informed consent
- cornerstone of the healthcare system
- basic principle of respect for the patient
- patient authorizes a procedure
- must tell the patients all the options no matter the cost or insurance
- tool to give patients options based on information
- maximizes autonomy
why is consent necessary
- we want to ensure we arnt over utilizing paternalism (when pts autonomy is limited and the professional team makes the decision)
- strong (extended) paternalism overrides competenet
- weak (limited or restricted) overrides doubtfully competent
elements of informed consent
- an explanation of the patients condition in terms the pt can understand
- what is the time frame?
- an explanation of the procedures to be used and risk and benefits of the procedures in noncoercive/understandable terms
- pause for questions and making sure they understand
- a fair description of alternative to the suggested procedures, including nontreatment options
- allow pts to change their mind and withdraw consent, without penalty
criteria for decision-making capacity
- able to communicate choice and maintain that over time
- understand relative information
- appreciate the situation and its consequences according to ones owns values
- ability to reason about treatment options- weigh information to arrive at decision
capacity
- medical term*
- medical concept- pts ability to weight medical information and make health decisions
- often referring to clinical judgement
- capacity may fluctuate -> can change consent
competence
- is a legal term*
- all persons are presumed competent until legally judged otherwise
research
-informed consent must be received from all subjects
placebos
-inert substance with no pharmacological effect
generic information
- treated extremely sensitive
- pt must know how their information is being used
emergencies and implied consent
- patient incapable, no surrogate, wishes unknown
- danger to life or impairment of health
- immediate treatment to avert danger
- consent in these situation is implied consent
- for pts who are unconscious or incapable of making informed decisions
expressed consent
- patient acknowledges they want you to provide care
- most often applies to simple, common procedures
- if someone goes into an office with an ear ache -> expressed consent they want treatment
involuntary consent
- court making decision or decision being legally imposed upon situation
- applies to patients who are:
- mentally ill
- in behavioral crisis
- intellectual or developmental disabilities
history of decision making and advanced directive legislation
-In 1969 a human rights lawyer from Chicago, Luis Kutner, wrote an article in which described the how patients should be treated when they cant making health care decisions.
-He suggested that individuals should indicate in writing, a head of time, the extent to which they would consent to treatment -> “living will.”
-embraced by the states and came to be known
as “advanced directive legislation”
-by 1986, 41 states had adopted advanced directives laws to improve upon the laws, proxy provisions were added
-1997- every state had advanced directive laws that include the need for health care proxy
health care proxy laws
- person who can speak for in
- in your will
- one can appoint a competent adult to make decisions about their medical treatment in the event that they lose the ability to decide for themselves- including decisions to remove or provide life sustaining treatment
- one can give health care proxy as little or as much authority as they want to decide about all or only specific health care treatments
- proxy must be 18 and there must be 2 witnesses to the signatures
- proxy must exercise the wishes of the individual when they make their wishes known ->
