”

Decision-Making Capacity to Refuse Treatment at the End of Life: The Need for Recognizing Real-World Practices

“…We will focus on one paper as an example. When we searched the database using the above keywords, we found four categories of papers: (1) written mainly from the perspective of ethicists or philosophers [ 1 , 2 , 3 ]; (2) written mainly from a clinical perspective [ 4 , 5 , 6 , 7 , 8 ]; (3) written mainly from the perspectives of other fields such as law [ 9 , 10 , 11 ]; (4) written mainly by interdisciplinary expert authors such as clinicians and ethicists [ 12 , 13 , 14 , 15 , 16 ]. All categories have merits and demerits.…”