Consent Flashcards
What are the four medical pillars of ethics?
- Respect of autonomy
- Beneficence
- Non-maleficence
- Justice
What was a key ruling regarding capacity?
Schloendorff vs New York 1914 ruling decided ‘Every human being of adult years + sound mind has right to determine what should be done with his own body.’
What is informed consent?
permission granted in full knowledge of the possible consequences typically given by a patient to a doctor
What are the three purposes of informed consent?
- Legal
- Moral: deontological + consequentialist - Clinical: patient compliance + partnership
What are the four criteria for valid consent?
- Capacity
- Informed
3. Consent voluntarily - Continuing consent
What is the consensus regarding freedom to make decisions (autonomy)?
- Mentally competent - Right to refuse to consent - Rational or irrational - No reason at all - Even if may lead to death
What forms of consent are there?
- Written consent
- Fertility treatment
- Good practice in surgery - Assumed consent
- Conduct - Verbal consent
What are the two approaches to capacity?
- Status: children do not, adults do
2. Function: ability to be mature + understand
What act protects capacity in Scotland? What is the criteria?
Adult Capacity (Adults with Incapacity (Scotland) Act (2000))
- Understand information
- Retain information
- Use or weigh the information
- Communicate decision
- Hold decision
What is incapacity?
Patient incapable of
..
1. Understanding information
2. Retaining information
3. Use or weigh the information to make a decision
4. Communicate their decision
5. Retain memory of decisions (hold decision)
Why might someone lack capacity?
Impairment of or disturbance in the functioning of the mind or brain (cognition)
- Permanent
- Temporary
What is a proxy-decision making? What forms are there?
Someone with capacity who can make the decision on behalf of another
- Lasting power of attorney
- Advance directives
- Best interests test (HCP, relatives, carers)
What are the problems with proxies? What do you do if a proxy is not in place?
- Proxy + patient do not always agree
- Proxy decisions normally subject to best interests thus not our own decisions;
If proxy is not in place, act in the best interest and document actions ready for justifications
What is Gillick Competence?
Respect for mature minor’s autonomy provided they have the capacity. Must understand + have sufficient maturity to understand what is involved ≈ status < function (two capacity measures)
What is voluntary consent?
Consent effective even when unwillingly or reluctantly given; few patients would consent to major surgery were it not for force of surrounding circumstances and knowledge that health or even life may be in jeopardy if they do not consent
