Autonomy and Consent Flashcards
What is autonomy?
Exercising a choice within a moral framework and consistent with one’s identity
How can we respect autonomy in health care?
- Respect for patient’s values and decisions
- Avoiding deception of patients
- Providing information about choices for patients
- Optimizing their capacity to make autonomous decisions
- Avoiding coercion
Give 4 examples of where consent is required in healthcare
- Treatment
- Investigation
- Examination
- Disclosure of information
- Research
- Education
Consent and battery in healthcare
Battery
To avoid a charge of battery a doctor must have a valid consent. For a patient to give a valid consent he/she must understand the broad nature of the procedure.
The patient need not be harmed by the procedure to claim damages if battery is proved.
Requirements for valid consent
Capacity (competence)
Information
Voluntariness
What is Capacity?
The ability (competence) of a patient to make their own descisions (maintain autonomy)
Capacity is function/decision specific
Capacity can fluctuate
There is an assumption of capacity in adults.
An imprudent decision is not grounds for deciding someone lacks capacity.
Assessment of capacity is ultimately a legal decision.
Under the mental capacity act 2005, when is a person deemed to lack capacity?
If they are unable to:
a) to understand the information relevant to the decision,
(b) to retain that information,
(c) to use or weigh that information as part of the process of making the decision
(d) to communicate this decision (whether by talking, using sign language or any other means
A person is not to be treated as unable to make a decision unless all practicable steps to help them do so have been made with no success
What information is required for valid consent?
Broad nature of the treatment. Failure to do this is battery
Information about reisks, benefis and alternatives. Level of information required relates to the standard of care. Failure to do this may result in allegation of negligence
What does voluntariness mean in consent?
Descision is made without explicit or implicit coercion by the medical professional or pressure from the family.
How can you enhance autonomy in the consent process?
Treat any mental or physical condition affecting a patient’s competence
Be aware of medication affecting competence e.g. morphine
Pay attention to environment and timing to enhance competence and avoid coercion
Make explanations simple and appropriate
Provide choices
Help patients to communicate their decision
Consent in adults
An adult (over 16) is assumed to be competent unless shown to lack capacity.
A competent adult can refuse treatment
A reason for refusal does not have to be prudent (sensible/careful) one
A competent adult patient (over 18) can make an advanced refusal of treatment ot appoint a proxy decision maker
Consent in children
Competence is not assumed in a child under 16, it must be demonstrated.
Competent consent to treatment should be respected.
Proxy consent can be given by someone with parental authority/court. Proxy must act in the child’s best interests.
Emergency treatment can be given without the consent of a proxy
Competent refusal can be overriden by consent from someone with authority (under 18)
Who has parental authority to consent in children?
Mother and married fathers
Unmarried fathers if name is on the birth certificate
Adoptive parents
Someone with parental responsibility from the court
Local authority if the child is under a care order
How to respect children’s autonomy
Involve them as much as possible in the decision
Provide information in a way they can understand
Respect a competent decision (consent confidentiality)
- Be aware of the difficulties of evaluating competence in a child.
Who can make advanced refusals of treatment?
Patients 18 and over
Person must have capacity at the time of the decision
Must be applicable to the treatment in question (treatment and circumstances must be specified)
Must be a valid refusal (i.e. not withdrawn decision, not done anything inconsistent with advanced decision, given power of attorney that allows person to make decisions about treatment)
Refusals for life sustaining treatments must be in writing, signed and witnessed.