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Using an Ethics of Care to Re-Interpret Consent in the Management of Care for Addiction Disorders Diann Ecret

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Duquesne University Duquesne Scholarship Collection Electronic Theses and Dissertations Spring 5-11-2018 Using an Ethics of Care to Re-interpret Consent in the Management of Care for Addiction Disorders DiAnn Ecret Follow this and additional works at: https://dsc.duq.edu/etd Recommended Citation Ecret, D. (2018). Using an Ethics of Care to Re-interpret Consent in the Management of Care for Addiction Disorders (Doctoral dissertation, Duquesne University). Retrieved from https://dsc.duq.edu/etd/1439 This Immediate Access is brought to you for free and open access by Duquesne Scholarship Collection. It has been accepted for inclusion in Electronic Theses and Dissertations by an authorized administrator of Duquesne Scholarship Collection. For more information, please contact [email protected]. USING AN ETHICS OF CARE TO RE-INTERPRET CONSENT IN THE MANAGEMENT OF CARE FOR ADDICTION DISORDERS A Dissertation Submitted to the McAnulty School of Liberal Arts Duquesne University In partial fulfillment of the requirements for the degree of Doctor of Philosophy By DiAnn C. Ecret May 2018 Copyright by DiAnn C. Ecret 2018 USING AN ETHICS OF CARE TO RE-INTERPRET CONSENT IN THE MANAGEMENT OF CARE FOR ADDICTION DISORDERS By DiAnn C. Ecret Approved April 12, 2018 ________________________________ ________________________________ Gerard Magill, Ph.D. Henk ten Have, MD, PhD Professor of Vernon F. Gallagher Chair Director, Center for Healthcare Ethics Professor, Center for Health Care Ethics Professor of Healthcare Ethics (Dissertation Director) (Committee Member) ________________________________ Joris Gielen, Ph.D. Assistant Professor, Center for Healthcare Ethics (Committee Member) ________________________________ ________________________________ James Swindal, PhD Henk ten Have, M.D., Ph.D. Dean, McAnulty College and Director, Center for Healthcare Ethics Graduate School of Liberal Arts Professor of Healthcare Ethics (Director) iii ABSTRACT USING AN ETHICS OF CARE TO RE-INTERPRET CONSENT IN THE MANAGEMENT OF CARE FOR ADDICTION DISORDERS By DiAnn C. Ecret May 2018 Dissertation supervised by Dr. Gerard Magill Patients who suffer from the biological, genetic, epigenetic neurocognitive dysfunction and social sequela of substance use disorders and addiction require the empowering support from healthcare professionals; necessitating the need to utilize an ethics of care to re-interpret consent for the management of care for those who suffer from substance use disorders and addiction. The care of the ‘other’ should embrace a care paradigm that is relational and collaborative in order to eliminate constructs of stigma, moral weakness and individual blame, which isolates those who manifest the trajectory of harms associated with addiction pathology. Relational consent and an ethics of care seeks to enhance the relational decision making processes for those who experience the complications from this stress surfeit and executive cognitive functioning disorder. The re-interpretation of consent seeks to improve patient outcomes, improve quality of healthcare delivery and enhance human dignity for vulnerable populations. iv DEDICATION To my family, (past, present, and future) with all my love. v ACKNOWLEDGEMENT In grateful appreciation, to my husband Mike for his unfailing support, belief, encouragement and care throughout the journey. In heartfelt gratitude, to my children, Mary Anne, Joe, John, and Jacob who patiently endured my pursuits, my love is always with you. My life long appreciation to my parents, Jim and Gloria Oscar who taught me the moral path through their love and care. In very special gratitude, to everyone at the Center for Health Care Ethics for their commitment to students and their diligent hard work. A special appreciation to my dissertation chair and advisor Dr. Gerard Magill, who was always willing to mentor and guide my scholarship. A special thank-you to the Center for Health Care Ethic’s Director Dr. Henk tenHave, for his kindness and support through the program. Lastly, a very warm and heartfelt acknowledgement of my gratitude for Glory Smith, her kindness sustained me more times than I could over count; her commitment to the Center and to ‘her’ students as her family is simply amazing. vi TABLE OF CONTENTS ABSTRACT ................................................................................................................ iv DEDICATION ............................................................................................................. v ACKNOWLEDGEMENT .......................................................................................... vi Chapter. 1 Introduction ............................................................................................... 1 Chapter 2 Scientific Evidence and Social Response of Addiction Disorders ............ 18 2.1 Scientific Evidence ............................................................................................... 23 a. Neurobiology of Addiction .......................................................................................... 28 b. Genetic Influences ........................................................................................................ 33 c. Epigenetic Influences ................................................................................................... 37 2.2 Social Stigma of Addiction ................................................................................... 44 a. Addiction as a Rational Choice .................................................................................... 49 b. Addiction as Weakness and Vulnerability ................................................................... 55 c. Moral and Social Culpability ....................................................................................... 60 Chapter 3 Ethics of Care ........................................................................................... 80 3.1 Autonomy and Relationships. ..................................................................................... 83 a. Autonomy and Frailty .................................................................................................. 89 b. Independency and Dependency. .................................................................................. 93 3.2 Relational Autonomy of Patients. ............................................................................. 100 a. Responsiveness and Reaction. ........................................................................................ 104 c. Responsibility and Wise Action. ................................................................................ 109 3.3 Relational Responsiveness of Professionals. ............................................................. 112 a. Professional Attentiveness and Treatment with Dignity. ........................................... 116 b. Responsibility and Competency. ................................................................................ 119 Chapter 4 Consent in Addiction Disorders ............................................................. 136 4.1 Altered Consciousness and Relational Decision-making. ......................................... 139 a. Criteria for Consent: Autonomy and Self-determination. .......................................... 143 b. Shared Decision-making: Developing a Treatment/ Social Plan. .............................. 149 4.2 A Relational Interpretation of Competency for Consent. ......................................... 153 a. Impaired Decision-making. ........................................................................................ 155 b. Improving Competency. ............................................................................................. 161 4.3 A Relational Interpretation of Coercion by Professionals. ....................................... 165 a. A call for Partnership Versus Radical Neglect .......................................................... 169 b. Assessing Benefit-risk Ratio. ..................................................................................... 173 Chapter 5: A Relational Paradigm for the Management of Care. .......................... 189 5.1 Substance Use Disorders Comorbidities in a Relational Context. ............................ 194 a. Psychiatric Comorbidities. ......................................................................................... 198 b. Neuroimmune/ Inflammatory Comorbidities. ............................................................ 205 5.2 Relational Vulnerabilities of the Patient: Consent and Coercion. ............................ 211 a. Empowering Personhood, Repairing Consciousness. ................................................ 216 b. Decreasing Vulnerabilities. ........................................................................................ 221 5.3 Relational Relief of Suffering: Patients, Professionals, and Society ......................... 225 vii a. Facilitating a Treatment Paradigm Shift. ................................................................... 230 b. The Contributions of Pharmacogenomics, Immunotherapies, Manipulation, and Enhancement....................................................................................................................... 234 Chapter 6 Relational Consent & Quality of Care for Addiction Disorders. ........... 253 6.1 Management of Care for Relational Consent. .......................................................... 255 a. The Phenotype of Addiction. ....................................................................................
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