Ethically problematic assumptions regarding patient self management and barriers to improved outcomes.
Patient self management of chronic conditions, both the disease and the symptoms, is an aged practice that is accelerating and disseminating throughout the world, fueled in part by home-based and portable technologies. Ethically problematic assumptions, continued from a provider-dominated era, have the potential to harm some patients and unnecessarily exclude others from self management. This special report will describe three such problematic assumptions, suggest ethically satisfactory alternatives and describe the barriers to making these transitions. Improved assumptions suggest that patient self management has the potential to set a new and higher standard than the current provider-based practice; that readiness to learn, literacy and intact cognitive function are frequently not essential to competent patient self management; that patients, however, are still excluded from it based on apparent defects in these characteristics; and that quality control standards for self management are essential but are not sufficiently rigorous. Barriers to improved outcomes from self management include the virtual absence of objective measures of patient competence to self manage, and of explicit, publicly available and well-argued descriptions of risk and benefit.
Redman
Barbara K
BK
Dean & Professor, College of Nursing Wayne State University, Cohn Building, Suite 112, 5557 Cass Avenue, Detroit, MI 48202, USA, and Visiting Scholar, University of Pennsylvania Center for Bioethics, 3401 Market Street, Suite 320, Philadelphia, PA 19104, USA. ae9080@wayne.edu.