Informed Consent

Question 1

what is the traditional paternalistic model?

Answer 1

professionals assumed to be competent and to protect patient’s best interest

patients considered ignorant about their bodies and medicine

Question 2

what ethical principle is the traditional paternalistic model based on?

Answer 2

principle of Beneficence: “I know what is best for you”

Question 3

what is the Collegial or contractual model?

Answer 3

patients and providers see themselves as colleagues solving a common problem

based upon mutual trust and confidence

shared decision-making where the patient is accorded the right to make decisions and to have control over their own life whenever significant decisions are to be made

Resnik (PT): “collaborative problem-solving”

Question 4

what ethical principle is the collegial/contractual model based on?

Answer 4

autonomy- respect for pt’s decision making

Question 5

legal and ethical doctrine seeks to?

Answer 5

protect the patient’s right to greater freedom of choice

binds practitioner to adequate DISCLOSURE and EXPLANATION of the tx, and the various options and consequences

Question 6

ethical and legal doctrine consists of what principles?

Answer 6

Ethical principles:
1- autonomy- respect for pt’s decision making
2- beneficence- promote good
3- non-maleficence- do no harm

Legal principles:
1- battery
2- disclosure
3- fiduciary relationship

Question 7

what is battery?

Answer 7

offensive touching.. w/out consent

Question 8

what is disclosure?

Answer 8

informed of what will happen

Question 9

what is a fiduciary relationship?

Answer 9

special trust.. watch out for best interests of pt)

Question 10

what is the process of informed consent?

Answer 10

1- disclosure of necessary elements –> info

2- consent must be VOLUNTARY

3- COMPETENT adult (or parent/legal guardian)

Question 11

disclosure– how much info is enough?

Answer 11

Professional standard- what a reasonable professional would disclose

Reasonable person standard- what a reasonable person would want to know

Question 12

“as a general rule, the more info a PT provides about benefits, risks and alternatives, the less likely…

Answer 12

it is that he/she will be held liable to a pt who claims that the PT failed to provide adequate info”

-Bennet

APTA

Question 13

what is competence? who is competent?

Answer 13

varying standard of competence is based on the consequences of the act

different levels of competence needed for different decisions

sufficiently rational or competent to understand and make health care decisions

adults assumed competent until court says otherwise

life threatening or irreversible intervention–> courts are more likely to get involved

Question 14

competence is the ability to?

Answer 14

1- communicate choices
2- understand relevant information
3- appreciate the situation and its consequences according to one’s own values
4- reason about tx options

Question 15

what are 2 types of incompetent patients?

Answer 15

1- never competent (infants, children, severe mental disability)

2- once were competent (organic brain disorder, adult psychosis, brain injury)

parents or legan guardians have the authority to speak for the patient

Question 16

what are 3 legal standards for incompetence?

Answer 16

1- pure autonomy: prior written or verbal

2- substituted judgements: projecting what the pt would want

3- best interest standard

Question 17

what is the “professional standard” in PT?

Answer 17

APTA STANDARDS OF PRACTICE
“The PT has SOLE RESPONSIBILITY for providing info to the pt and for obtaining informed consent in accordance with jurisdictional law before initiating intervention.”

Pt. (or legal guardian) must acknowledge understanding of the intervention and give consent before tx is initiated.

Question 18

Declaration of principle on informed consent:

what information should be disclosed to the pt?

Answer 18

1- description of tx to be provided
2- clear explanation of the risks
3- expected benefits
4- anticipated time frame
5- anticipated costs
6- reasonable alternatives

Question 19

what rights in regards to medical tx does every competent adult have?

Answer 19

1- to be informed and to give consent

2- to leave the hospital against the advice of their doctors (except if they are a danger to others)

3- to not have extraordinary measures performed to save their life

4- to appoint a legal representative to make informed decisions on their behalf if they should become incompetent