Informed Consent and POA Flashcards
The United States Supreme Court has held that ___ and ___ adult patients have the right to decline any and all forms of medical intervention, including lifesaving or life-prolonging treatment
Competent, adult
Competent and adult patients can
Decline care and consent to care
What is consent?
Voluntary agreement by a person who possess sufficient mental capacity to make an intelligent choice to allow something proposed by another to be performed on himself or herself.
What is a power of attorney (POA)?
A Legal document that allows someone else to make decisions for you
Can be financial and medical or often, both
Proactive, not a reactive step
Is a POA permanent?
No - it can be changed
POA general considerations?
Establish POA earlier than later
Appoint someone you really trust
Tell your family and friends ahead of time that you have one and who they are
Not required in the parental/child relationship
What is informed consent?
It is a legal concept
Patients have the right to know the potential risks, benefits and alternatives of a proposed procedure…and the consequences of refusal
Of note: in 1973, Informed consent in the Caterbury v. Spence case set the reasonable man standard for requiring informed consent for treatment
What is the physician/provider duty in relation to informed consent?
Informed consent is predicated on the duty of the provider to disclose to the patient sufficient information to enable the patient to evaluate a proposed medical or surgical procedure before submitting to it
Requires that a patient have a full understanding of what to which they have consented
How to assess whether a patient has decision making capacity?
Overall: a patient “gives an informed consent” if:
1. One is competent to act
2. Receives a thorough disclosure
3. Comprehends the disclosure
4. Acts voluntarily
5. Consents to the intervention/treatment
In most cases, a patient is considered competent to make medical decisions regarding their care unless a court determines otherwise
What preconditions should be considered to determine in/capacity of the patient’s decision-making capacity?
Does the patient have the competence to understand?
Does the patient have the competence to decide?
Does the patient have the voluntariness to decide?
If a patient is unable to make decisions by reason of age or incapacity, a patient-appointed decision maker may “substitute his or her judgment” on behalf of the patient: Health Care Agent
What things must be noted in the patient’s chart if you deem the patient incapable of decision-making capacity?
The cause, the nature, the extent, probable duration of incapacity
Ex: patient comes to clinic intoxicated, some unexpected event happens during surgery while patient is under anesthesia, etc
Of note: before withholding treatment, a second provider must confirm and document the incapacity before any new decisions are acted upon by the health care agent
What are the 3 elements of necessary information that is needed in the patient’s note to document adequacy of consent?
- Disclosure of material information (ex: We discussed the diagnosis of ___. I discussed treatment options with the patient, including…..)
- Recommendation of a plan (I either recommend or do not recommend x/y/z treatment option because of reason)
- Understanding disclosure and recommendations
Tying in with #3 –> final elements of completing consent: decision in favor of or against plan and authorization of the chosen plan (ex: the patient understands and agrees with this plan; OR the patient voiced understanding and that they would like to first consider their options before making a treatment decision; OR the patient voiced undserstanding and has decided to forgo treatment options at this time in lieu of observation, etc)
Who can authorize consent?
Competent adult patients
In the event of incapacity:
spousal consent (assumed for spouse if no POA or health care agent appointed), guardianship/health agents, parents, healthcare provider (x2)
What are some types of proof of consent?
Oral, written (written preferred as it provides visible proof; oral consent can be hard to proved as it’s difficult to corroborate, but if proven true is as binding as written consent)
What are some exceptions for authorizing consent in a competent adult?
Preserve life of the patient, prevent suicide, safeguard the integrity of the medical profession and protect innocent third parties.
What is guardianship?
An individual who by law is invested with the power and charged with duty of taking care of a patient by protecting the patient’s rights and managing their estate
Can be temporary
Courts uphold that minor consent is ___ and you must secure consent of a parent or guardian- although this shouldn’t delay emergent treatment
Ineffective
When is minor consent not necessary?
The minor is married
The minor has a minor
The minor is emancipated
State law defines minor’s age of autonomy in sexual health (MN = age 14)
If emergent treatment is required to preserve the life of a patient or prevent injury AND it is impossible to obtain consent of the patient or legal representative, consent is ___
Implied
EVERY effort should be made to obtain consent and if not: the record should reflect: the efforts to obtain consent,
the nature of the threat to life or health, it’s immediacy, and its magnitude
This is “privilege to proceed” because inaction at this time may cause greater injury and would be contrary to good medical practice
What is implied consent?
Determined by some act or silence, raising a presumption that consent has been authorized
Presumed in emergency situations (ex: risk to life or limb)
Unconscious patients are presumed under law to approve treatment that appears to be necessary
Non-emergent situations- patient submits to procedure, implying consent without an explicit spoken or written expression of consent
What are some common reasons that patients (competent adults) treatment?
Lack of confidence in provider
Disagreement with the opinion of the provider
Fear of the procedure
Doubt as to the value
Religious beliefs
Just becase
Important point with failure to inform?
Liability may be imposed for nonconsensual touching of a patient who had refused, EVEN if that procedure improved health
(ex: patient’s chief complaint is a breast concern, nonconsensual initiation of a breast exam)
