Health Care and Nursing and Ethics of Patient Education
Whats Are Ethics of Patient Education
Virtually no dialogue has occurred about special ethical challenges
in the practice of patient education. Several points might be made.
Harm of Poor Education of Patient
Patient education poorly done can create harms such as loss of
confidence and incapacitating confusion. Since it is not possible to predict
when this will happen, an essential step in patient education is outcome
assessment.
This is rarely done. In addition, lack of patient education
services when they are needed can also cause harm. Likewise, there is no
routine surveillance to see how often this occurs; many chapters in this book
document patient education not being done.
Restriction of Freedom In Patient Education
Because paternalistic behavior among providers is still evident,
patient education contains opportunities for witting and unwitting
coercion/oppression. While it may be possible to achieve the value free
standard expected in genetic counseling, a more realistic goal would be to
ensure that the patient’s values are utilized and to negotiate or fully discuss
those areas in which this is not possible.
Example of Past Experiences
Throughout much evidence has been presented that
patient education as it is currently practiced is far less available for those
with lesser educational levels and that educational level is significantly
related to health outcomes. An old set of assumptions about who can and cannot
(the mentally ill, the elderly, etc.) learn is beginning to be challenged. But
to an unknown extent, current practice contributes further to oppression and
lack-of-life opportunity these groups already experience.
Professional Education of Patient As Compare to Traditional Education
Centrality of patient education is significantly different in
the professional practice of various health disciplines, most particularly
medicine and nursing. A negotiated consensus on the importance of patient
education is unlikely.
In this situation, each profession should be able to
practice according to its philosophical dictates, and the team should be
required to work out areas in which the patient could be disadvantaged by such
practice.
Such a scenario is preferable to the current one in which nursing’s
professional philosophy is violated in order to accommodate medicines. The
standards of evidence based practice should support common practice across
disciplines but currently does not.
Patient Errors Can Be Avoided
Practitioners should be held responsible for reasonably for see able
patient errors that could be avoided by patient education. Legal and
quality of care standards to this effect would both protect patients and
provide a clear signal that patient education is an accountable element of
professional practice.
Since Western ethics is heavily focused on patient subject
autonomy, many of the transactions involved in clinical care and research
depend on patient subject understanding. Patient education has not been
considered as central to bioethics, and although many studies have documented
lack of patient subject understanding, a sense of resignation and inevitability
reigns.
It does not have to, but even the threat of litigation from lack of
informed consent does not seem to motivate toward more rigorous practice. We
know how to help people understand these and many other concepts central to
autonomy and informed decision making, we just need to decide it’s worth
investing in. In addition, the long-standing lack of attention to the ethics of
patient education must be addressed .