Informed Consent Flashcards
Consent to Treatment and Substitute Decisions
When providing care, the nurse is applying various ways of knowing.
Carper’s Ways of Knowing (Empirics, Aesthetic, Personal Knowledge, Ethics)
Autonomy
The principle of autonomy supports the capable and competent patient’s right to determine and act on a self-chosen plan.
Competent persons have the right to refuse consent to treatment.
Informed Consent and the Health Care Consent Act (1996)
The nature of the treatment
The expected benefits of the treatment
The material risks of the treatment
The material side effects of the treatment
Alternatives courses of action
The likely consequences of not having the treatment
The Code of Ethics for RNs
The Code of Ethics for Registered Nurses requires nurses to respect and promote the autonomy of clients by supporting them in expressing their values.
The Code of Ethics also requires that nurses ensure that clients under their care have the right information, guidance, and support to make informed decisions.
Free and Informed Consent
Patients have the right to refuse consent to be treated, even if treatment is in their best interest
Nurses are obligated to advocate for patients
- who are not fully informed
- who require more time to reflect on alternatives
- when their wishes have not been respected
Lack of Consent (Battery)
Battery, an intentional tort, is the touching of another person without consent.
In health care settings, any treatment, surgery, nursing action, diagnostic test, or intervention that occurs without prior consent is forbidden unless the patient is unable to consent and delay could result in serious bodily harm or death.
Case Law on Consent Reibl v. Hugues (1980)
Reibl v. Hughes (1980): the plaintiff suffered from a blocked left carotid artery. He was booked for an elective internal carotid endarterectomy, which was performed by the defendant, a neurosurgeon.
The plaintiff sued the neurosurgeon for the surgeon’s failure to inform him adequately of the risks of the surgery.
Case Law on Consent Malette v. Shulman (1990)
The plaintiff had been seriously injured in a motor vehicle accident and rushed to a nearby hospital. She had sustained serious injuries to her head and face and was bleeding profusely.
She had a card printed in French and signed by the patient identifying her as Jehovah’s Witness with clear refusal of blood transfusion.
Case Law on Consent Ciarlariello v. Schacter (1993)
The plaintiff was asked to be at the hospital to undergo the first of two angiograms. Her first language was Italian and her daughter took the role of the interpreter.
During her second test, she experience pain and asked them to stop the procedure. The test was stopped. She had suffered some paralysis. She was explained that it would take 5 more minutes to continue and she agreed. She suffered a reaction during the procedure and was left quadriplegic.
Conditions of Informed Consent
For consent to be valid, it must be given voluntarily without coercion or undue pressure.
Consent must be fully informed regarding the risks and benefits of treatment, as well as the risks of foregoing treatment.
Consent muse be specific, regarding the proposed treatment or procedure and who will perform the treatment or procedure.
Consent must be given by a legally capable person.
Types of Consent
Expressed consent is a clear statement of consent given by the patient. It is often a written consent.
Implied consent is inferred from the patient’s conduct (e.g., holding out his or her arm for an injection).
Incompetent Adults
Seemingly irrational refusal of consent cannot be considered evidence of mental incompetence.
If a patient can appreciate the nature and consequences of the proposed treatment, they are considered capable.
If there is a concern, a substitute decision maker should be asked to consent.
Children
In some provinces, a child mature enough to understand the nature and risks inherent in a procedure is given the right to consent.
In Ontario, a person (including a child) is presumed to be capable unless the practitioner has reason to believe otherwise.
The capacity will depend on the child’s age, intelligence, maturity, experience.
A Children’s Aid Society (CAS) may apply to a court to have a child in need of protection made its ward so that it can make treatment decisions on that child’s behalf.
Legislation Regarding Consent
In Ontario, legislation related to consent is found in the Health Care Consent Act (1996) and the Substitute Decisions Act (1992).
These acts outline the requirements for informed consent, who is capable of consenting, when a substitute decision maker is required.
These acts determine a hierarchy of substitute decision makers
Ontario’s Substitute Decisions Act (1992)
Under this Act, the two methods of providing a substitute decision maker for an incapable person are:
- The appointment (in advance of becoming incapable) of a power of attorney for personal care
- An application to the court for the appointment of a guardian
