informed consent

Question 1

what constructs must be present to be considered informed consent?

Answer 1

• information and knowledge
• comprehension and understanding
• freedom and voluntary participation

Question 2

what exceptions apply to the constructs of informed consent?

Answer 2

• minor children
• mentally impaired
• comatose patients

Question 3

describe construct 1 of informed consent

Answer 3

information and knowledge

• pt. should understand clearly: purpose, risks and benefits, alternative procedures, and anticipated results
• forthcoming and truthful; never withheld to elicit consent

Question 4

describe construct 2 of informed consent

Answer 4

comprehension and understanding

• info must be presented to the patient at the level the pt. can understand (not informed consent unless understood)
• the more serious the risk, the more important full comprehension becomes
• may ask “which option do you choose and why?” to ensure comprehension
• may want to quiz the pt. to ensure comprehension
• dialogue is specific and direct and should include: ordinary terms, their customary language, possibility of no treatment and the consequences of that selection

Question 5

describe construct 3 of informed consent

Answer 5

freedom and volunteerism

• freedom implies that the subject understands the situation and no coercion or undue influence has been used
• CRNA is allowed to state his/her own judgment about what is best for the patient if asked

Question 6

what premise is informed consent based upon?

Answer 6

• based on the right/premise that people are responsible for their own destinies
• in a free society, people must be allowed to make important decisions of life for themselves whenever possible
• demonstrates respect for persons

Question 7

describe informed consent

Answer 7

a competent individual makes his or her own decisions

-requires: 1) information 2) comprehension 3) freedom

Question 8

describe presumed consent

Answer 8

a person is unable to give consent of their own accord, but it is reasonable to believe they would consent if able
ex: person is stabbed, makes it to ER and passes out; presumed consent to treatment since they brought themselves to the ER

Question 9

describe implied consent

Answer 9

when a person gives consent to general things, it is implied that consent is given to the individual things involved
ex: sitting still and offering are for an IV prior to surgery, pt. is implying consent for anesthesia and surgery

Question 10

describe proxy consent

Answer 10

when a patient is unable to give consent, another person makes the decision

• “substitute informed consent”
• specific conditons: 1) pt. unable to offer TRUE and INFORMED consent 2) person offering proxy consent must determine what the incompetent pt. would have wanted or decided were she or he able to
• proxy decision may not always warrant the well being of the pt.; therefore, it’s not absolute

Question 11

what are specifics to a proxy consent?

Answer 11

• if a healthcare worker or physician determines that the proxy is not acting in the best interest of the pt., they have an ethical obligation to intervene
• proxy is asked to choose as the pt. would if able
• if no evidence exists about the pt.’s desires, the proxy is asked to choose the options that a “reasonable person” would choose (after complete informed consent about process, procedures, and potential outcomes)
• medical parties and proxy agree- care is rendered

Question 12

what are exceptions that allow minors (under age 18) to provide own consent?

Answer 12

• married
• pregnant
• has children

Question 13

define assault in criminal and tort law

Answer 13

threat or use of force on another that causes that person to have a reasonable apprehension of imminent harmful or offensive contact

Question 14

define aggravated assault

Answer 14

criminal assault accompanied by circumstances that make it more severe, such as use of deadly weapon, the intent to commit another crime, or the intent to cause serious bodily harm
ex: assault with a deadly weapon in which the defendant, controlling the deadly weapon, threatens the victim with death or serious bodily harm (felonious assault)

Question 15

define conditional assault

Answer 15

an assault expressing a threat on condition

ex: “your money or your life”

Question 16

define sexual assault

Answer 16

sexual intercourse with another person without that person’s consent

• many state statutes have abolished “rape” and replaced with offense of sexual assault
• offensive sexual contact with another person, exclusive of rape in termed indecent assault

Question 17

define assault in medical terms

Answer 17

an act that creates an apprehension in another of an imminent, harmful, or offensive contact
ex: if pt. clearly states don’t want a regional anesthetic, and pt. is sedated, then the caregiver PLANS to proceed with the regional = ASSAULT

Question 18

define battery in criminal law

Answer 18

application of force to another resulting in harmful or offensive contact

Question 19

define aggravated battery

Answer 19

criminal battery accompanied by circumstances that make it more severe, such as the use of a deadly weapon or the fact that the battery resulted in bodily harm

Question 20

define simple battery

Answer 20

criminal battery not accompanied by aggravating circumstances and not resulting in grievous bodily harm

Question 21

define battery by medical law

Answer 21

unpermitted, unprivileged, intentional contact with another person

Question 22

what are the main differences between assault and battery?

Answer 22

• main distinction between the two offenses is the existence or nonexistence of a touching or contact
• contact is an essential element of battery; there must be an absence of contact for assault
  ex: if caregiver goes ahead with regional anesthesia rather than just planning, committed battery

Question 23

define negligence

Answer 23

failure to exercise the standard of care that a reasonably prudent person would have exercised in the same situation

Question 24

define collateral negligence

Answer 24

independent contractor’s negligence, for which the employer is generally not liable (contracted CRNA)

Question 25

define comparative negligence

Answer 25

a plaintiff's own negligence that proportionally reduces the damages recoverable by the plaintiff (pt. withholds information directly asked for and later sues)

Question 26

define concurrent negligence

Answer 26

the negligence of two or more parties acting independently but causing the same damage

Question 27

define contributory negligence

Answer 27

a plaintiff's own negligence that played a part in causing the plaintiff's injury and that is significant enough to bar the plaintiff from recovering damages -in most jurisdictions, this defense has been superseded by comparative negligence

Question 28

define criminal negligence

Answer 28

gross negligence so extreme that it is punishable as a crime ex: involuntary manslaughter or other negligent homicide can be based on criminal negligence like when an extremely careless automobile driver kills someone or if CRNA has abandoned pt. or is on cellphone not paying attention and something happens to the patient

Question 29

define gross negligence

Answer 29

conscious, voluntary act or omission in reckless disregard of a legal duty and of the consequences to another party, who may typically recover exemplary damages * reckless negligence * wanton negligence * willful negligence

Question 30

define imputed negligence

Answer 30

- resulting from a party's special relationship with another party who is originally negligent ex: a parent might be held responsible for some acts of a child - negligence of one person is charged to another (anesthesiologist tells CRNA to give a drug in a crisis situation that causes harm)

Question 31

define slight negligence

Answer 31

failure to exercise the great care of an extraordinarily prudent person, resulting in liability in special circumstances in which lack of ordinary care would not result in liability (just made the wrong decision)

Question 32

define abandonment

Answer 32

medical abandonment results when the caregiver--patient relationship is terminated without making reasonable arrangements with an appropriate person so that care by others can be continued *even if cases are not started, must be sure they are covered

Question 33

what factors should be considered with abandonment

Answer 33

- did the caregiver accept the patient assignment, creating a caregiver-patient relationship - did the caregiver provide reasonable notice before terminating the caregiver-patient relationship? - could reasonable arrangements have been made for continuation of care by others when proper notification was given?