Informed consent Flashcards
A health care provider has the duty to do what prior to any procedure
disclose all significant information that he/she possesses or reasonably should possess that is material to an intelligent decision by the patient
informed consent may include
- nature of patient’s condition;
- nature/probability of risk;
- reasonable expectation of benefits;
- inability of provider to predict risks/results;
- irreversibility of a procedure
- likely result of no treatment;
- available alternatives including risks and benefits;
Doctrine of informed consent
- a plaintiff was not successful in a claim because the court determined that regardless of the severity fo the potential injury, if the probabiliby that the injury will occur is so small as to be almost non-existent, then the possibility of that injury occurring cannot be considered a material factor
Providers do not have to explain what with informed consent
every possibility that may occur but isn’t anticipated by equipment use
provider must only disclose
known drug-related events, not predic what might happen
Limits to informed consent
- courts recognize limiting factors;
- courts acknowledge that the patient’s right to know must be balanced with the recognition tat an undue burden must not be placed on healthcare providers
Limiting factors of informed consent that the court may recognize
- medical matters are complex;
- communicatio of scientific information by a trained healthcare provider to an untrained pt may be difficult
- the remote possiblity of risk is almost limitless;
- there should be a limit to what a provider is held to
Obligaion to give adequate information does not require
disclosure of information the healthcare provider reasonably believess patient has
medical consent forms list
risks
capacity/incapacity
physical ability to make and communicate decisions
competence/incompetencd
mental capacity/incapacity
guardian
makes decisions patient would make
guardian ad litem
makes recommendations for patient in court
conservator
makes financial decisions for patient
proxy
can be activated/inactivated to act on behalf of patient as needed
self-care directives
vary by jurisdiction {i.e. living wills, etc}
differences between legal and ethical responsibility to obtain informed consent
ethical: may be to do no harm;
legal: encompasses multiple criteria
In abasence of court decisions/legislation professionals are guided by
ethics/personal moral standards
court decisions vary by
jurisdiction
when there is a conflict {ethical vs. legal} courts will evaluate
wheter a rational basis exists for a decision, and generally consider the public good when deciding an issue
Prevention from deviating from standard
goal is to be proficient and up-to-date
Legal issues with deviating from standards
failure to keep up with current treatment;
- potential for malpractice suit
Failure to show consern and consideration is considered legal or ethical
Both:
- Ethical: patient has right to self-determination, provider must show concern and consideration to allow that;
- Legal: potential omission if provider fails to communicate;
Is fialure to communicate/poor communication with the treatment team considered legal or ethical issues
legal
Is failure to follow the chain of command considered legal or ethical
legal
Is failure to follow/understand institutional policies/procedures considered legal or ethical
legal
Is failure to understand/master use of equipment considered ethical or legal
legal
Is failure to document appropriately/accurately considered legal or ethical
legal
Is failure to obtain informed consent considered legal or ethical
legal and ethical
Is competency issues considered legal or ethical
legal and ethical
Practice tips
- know red flag complaints and conditions
- treat worst thing first;
- know risk factors that call for screening exams/tests;
- follow up on diagnostic tests and referrals;
- revisit unsloved problems until solved;
- have systems in place for follow up;
- audit charts;
- treat every medical opinion as though they are a pt.
Trouble spots
- failure to treat in accordance with standards;
- failure to refer;
- improper managment/care;
- delay treatment/care;
- medication errors;
- incompatibility/contraindications
Ethics
branch of philosophy concerned with “doing good” and “right action”
ethical lens helps us
consider all views and build consensus
ethics and morals has what root meanings
- customs;
- conventions;
- institutions;
- laws
Morals tend to be associated with
values or habits that reflect behavior;
- religious beliefs
Ethics tend to be associated with
- critical reflection on our values;
- personal beliefs and experiences;
- societal norms;
- professional guidelines;
- organizational standards;
What role do ethics committees perform
- provide education and consultation on ethical issues;
- help raise awareness of ethical issues;
- increase knowledge about ethical issues;
- provide context and model for moral discourse in complex situations;
- provide a forum for discourse and consensus building in face of conflicts
Preventative ethics
- integration into daily practice through ethics rounds or opportunities for reflection;
- opportunity to prevent ethical dilemma becoming a crisis;
- acceptance of daily ethics rounds in some institutions
What is one of the richest professional code of ethics
the ANA code of ethics
The ANA code of ethics guides us to
- respect persons;
- help maintain patient’s autonomy;
- promote patient’s dignity;
- ensure patient’s safety;
- should be reflected on and considered every day
Autonomy as ethic principles
self-rule;
- person’s right to determine what is best for them
A patients right to determine what is best for them is based on
- ability to reason;
- capacity for personal decision making;
- knowledge of personal goals;
- self-knowledge
- ability to act on one’s choices
Autonomy assumes
no other influences however no one is completely autonomous
What can impact one’s ability to act autonomously
stress of illness
Nonmaleficence
- do no intentional or needless harm;
- be accountable;
- advocate for patient/family to prevent unnecessary harm;
- supervise delegated tasks;
- max benefit with minimal harm
Nonmaleficience possess the professional competence that allows you to
- foresee consequences;
- perform action;
Beneficence
- promotion of patient’s good;
- potential conflict with principle of autonomy
What is the ultimate goal of nursing and medicine
beneficence
Boundaries to beneficence
- patients/families wishes;
- society’s provisions;
- health and heatlhcare system
With beneficence it is important to
- be careful to avoid paternalism;
- promote self-awareness in ourselves and patients;
What is the most important thing with beneficence
knowing what is right for the patient
Veracity
truthfulness in support of patient autonomy;
- obligation to tell the truth;
Veracity requires
factual knowledge and knowledge of patient as an individual;
ongoing reflection
Veracity is what part of jusdicious process communication
transparency
with veracity it is important to consider
the vulnerability of patients in need of care;
Justice and fidelity
- fairness, both to individuals and in allocating resources;
- no undue burden on people;
- faithfulness to professional commitments even if conflicts about allocation of resources
What are 2 main ethical frameworks
- principle orientation to ethical decision making;
2. relational or care-based approach to ethical decision making;
Ethical framework: principle orientation to ethical decision making
- ethical principles as overriding guides;
- particulars of situation less important than adherence to principles;
Ethical framework: relational or care-based approach to ethical decision making
- particulars of situation more important than principles;
- every situation, patient, family unique
CERN helpful guidelines
- Get the story straight before making any decisions.
- Recognize the ethical principles and apply the theory.
- Theory as a tool to quickly assess a situation
- Adhere to unbiased and honest communication.
- Honesty protects the good of patient and family.
- Use the notion of preventative ethics.
- know the kind of pain you are treating
CERN guideline for using the notion of preventative ethics
- patient and family education;
- preparation for conversation about end-of-life issues with Md
CERN guideline types of pain that can be treated
- emotional pain;
- physiologic pain;
- changes in mental status potentially caused by pain treatment;
- existential distress
Ethical dimensions
- listen
- respect;
- take other person’s point of view;
- reflect on challenge vs. inquiry;
- consider that education of family on intervention may not be sufficient;
- summarize everything to be sure everyone’s goals and intentions are same
Ethical implications of palliative sedation
- goal of medication;
- apassing;
- ability to provide the care (i.e. ketamine drip’s success not guaranteed);
- interventions appropriate execution possible;
- validation in myself through palliative MD’s assessment after patient’s passing;
- confirmation of team effort in treating
Rule of double effect
- initial inentions must be good;
- may not always acheive best outcome but you are upholding good morals and ethics
You are upholding good morals and ethics if
- you are honest;
- you have a trusting relationship;
- you have good communication;
- you express the intended benefits of the intervention;
Ethics at end-of-life
- maintain patient relationship;
- advocate for the patient;
- alleviate pain;
- ensure optimal quality of life;
- provide family-centered care;
- know how to deal with hope;
foundation of relational ethics
relationships with patients and families
Relational ethics
- unique knowledge about patient d/t privaleged info;
- must gather extensive info on patient and family in very short time;
- relatioinships can last over time;
