Ethics and Capacity

Question 1

What are the 4 elements of consent?

Answer 1

1. Relate to treatment
2. Informed
3. Voluntary
4. Not obtained through misrepresentation or fraud

Question 2

What 6 components define informed consent?

Answer 2

Received information that a reasonable person would require regarding:
1. Nature of tx
2. Benefits
3. Material risk
4. Material sfx
5. Alternatives
6. Consequences of no tx
Received response to request for additional info

Question 3

What defines emergency treatment without consent?

Answer 3

Can administer without consistent if person incapable if:
1. There is an emergency
2. Delayed required to obtain consent from SDM would prolong suffering or put them at serious risk of harm

Question 4

What defines capacity to consent to treatment?

Answer 4

Person can UNDERSTAND info relevant to making a decision
Person can APPRECIATE consequences of decision or lack thereof

Question 5

4 decision making abilities required for capacity

Answer 5

U Are Really Capable
1. Understand information
2. Appreciate situation and consequences
3. Ability to reason
4. Ability to communicate and express a choice

Question 6

What happens if MD finds person incapable?

Answer 6

1. Inform patient
2. Inform them you’ll be asking SDM for consent
3. If patient disagrees - apply to Consent and Capacity Board
4. If disagrees with current SDM - apply to CCB to appoint another
5. Must involve incapable patient when able

Question 7

What is the SDM hierarchy?

Answer 7

1. Guardian of person with authority for health decisions (legal through court)
2. POA for personal care
3. Appointed by CCB
4. Spouse/partner
5. Child or parent
6. Brother or sister
7. Any other relative
8. OPGT

Question 8

What are requirements to be a SDM?

Answer 8

1. Capable
2. 16+ yo
3. Not prohibited by court order
4. Available
5. Willing to assume role

Question 9

How must the SDM act?

Answer 9

1. In accordance with previously expressed wishes
2. If none expressed, patients values and beliefs
3. If none expressed, act in best interest of patient

Question 10

What is the HCCA?

Answer 10

1. Treatment/personal care - decided by person who proposes treatment
2. Shelter - Home Care, legal professional

Question 11

What is the Substitute Decisions Act?

Answer 11

Financial decisions
1. MRP psychiatrist
2. Capacity Assessor (private)
3. POA property

Question 12

Can you give medication without person knowing/accepting?

Answer 12

Yes, treatment may be administered without consent if person is incapable
AND
If HCP feels there is an emergency and the delayed required to obtain consent will prolong suffering or put person at risk

Question 13

What are the 7 components to the aid to capacity evaluation?

Answer 13

1. Identify the medical condition
2. Proposed treatment
3. Alternatives to treatment
4. Option of refusing treatment
5. Consequences of accepting proposed treatment
6. Consequences of refusing proposed treatment
7. Decision affected by depression or psychosis

Question 14

Is consent still valid if obtained while capable but at time of procedure patient no longer capable?

Answer 14

NO
Must get consent again when treatment is occurring
If unable to then SDM must give consent on their behalf

Question 15

When might a physician have to act against the SDM?

Answer 15

1. The SDM is incapable
2. The SDM is going against patient’s previously expressed wishes

Question 16

Cognitive domains associated with capacity

Answer 16

1. Executive function - insight/judgement, abstraction
2. Memory - need to retain information
3. Attention - register and retain info
4. Language, comprehension - need to be able to communicate wishes

Question 17

What are the four principles of ethics?

Answer 17

1. Autonomy - pt makes their own decision
2. Beneficence - doing what is best for the patient
3. Non-Maleficence - do no harm
4. Justice - equal access to all

Question 18

What are additional ethical principals?

Answer 18

1. Informed consent
2. Truth telling
3. Confidentiality

Question 19

3 conditions that must be met for patient with dementia who is incapable to be included in clinical trial?

Answer 19

1. Involve participant as much as possible
2. Seek and maintain consent from authorized party (not a member of team)
3. Demonstrate that research being carried out for participant’s direct benefit or benefit of others in same category (if so only expose to minimal risk and burden)

Question 20

Three factors to consider when asking for consent for patients with dementia regarding research?

Answer 20

1. Potential benefit
2. Potential harm
3. Patient’s ability to consent

Question 21

Things to bring up in code status discussion

Answer 21

1. Prognosis of illness
2. Description of what CPR involves
3. CPR success rates
4. Alternatives to aggressive treatment
5. Advanced directives

Question 22

Survival to discharge and impairment rate OHCA

Answer 22

~11%
18%

Question 23

Survival to discharge and impairment IHCA

Answer 23

25%
40%

Question 24

4 benefits to prompt disclosure of error

Answer 24

1. Promote safe and quality medical care
2. Contributes to trust
3. Strengthens physician patient relationship
4. Provides information

Question 25

6 strategies to discuss bad news/error

Answer 25

SPIKES
1. Setting - privacy, sit down, rapport
2. Perception of condition/seriousness - what does patient understand
3. Invitation from patient to give info - ask if they want to know details
4. Knowledge - give medical facts
5. Explore emotions and sympathize
6. Strategy and summary

OR

1. Analyze error
2. Plan ahead the meeting
3. Provide known facts
4. Be sensitive
5. Don’t speculate or blame others
6. Provide emotional support
7. Apologize for your part
8. Document adverse event and discussion
9. Plan to meet as needed