informed consent Flashcards
what constructs must be present to be considered informed consent?
- information and knowledge
- comprehension and understanding
- freedom and voluntary participation
what exceptions apply to the constructs of informed consent?
- minor children
- mentally impaired
- comatose patients
describe construct 1 of informed consent
information and knowledge
- pt. should understand clearly: purpose, risks and benefits, alternative procedures, and anticipated results
- forthcoming and truthful; never withheld to elicit consent
describe construct 2 of informed consent
comprehension and understanding
- info must be presented to the patient at the level the pt. can understand (not informed consent unless understood)
- the more serious the risk, the more important full comprehension becomes
- may ask “which option do you choose and why?” to ensure comprehension
- may want to quiz the pt. to ensure comprehension
- dialogue is specific and direct and should include: ordinary terms, their customary language, possibility of no treatment and the consequences of that selection
describe construct 3 of informed consent
freedom and volunteerism
- freedom implies that the subject understands the situation and no coercion or undue influence has been used
- CRNA is allowed to state his/her own judgment about what is best for the patient if asked
what premise is informed consent based upon?
- based on the right/premise that people are responsible for their own destinies
- in a free society, people must be allowed to make important decisions of life for themselves whenever possible
- demonstrates respect for persons
describe informed consent
a competent individual makes his or her own decisions
-requires: 1) information 2) comprehension 3) freedom
describe presumed consent
a person is unable to give consent of their own accord, but it is reasonable to believe they would consent if able
ex: person is stabbed, makes it to ER and passes out; presumed consent to treatment since they brought themselves to the ER
describe implied consent
when a person gives consent to general things, it is implied that consent is given to the individual things involved
ex: sitting still and offering are for an IV prior to surgery, pt. is implying consent for anesthesia and surgery
describe proxy consent
when a patient is unable to give consent, another person makes the decision
- “substitute informed consent”
- specific conditons: 1) pt. unable to offer TRUE and INFORMED consent 2) person offering proxy consent must determine what the incompetent pt. would have wanted or decided were she or he able to
- proxy decision may not always warrant the well being of the pt.; therefore, it’s not absolute
what are specifics to a proxy consent?
- if a healthcare worker or physician determines that the proxy is not acting in the best interest of the pt., they have an ethical obligation to intervene
- proxy is asked to choose as the pt. would if able
- if no evidence exists about the pt.’s desires, the proxy is asked to choose the options that a “reasonable person” would choose (after complete informed consent about process, procedures, and potential outcomes)
- medical parties and proxy agree- care is rendered
what are exceptions that allow minors (under age 18) to provide own consent?
- married
- pregnant
- has children
define assault in criminal and tort law
threat or use of force on another that causes that person to have a reasonable apprehension of imminent harmful or offensive contact
define aggravated assault
criminal assault accompanied by circumstances that make it more severe, such as use of deadly weapon, the intent to commit another crime, or the intent to cause serious bodily harm
ex: assault with a deadly weapon in which the defendant, controlling the deadly weapon, threatens the victim with death or serious bodily harm (felonious assault)
define conditional assault
an assault expressing a threat on condition
ex: “your money or your life”
define sexual assault
sexual intercourse with another person without that person’s consent
- many state statutes have abolished “rape” and replaced with offense of sexual assault
- offensive sexual contact with another person, exclusive of rape in termed indecent assault
define assault in medical terms
an act that creates an apprehension in another of an imminent, harmful, or offensive contact
ex: if pt. clearly states don’t want a regional anesthetic, and pt. is sedated, then the caregiver PLANS to proceed with the regional = ASSAULT
define battery in criminal law
application of force to another resulting in harmful or offensive contact
define aggravated battery
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
define simple battery
criminal battery not accompanied by aggravating circumstances and not resulting in grievous bodily harm
define battery by medical law
unpermitted, unprivileged, intentional contact with another person
what are the main differences between assault and battery?
- main distinction between the two offenses is the existence or nonexistence of a touching or contact
- contact is an essential element of battery; there must be an absence of contact for assault
ex: if caregiver goes ahead with regional anesthesia rather than just planning, committed battery
define negligence
failure to exercise the standard of care that a reasonably prudent person would have exercised in the same situation
define collateral negligence
independent contractor’s negligence, for which the employer is generally not liable (contracted CRNA)
define comparative negligence
a plaintiff’s own negligence that proportionally reduces the damages recoverable by the plaintiff (pt. withholds information directly asked for and later sues)
define concurrent negligence
the negligence of two or more parties acting independently but causing the same damage
define contributory negligence
a plaintiff’s own negligence that played a part in causing the plaintiff’s injury and that is significant enough to bar the plaintiff from recovering damages
-in most jurisdictions, this defense has been superseded by comparative negligence
define criminal negligence
gross negligence so extreme that it is punishable as a crime
ex: involuntary manslaughter or other negligent homicide can be based on criminal negligence like when an extremely careless automobile driver kills someone or if CRNA has abandoned pt. or is on cellphone not paying attention and something happens to the patient
define gross negligence
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
- reckless negligence
- wanton negligence
- willful negligence
define imputed negligence
- resulting from a party’s special relationship with another party who is originally negligent
ex: a parent might be held responsible for some acts of a child - negligence of one person is charged to another (anesthesiologist tells CRNA to give a drug in a crisis situation that causes harm)
define slight negligence
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
(just made the wrong decision)
define abandonment
medical abandonment results when the caregiver–patient relationship is terminated without making reasonable arrangements with an appropriate person so that care by others can be continued
*even if cases are not started, must be sure they are covered
what factors should be considered with abandonment
- 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?
