Consent Flashcards
What are the four basic ethical principles of medicine
1) beneficence: the duty to do the best for the patient
2) non-maleficence: the duty to do no harm to the patient
3) autonomy the right of individuals to make decisions on their own behalf
4) justice the fair distribution of resources incorporating the notion of responsibility to the wider community
Discuss concepts of informated conset
1) competence
2) provision of adequate information to the patient (informed)
3) voluntariness non coerced
Differentiate capacity from competency
CAPACITY: is a functional term that refers to the mental or cognitive ability to understand the nature and effects of ones actions
COMPETENCE: is a legal term that can be defined as being “duly qualified: having sufficient capacity, ability or authority” in practice it requires health profressional to perform test of competence to examine the ability of the particular patient to consent to the specific treatment being offered
Describe the Bolam standard
Reasonable standard of care around consent practices - this standard shoud be that which is thought to be reasoable by a responsible body of profressional opinion.
BOLAM vs Friern
Discuss forms of consent
Can be verbal, implied or written
Implied: presenting to the ED for management implies some degree of consent. Extending an arm when asked for venosection to take blood also implies consnet
Vebral: - when the patient orally states agreement to the treatment or procedure.
Written: general sought before more invasive, potentially complex or prolonged procedures and where the treatment or procedure carriers significant risk.
Written consent is not more valid then verbal but it is easier to prove
Discuss information required for informed consent
1) treatment options
2) the foreseeable consequences and side effects of any proposed treatment of intervention
3) the consequences of not proceeding with the advised treatment.
Langauge and communications needs must be met and use of interpreter if needed.
Must have a option for the patient to ask questions and seek additional information if needed.
Physicians in australia need to be aware of family and kinship responsibilities in indigenous peoples
Discuss presumptions of competence
In australia at common law and under some statutes adults (people over the age of 18) are presumed to be competent
The presumption is revered for children - they are presumed incompetetent unless they can prove otherwise
-14-17 variable
>14 always incompetent
Competence can vary over time
Competence is decision specific
List indicators that may make you consider lack of capcity
1) decisions at odds with the treatment advise wihtout a rational explanation as to why
2) decisions which change with no clear justifications
3) decisions taken on the background of failure to understand the discussion around the options for any reasons.
Capacity may fluctuate in any direction - drugs and alcohol for example.
List indicators that may make you consider lack of capcity
1) decisions at odds with the treatment advise wihtout a rational explanation as to why
2) decisions which change with no clear justifications
3) decisions taken on the background of failure to understand the discussion around the options for any reasons.
Capacity may fluctuate in any direction - drugs and alcohol for example.
List elements required to demonstrate competence
CURVES
1) Choose/communicate: the ability to maintain and communicate a choice
2) Understand: the ability to understand the relevant information
3) Reason: the ability to appreciate the situation and its consequences and weight the information in a rational fashion
4) Remember: the ability to remember information relevant to the decision
5) Values: consistent
6) Emergency –> risk to pt –> implied
7) surrogate –> decision makers
Questions to ask
1) comprehension - what is your present conditions and what treatment option do you have ]
2) belief - what do you think is wrong with you, do you believe you need treatment , what do you believe treatment will achieve
3) weighing - how did you reach the treatment decision that you have chosen what factors help make the decision
4) Choice - have you decided whether to accept the treatment choice that was recommended
Give examples of patient who may not be able to give consent and who may consent for them
1) Children –> parent or garuding, guardianship board, local authority
2) serious mental health illness –> parent, guardian, or guardianship board
3) Toxic impairemnt –> pateint when competent, gaurdianship board, medical director
4) intellectual impairment –> Guardian, guardianship board, local authority
5) emergency situations –> patient guardian, medical director, local authority
List guiding principles under the mental health act for capacity assessment
1) capacity to give informed consent is specific to the decision that needs to be made
2) a persons capcity to give informed consent may change over time
3) it should not be assumed that a person lacks capacity to give informed consent based only on their age appearance conditions or behaviour
4) A determination that a person lacks capacity to give informed consent should not be made only because the person makes a decision that could be considered unwise
5) An assessment of a person’s capacity should occur at a time and in an environment in which a persons capacity can be most accurately assessed
