Chapter 8 Test 3

Question 1

The law recognizes the right to control one’s own body, including medical decision-making.

Answer 1

Consent to Treatment

Question 2

Rights regarding consent to treatment can be affected by:

Answer 2

Age
Competence
Emergency circumstances

Question 3

Treatment without consent or without proper consent can result in liability for what?

Answer 3

Negligence

Battery

Question 4

________ is a broad process that can be in written or nonwritten form and vary in terms of how much information is provided.
In most cases, __________ involves a patient’s acknowledgement that he or she understands a proposed intervention, including that intervention’s risks, benefits, and alternatives.

Answer 4

Consent

Question 5

What are the three types of consent?

Answer 5

Express consent
Implied consent
Informed consent

Question 6

Consent that is communicated through written or spoken word
Written is more desirable than oral consent as evidence
Does not necessarily result in “informed consent”

Answer 6

Express consent

Question 7

Consent for treatment communicated through person’s conduct or other means besides words
Most appropriate for non-invasive, low-risk interventions such as patient presents self for appointment and submits to an exam
Law presumes consent is given by incapacitated individual (patient) needing emergency treatment

Answer 7

Implied consent

Question 8

Part of standard of care required by CMS and the Joint Commission
Patient’s consent should be informed:
Demonstrates a competent patient’s understanding of the treatment and voluntary consent to it
Not just a form; it is a patient-provider process
Is the responsibility of the treating provider
Includes information material to the patient’s decision
Shows that procedure consented to = procedure performed
_________ should be documented in the health record and form placed in record
What shall be disclosed to the patient?
Diagnosis/nature of illness or injury
Nature and purpose of proposed treatment
Risks/benefits and probable success of proposed treatment
Alternatives (invasive and non-invasive), regardless of cost or extent to which they are covered by insurance
Risks and benefits of alternatives
Risks and benefits of not receiving or undergoing a treatment
Names of individuals who will provide the treatment
Other information that would be material to the patient’s decision-making process

Answer 8

Informed consent

Question 9

______ addresses informed consent through its authorization requirements.
Separate informed consent for research is preferable.
However, ______ allows an organization’s IRB or privacy board to permit compound authorizations.
Combine informed consent (for treatment) with authorization for use and disclosure of a research subject’s health information

Answer 9

Informed Consent and HIPAA

Question 10

Often pertains to requests by law enforcement (for example, test for alcohol in patient’s blood)
Mandatory interventions for certain infectious diseases

Answer 10

Criminal cases

Question 11

Mental or physical condition of a party is at issue; court orders exam

Answer 11

Civil cases

Question 12

Emergency admissions of mental health patients

Court-ordered examinations of criminal defendants

Answer 12

Cases involving mental competence

Question 13

Must be patient-initiated (patient didn’t want to be informed)
Not recommended
Or ______ may be approved by IRB for research subjects if
The research involves no more than minimal risk to the subjects
The _______ or alteration will not adversely affect the rights and welfare of the subjects
The research could not practicably be carried out without the _______ or alteration
Whenever appropriate, the subjects will be provided with additional pertinent information after participation

Answer 13

Waiver

Question 14

Disclosure may be of significant detriment to the patient (risk of disclosure outweighs right to be fully informed)
Does not apply if the only fear is that information would cause the patient to forgo treatment
Highly discouraged
Risk is too common to warrant special disclosure or risk is remote and improbable (not material to decision)
May or may not be a valid defense in a legal case

Answer 14

Therapeutic privilege

Question 15

Legal documents that specify an individual’s healthcare wishes in event of temporary or permanent loss of competence
May appoint another person to make decisions for oneself (legal and healthcare through powers of attorney)
May leave instructions on restricting use of equipment or procedures to prolong life
Do not resuscitate” order (DNR)
No CPR/no Code Blue order
Exception to universal standing order to provide CPR
Pertains to emergency situations only
Patient or representative signs form, in addition to physician order
Preceded by informed consent procedure
Can be revoked

Answer 15

Advance Directives

Question 16

must be durable otherwise only good if person is competent or has capacity. If person becomes incapacitated POA would be void.
State law defines language to create _____ vs. a POA
_______ may act for person (principal) in legal, financial and real estate matters even when person becomes incapacitated.

Answer 16

Durable Power of Attorney (DPOA)

Question 17

May also be called a medical power of attorney or healthcare proxy, may be revoked by principal
Authorizes an individual (agent) to make personal health care decisions if the authorizing individual (principal) becomes incapacitated
Unlike power of attorney, it is in effect when principal is incapacitated (thus, “durable”)
Principal must be competent when executing the instrument.
Agent must make decisions consistent with principal’s wishes or in principal’s best interest
May be revoked or have an expiration clause
A copy should be kept in an easily accessible location as well as in the health record.

Answer 17

Durable Power of Attorney for Healthcare Decisions (DPOA-HCD)

Question 18

Competent adult prepares document providing direction as to medical care in case of incapacitation or inability to make personal decisions.
State requirements include signature, date, witness(es)
Limitations on care generally involve
Respirators
Artificially supplied nutrition and hydration
Cardiopulmonary resuscitation (CPR)
May be revoked
A copy should be kept in an easily accessible location, as well as in the health record.

Answer 18

Living will

Question 19

May also be called a healthcare directive or advance care plan.

Answer 19

Living will

Question 20

_________ requires all accredited acute care facilities to have policies and procedures regarding advance directives (including DNR orders).

Answer 20

Joint Commission

Question 21

Federal statute (effective 12-1-91) raised ‘public’ awareness of advance directives
Applies to providers receiving Medicare or Medicaid funds
Must:
Inform patients of legal right to make medical decisions, including the right to create advance directives
Document in the health record the existence of advance directive
Educate staff and community about advance directives
Not condition care on presence or absence of advance directives
Ensure compliance with state law regarding advance directives

Answer 21

Patient Self-Determination Act (PSDA)

Question 22

What Kind of people can consent?

Answer 22

Competent Adult
Incompetent Adult
Minor/ Child

Question 23

Age of legal majority varies per state
May refuse to consent or authorize withdrawal of treatment
Religious beliefs
Pursuant to advance directives
Medical record is primary or sole source documenting decision to withdraw or forgo life-sustaining medical treatment.
When treatment is refused, two competing sets of interests are at play:
Individual’s right to privacy, due process, and self determination
The government’s interest in protecting and preserving human life, which has been established via case law

Answer 23

Competent Adult

Question 24

Generally categorized as:
Adults who were once competent and executed an advance directives
Adults who were once competent but did not execute an advance directive
Adults who never had competence
Decision is by guardian (court designee) or next of kin
Known wishes of the patient are to be considered
have no right to refuse treatment if refusal was not previously expressed

Answer 24

Incompetent adults

Question 25

Who Can Give Consent?

Answer 25

Incompetent adults and Temporary incompetence

Question 26

Treatment should be postponed until patient is deemed competent unless postponement would lead to substantial risk
Consent maybe implied in an emergency situation

Answer 26

Temporary incompetence

Question 27

May vary according to State Law, but customary hierarchy would be:
Spouse
Adult Children
Adult Siblings
Parents
Court Appointed Surrogate

Answer 27

Hierarchy of Consent Decisions

Question 28

Legally classified as incompetent unless emancipated or identified as mature
Generally do not have the legal right to consent to or refuse treatment unless emancipated or identified as mature
Refer to state law for consent requirements for minors of divorced or legally separated parents.
Parental or guardian consent should be obtained prior to treatment unless:
1) Emergency treatment required (implied consent)
2) State statute grants minors the right to consent (for example, emancipated and mature minors)
3) State statute grants minors the right to consent for treatment for STDs, drug or alcohol conditions, prenatal care, abortion, etc.
4) Court or other legal authority orders treatment

Answer 28

Minors

Question 29

Patient did not give consent (battery)
Patient was not (fully) informed of risks or other factors that would have been material to the patient’s decision (negligence claim based on lack of informed consent)
Patient was not competent at time of completion
Form was too technical to be understood
Signature was not voluntary (perhaps due to physician misrepresentation)

Answer 29

Challenges to Consents

Question 30

General consent given at time of admission for treatment
If more specific type of treatment is given provider is required to obtain consent.
Must be documented in record as required by organization, CMS, Joint Commission, and others

Answer 30

Documenting Consent

Question 31

What are the three types of consent forms?

Answer 31

General (blanket) consent form
Short consent form
Long consent form

Question 32

Signed upon admission
For general medical treatment, general diagnostic procedures, routine hospital care and nursing services (routine touching)
Is not evidence of consent to major procedures
May be valid for minor and noninvasive procedures with insignificant risk

Answer 32

General (blanket) consent form

Question 33

Acknowledge of that explanation of risks benefits, and alternatives have been explained
Also applies to human subject research

Answer 33

Short consent form

Question 34

Includes medical condition, proposed procedure, consequences risks, alternatives, other factors material to the patient’s decision
In human subjects research, includes all consent requirements in the Common Rule
Much more difficult for patient to prove lack of informed consent with this form
Is not a substitute for verbal explanation and dialog

Answer 34

Long consent form