Informed consent Flashcards
What is informed consent?
- agreement with physician recommendations
- Refuse recommended interventions
- choice among alternatives
- shared decision-making (between pt & doc)
What is negligence, as it relates to informed consent?
- Physician failed to disclose a risk that should have been disclosed
- patient would not have consented had the risk been discussed
- that risk occurred and caused harm
What are the requirements of informed consent?
- discussion of pertinent information (disclosure, understanding)
- obtain patient’s agreement (authorization)
- Freedom from coercion (voluntary choice)
- To be done by the physician performing the procedure
What facets are required when disclosing pertinent information about a procedure?
- Diagnosis
- Nature and Purpose of Intervention
- Expected Benefits
- Risks
- Likely Consequences
- Medically Reasonable Alternatives (including no intervention)
What are the two main problems with informed consent?
- lack of patient understanding of information
- patient does not want to make decisions
Clinicians_______-estimate patients’ desire to make decisions, ______-estimate their desire for information.
- over
- Under
What are the exceptions to informed consent, where you don’t need their consent?
- Lack of decision making capacity
- emergencies
- therapeutic privilege
- waiver of consent
What is the therapeutic privelege?
-doc may withhold information when disclosure would severely harm the patient, or undermine informed decision-making.
You are discussing the care of an elderly woman with her family. Although she is awake and alert, the patient is very ill and physically fragile. You are awaiting the results of a biopsy for what will likely be cancer, which has already metastasized through the body. The family asks that you inform them first about the results of the biopsy. They are very loving and caring and are constantly surrounding the patient. They do not want to depress the patient further, and because there will be no hope for a cure they see no reason to ruin her remaining life with this information. What should you tell them?
A. You will honor their wishes.
B. You agree with their wishes and you ask them to give you the written request.
C. You ask them to involve the hospital ethics committee.
D. You tell them you are obligated to inform the patient of the findings.
E. Explain to them that decision can only be made by the health care proxy.
D. You tell them you are obligated to inform the patient of the findings.
When is revisiting consent appropriate?
- if there is an increase in risk
- if there is a decrease in benefits
In Texas, informed consent requires
A. That the health care provider identify what information is important to the patient in front of her/him and disclose that.
B. That the health care provider disclose all remotely possible alternatives.
C. That the health care provider performing the procedure be the one who obtains consent.
D. That the health care provider disclose only the alternatives covered by the patient’s insurance.
- C. That the health care provider performing the procedure be the one who obtains consent.
- A. is incorrect because Texas (like most states) does not have a subjective standard of disclosure.
What are the 4 components of decision making capacity?
- Patient Makes and Communicates a Choice
- Patient Understands the Relevant Information
- Patient Appreciates Relevance of Information to Own Situation
- Patient Uses Reasoning In Light of Their Values and Goals
Which of the following are key components of decision making capacity?
A. Understanding, Affect, Judgment, Conclusion
B. Reasoning, Understanding, Clarity, Insight
C. Understanding, Appreciation, Reasoning, Communication
D. Reasoning, Understanding, Insight, Communication
C. Understanding, Appreciation, Reasoning, Communication
A 58 year old man is out of town on business in New York. He has a myocardial infarction and deteriorates despite thrombolytics and angioplasty. He is intubated and is disoriented and unable to understand his condition. He needs a coronary bypass. His wife is the health-care proxy but she is in another city. You would like her consent in order to perform the surgery because she is the designated surrogate. Which of the following is true in this case?
A. She must come to the hospital to sign consent in person.
B. The wife must designate a local guardian until her arrival.
C. You must repeat the angioplasty instead.
D. Telephone consent is only valid for minor procedures.
E. Take consent for the bypass over the phone and have a second person witness the telephone consent.
E. Take consent for the bypass over the phone and have a second person witness the telephone consent.
*The wife is the designated surrogate decision maker. She can exercise substituted judgment without being present. Documentation of consent is always important, hence the witness.
What is the “substituted judgment” standard?
Decision based on what they know the patient would have wanted.
