FOM 5.3.1

Question 1

What is the AMA’s definition of informed consent?

Answer 1

The process of communication b/t a patient and physician that results in the patient’s authorization or agreement to undergo a specific medical intervention.

Question 2

What are the four components of informed consent?

Answer 2

indications, risks, benefits, and alternatives

Question 3

What is the ethical duty of physicians when it comes to making choices about a patient’s health care?

Answer 3

Involving the patient

Question 4

Mary schloendorff, was admitted to NY Hospital. She consented to examination under ether to determine if a diagnosed fibroid tumor was malignant, but withheld consent for removal of tumor. Surgeon found to be malignant. He then disregarded Schloendorff’s wishes and removed the tumor. What’s the issue?

Answer 4

Lack of consent, not a lack of informed consent. (medical battery)

Question 5

What’s the difference b/t medical negligence and medical battery?

Answer 5

Negligence: deviation from standard of care
Battery: Standard of care is not in question. Consent was not obtained

Question 6

What was the Nuremberg court about?

Answer 6

Nazi trials. No personal autonomy (voluntary consent)

Question 7

What was the scandal with Willowbrook State School and Hospital for Mentally Retarded?

Answer 7

Injecting residents with hepatitis.

Question 8

What was the issue in “Tuskegee” Study of syphilis?

Answer 8

Stopped treating patients to analyze natural course of dz (399 African-American men)

Question 9

What 4 rights were provided by the Patient Self-Determination Act?

Answer 9

1) Participation in health decisions (info they request)
2) Accept/refuse treatment
3) Prepare advance directive
4) Clear info on providers’ policies that govern the implementation of these rights

Question 10

What is implied consent?

Answer 10

Providing optimal care to an unconscious patient (until they can make their own decisions)

Question 11

What are the appropriate methods for dealing w/ a patient whose capacity varies from day to day?

Answer 11

1) catch him on a lucid day
2) if medicated, lower dose to provide informed consent
3) If never lucid enough, use a durable POA or next of kin

Question 12

What are the methods for dealing w/ a patient who does not wish to be fully informed?

Answer 12

An attempt to provide full disclosure must be made (and noted in chart). Patient has the right to refuse any info. If one thinks the patient should have more info, involving others into the process or proceeding on a subsequent visit may be beneficial.

Question 13

How are children different when considering requirements of informed consent?

Answer 13

When very young (under 12), parents are surrogate decision makers providing informed permission. At around 12 or when possible, children should be involved in decision making process. If ever parents are forcing a decision that is detrimental to a child’s health, the doctor and child services can take the parents to court.

Question 14

What are some possible surrogate decision makers?

Answer 14

POA and next of kin (guardian, spouse, adult children, and so on)

Question 15

What the the three phases of informed consent?

Answer 15

Preconditions (competence, voluntariness)
Info (nature of intervention, risk, benefit, alternative)
Consent (patient decision authorization)

Question 16

What are the three approaches to adequate information for consent? Describe them.

Answer 16

Reasonable physician standard: What a typical physician would say
Reasonable patient standard: What avg patient needs to know to make informed decision
Subjective standard: what this particular patient needs to know

Question 17

What are the interventions that require informed consent?

Answer 17

Most health care institutions have their own policies. They typically include surgery, anesthesia, and other invasive procedures.

Question 18

What are three factors to consider when determining whether to question a patient’s ability to participate in decision making?

Answer 18

1) understand situation and nature of intervention
2) understand risk/benefit of decision along w/ alternative
3) communicate decision based on that understanding

Question 19

A child cannot provide informed consent because of their age, but what can the provide?

Answer 19

Child assent

Question 20

What is a physician’s legal and ethical duties to a child?

Answer 20

Care based on what the child needs

Question 21

56 year old woman with confusion and fatigue. Presents to ED and found to be anemic to hemoglobin of 7 g/dL (normal 11-16) and in liver failure
Speaks only Cambodian
Husband speaks English, but he went home when she was admitted
Hospital does not have in-person translation services; telephone translation will be available at 8 am
What do you do?

Answer 21

Try to contact husband to translate. Use a phone translator. If translator is not available and patient is stable, monitor condition until one becomes available.

Question 22

A 55-year-old man has a 3-month history of chest pain and fainting spells. You think his symptoms indicate the need for cardiac catheterization. You’re worried about him. You explain the risks and potential benefits to him, and include your assessment of his likely prognosis without the intervention. He is able to demonstrate that he understands all of this but refuses the intervention.
Can he do that legally?
Should you leave it there?

Answer 22

Yes (Sean, you can’t just use chloroform to knock him out then do the procedure before he wakes up)
No, you should make additional recommendations and implore alternate techniques.