Consent in Clinical Practice Flashcards
What is valid consent?
Consent that is:
Specific to the treatment proposed
Informed
Voluntary and uncoerced
From a capable/competent patient who understands ‘continuing’- ie they know they can change their minds
How is consent expressed and passed on?
Expressed, implied, oral or written consent
Consent can be passed on between doctors
Why is consent important on a professional basis?
Vital part of good medical practice–> required on every occasion of examination or treatment, intervention
Except in emergencies or where the law prescribes otherwise
What is battery, negligence and assault in terms of both civil and criminal definitions?
Civil:
* Battery (rare) – entirely absent or invalid, but adequate, consent
* Negligence (rare-ish) – some form of consent takes place, but it is invalid and inadequate
Criminal:
* Assault/battery (very rare) – entirely absent or invalid, but adequate, consent
What is the difference between valid and adequate consent?
Valid: info about nature and purpose and other info – e.g. about risks, benefits, alternatives. Also allows the patient to ask questions
Adequate: information about nature, purpose but not much else (e.g. risks/benefits)
What does a Dr do if a patient refuses treatment?
Assess if the patient is COMPETENT and is giving valid consent. For a patient to be legally competent they must:
Understand
Retain + weigh up information
Communicate their decision
If the patient declines ALL info then informed consent is not possible
What is the ethical basis for consent?
- Respect for autonomy
- Benefits patients – more control –>more realistic expectations –> more adherent
- Establishes trust with patient
- Respect for person/dignity
- Legal and professional requirement
- Virtues – trustworthiness
What issues can arise trying to judge a patient’s competence?
- Task specific – not an all-or-nothing affair
- Can fluctuate – confusion, panic, shock and fatigue
- Irrational or unwise decision can still be a competent decision
What does the Mental Capacity Act of 2005 say about competence?
- Physicians to act in patients’ best interests
- Gillick competency in children for to consent between aged 16 – 18
How much information is “adequate” information? Explain using the 3 models
- Professional practice standard – conforms to professional practice
- Reasonable/prudent person standard – hypothetical reasonable person
- Subjective standard – enables individual to make informed choice
What is the Bolam test and its use?
Applied to situations to determine whether the doctor’s omission to warn patient of risks was a breach of duty of care
Includes collecting a responsible body of medical opinion about the situation
This can help see if the doctor’s actions can then be seen and rejected as irrational
What is a ‘material’ risk in terms of giving consent?
- Dr’s duty to ensure patient is aware of ‘material’ risks involved in proposed treatment and reasonable alternatives
- A risk is “material” if a “reasonable person” in patient’s position would be likely to attach significance to it
What are some issues with given consent?
- Consent is specific
- Signed consent forms provide MINIMAL
evidence that decision making process
was adequate - Consent can be delegated to others BUT
have to stick to rules
What are some problems with OBTAINING informed consent?
- Presenting info is difficult; there is clinical uncertainty on the complexity of info doctors should give
- Fear, illness, social status of doctor, embarrassment, clinical environment can all affect patient’s decision on consenting
- Process of obtaining informed consent is time consuming
What is the relationship between consent and death?
Under the HTA (2004), consent is needed for the removal, storage and use of material from the deceased for all scheduled purposes including:
Transplantation
Education or training
Public display
