What are the two meanings of informed consent?
- Autonomous authorization
2. Institutional/policy rules of consent
What are the benefits of promoting shared decision making?
- Ensure pt has active role
- Pt is informed
- Dr protects pt’s interests
What is the reasonable person standard?
Standard that a dr is required to disclose what a reasonable person would want or need to know to make an informed choice
What is the professional standard?
When dr. relies on judgement about what colleagues would do in similar situations
When is implied consent applicable?
When the patient cannot give informed consent, and there is no surrogate
True or false: Implied consent provides physician with defense against battery, and may defend against charges of negligence
False–no protection against negligence
What are the four rights set out by the patient self-determination act?
- Right to participate in their healthcare
- Right to accept or refuse medical treatment
- Right to prepare an advance directive
- The receipt of information on the providers policies that govern the utilization of these rights
What are the four instances in which the Dr can disobey the pt’s wishes?
- Pt lacks MDM capacity
- Pt wants more than medical standard
- Pt requests are unreasonable
- Conscientious refusal by dr.
Does medical decision making capacity = competence? Who decides this?
No–only the court can decide competence
Can you have a pt that is competent, but lacks medical decision making capacity?
Yes
Is the determination of capacity a continuum (degree), or a threshold (either/or)
Continuum
What are the four aspects that a patient must have, in order to have medical decision making capacity?
- Understand relevant info
- Appreciate situation and consequences
- Communicate choice
- Deliberate rationally
True or false: the mental capacity of patients who refuse low-risk, high-benefit treatment without which they face serious injury or death must be assessed
True
True or false: it is likely that someone with schizophrenia, depression, dementia etc. lacks medical decision making capacity
False
What is the “durable power of attorney”?
Document that identifies who will make decisions when pt lacks medical decision making
What is substituted judgement?
“what would pt want”?
