Informed Consent Flashcards
The 3 Basic Construct of informed Consent…
ALL THREE MUST BE PRESENT FOR INFORMED CONSENT
The exceptions are ____ _____, ____ ______, or ______ patients
- Information and Knowledge
- Comprehension and Understanding
- Freedom and Voluntary Participation
minor children, mentally impaired, or comatose patients
Construct 1: Information and Knowledge
The patient should understand clearly:
- The _______ of the procedure
- ____ and _____ of your anesthetic
- _______ specifically to the anesthetic
EX. The anticipated or expected RESULTS (tap block for lap chole. Expected result you wake up with no pain for a couple of hours)
- PURPOSE
- Risks and benefits
- alternatives
So, must ALL risks, benefits, and alternative treatments be explained? That would take DAYS! The answer is NO. Just a general description of the most common risks and treatments and outcomes can be discussed.
Construct 1: Information and Knowledge
Information or knowledge should be forthcoming and truthful, never ______ to elicit consent.
Answers should always be truthful.
So, Why do actually HAVE to have informed consent, I mean, if the patient shows up for surgery…..???
Well, in fact they have given _____ consent by showing up, but we inform them of the risks and options so they may make their own choice about their own care after they have been informed.
withheld
implied
Construct 2: Comprehension and Understanding
Information MUST be presented to the patient at the ________ can understand.
Capability to understand varies greatly
You are dealing with varying _______ levels.
level the patient
educational
Construct 2: Comprehension and Understanding
YOU are responsible for informed consent related to ________.
It is your responsibility to ascertain that the patient _______ the information.
The more serious the risk, the more important ____ ______ becomes.
anesthesia
comprehends
full comprehension
Construct 2: Comprehension and Understanding
Informed consent dialogue is ____ and ______ . Components include:
1) information in _____ terms
2) information in their own ____ ______
3) the possibility of __ ______ and the consequences of that selection
4) . Special circumstances such as ____ ______ _____. Tell them the risks.
specific and direct
- ordinary
- customary language
- no treatment
- expensive dental work
So, you are saying that I don’t have to explain ALL potential risks and outcomes of anesthesia? That is right, not ALL but try to be broadly inclusive if you do not have a written preprinted consent.
Construct 3: Freedom and Volunteerism
- ______ implies that the subject understands the situation and no coercion or undue influence has been used.
The line between persuasion and coercion becomes blurry at some point.
- The CRNA is allowed/not allowed to state his/her judgment about what is best for the patient.
- But DONT strongly engage in _____ the anesthesia
Often ask, “what would you do?”
- Freedom
- allowed
- “selling”
INFORMED CONSENT: Based on the right/premise that people are responsible for __________.
In a free society people must be allowed to make important decisions of life for themselves whenever possible.
Informed consent demonstrates _____ __ ______.
So, we operate under the premise that people are responsible for their own destinies and everyone of _____ ____ and _____ __ _____ has the right to decide what is done to their body.
their own destinies
respect for persons
sufficient age
soundness of mind
INFORMED A competent individual makes his or her own decisions Requires... 1) \_\_\_\_\_ 2) \_\_\_\_\_\_\_ 3) \_\_\_\_\_\_\_
1) information
2) comprehension
3) freedom
A person is unable to give consent of their own accord, but it is reasonable to believe they would consent if able.
Presumed Consent
Ex. GSW= loc= bleeding death= presumed they want us to save their life if no one is available to give consent
When a person gives consent to general things, it is _____ that consent is given to the individual things involved:
Example: Sitting still and offering arm for an IV prior to surgery. The patient is _____ consent for anesthesia and surgery.
Implied Consent
______ : When a patient is unable to give consent, another person makes the decision.
This is called a ______ informed consent.
PROXY
substitute
Proxy consent has specific conditions:
1) The patient is unable to offer _____ and ______ consent. EX: ______ or mentally ______.
2) The person offering proxy consent must determine what the incompetent patient would have ______ or ______ were she or he able to make the decision.
The proxy decision may not always ______ __ ______ of the patient.
Thus, the proxy decision is ___ absolute!
Proxy may have a reason to not want a good patient outcome
- TRUE and INFORMED
- Unconscious or mentally incompetent - wanted or decided
- promote the well being
- NOT
If the health care worker or physician determines that the proxy is not acting in the best interest of the patient, they have an ________________.
Notify appropriate involved parties (Physicians, supervisors, administration, and the ethics committee)
- ethical obligation to intervene
Minor Consent (Considered a minor under the age of 18 in most states) The minor may make decisions if:
1) The minor is \_\_\_\_\_ 2) The minor is \_\_\_\_\_\_ 3) The minor has \_\_\_\_\_\_\_\_
- married
- pregnant
- children
So, a married or pregnant 13 year old could make her own medical decisions even if her parents disagree?? Yes.
The proxy is asked to choose as the patient would if they were able.
If no evidence exists about the patients desires, the proxy is asked to choose the options that a “_______ ______” would choose.
This is done _____ complete informed consent about process, procedures, and potential outcomes.
______ ____ and _____ agree and care is rendered.
REASONABLE PERSON
after
Medical parties and proxy
Four Concepts Related to Consent
Battery
Assault
Abandonment
Negligence
ASSAULT: In criminal law and tort law, the ____ or ___ of force on another that causes that person to have a ______ ________ of imminent harmful or offensive contact.
threat or use
reasonable apprehension
Aggravated assault is a criminal assault accompanied by circumstances that make it more severe, such as the use of deadly weapon, the intent to commit another crime, or the intent to cause serious bodily harm
_______ the victim with death or serious bodily injury
threatens
_______ Assault is an assault expressing a threat on condition, such as “your money or your life.”
Conditional
______ Assault is sexual intercourse with another person without that persons’ consent
Offensive______ contact with another person, exclusive of rape is termed _______ assault.
Sexual
indecent
KNOW THIS ONE!
In medical law terms, assault is:
Assault is an act that creates an ______ in another of an ______, ______, or _______ contact.
If the patient has clearly stated they do not want a regional anesthetic, and the patient is sedated, then the caregiver PLANS to proceed with the regional….this is ASSAULT.
apprehension
imminent, harmful, or offensive contact.
________ is a criminal battery accompanied by circumstances that make it more severe, such as the use of a deadly weapon or the fact that the battery resulted in bodily harm.
_______ is a criminal battery not accompanied by aggravating circumstances and not resulting in grievous bodily harm.
Medical law definition: _______, unpriviledged, ______ contact with another person.
Aggravated battery
Simple battery
unpermitted, intentional
The main distinction between the assault and battery is the ________________.
While contact is an essential element of battery, there must be an _____ _ _____ for assault.
In the previous scenario of the sedated patient, if the caregiver GOES AHEAD (Action) with regional anesthetic, they have committed BATTERY.
the existence or nonexistence of a touching or contact.
absence of contact
_________ is the failure to exercise the standard of care that a reasonably prudent person would have exercised in the same situation.
negligence
_______ _______ is an independent contractor’s negligence, for which the employer is generally not liable
Example: contract CRNA
Collateral negligence
______ _______: is a plaintiff’s own negligence that proportionally reduces the damages recoverable by the plaintiff.
Example: dentures or rotten teeth
Comparative Negligence
_____ _______: is the negligence of two or more parties acting independently but causing the same damage
Both surgeon and CRNA don’t recognized excessive blood loss
Concurrent Negligence
_______ _______: is a plaintiff’s own negligence that played a part in causing the plaintiff’s injury and that is significant enough (in few jurisdictions) to bar the plaintiff from recovering damages; in most jurisdictions, this defense has been superseded by comparative negligence.
Contributory Negligence
_____ _______: is a conscious, voluntary act or omission in reckless disregard of a legal duty and of the consequences to another party, who may typically recover exemplary damages. Aka reckless negligence; wanton negligence; willful negligence.
Gross Negligence
______ ______: is negligence resulting from a party’s special relationship with another party who is originally negligent—so that, for example, a parent might be held responsible for some acts of a child; negligence of one person charged to another. CRNA might be held responsible for giving a drug that an MDA told us to give.
Imputed Negligence
_____ _______: is the failure to exercise the great care of an extraordinarily prudent person, resulting in liability in special circumstances in which lack of ordinary care would not result in liability.
example:______
Slight Negligence
Example: HR 36 and CRNA gave neo instead of robinul
Medical ________ results when the caregiver-patient relationship is terminated without making reasonable arrangements with an appropriate person so that care by others can be continued.
abandonment
Abandonment Factors to be considered:
Did the caregiver accept the patient assignment, creating a caregiver-patient relationship?
Did the caregiver provide reasonable notice before terminating the caregiver-patient relationship?
Could reasonable arrangements have been made for continuation of care by others when proper notification was given?
just read
