Informed Consent and Respect for Autonomy Flashcards
What are the two aspects of autonomy?
1) Moral Autonomy
2) Psychological Autonomy
What is Moral Autonomy?
The moral authority or right to make one’s own decisions
What is Psychological Autonomy?
The competency to make one’s own decisions and the ability to reason and act rationally
*Presupposed when one exercises one’s moral autonomy
What type of people lack Psychological Autonomy?
Infants and people with advanced Alzheimer’s disease
What is medical paternalism?
The view that physicians are justified in promoting the well-being of patients as defined by the physician, regardless of whether the patient gives prior consent
**There has been a dramatic shift away from this
What 3 things must be avoided in order to respect the autonomy of the patient?
(1) Coercion
(2) Deceiving the Patient
(3) Pressuring a Patient
What does coercion mean?
To restrain or dominate by force
What does deceiving the patient mean?
To cause to accept as true or valid what is false or invalid
What does pressuring the patient mean?
The burden of physical or mental distress
What is an important thought to keep in mind regarding autonomy?
“Treat persons as autonomous rational beings who have their own purposes and never as a mere means to reaching your own purposes.”
What is the first and most important implication of respect for autonomy in health care?
The duty to obtain Informed Consent
What is informed consent?
The disclosure to a patient what is to be done to him or her, including the potential risks and desired outcomes, and obtaining the patient’s consent to/or refusal of the procedure
Is informed consent an ongoing process?
Yes
It is an ongoing process and not something that is finalized with a signature on an intake form.
Patients always have the right to know and a right to refuse
What are the 3 conditions that must be met for patients to give informed consent?
(1) Information
(2) Voluntariness
(3) Competence
8 Things one must provide to patients seeking informed consent
(1) Education regarding the planned examination/assessment
(2) Education regarding the evaluation, diagnosis, prognosis, and plan, including whom will be treating the patient
(3) Education regarding the intervention to be provided
(4) Education regarding the associated risks of the aforementioned
(5) Expected Benefits
(6) Anticipated Time Frames
(7) Anticipated Costs
(8) Any reasonable alternatives to recommended interventions
What are some examples of relevant information?
The facts about what is involved in the proposed therapy and alternative therapies, risks and benefits of the proposed therapy and of alternative therapies financial costs, and whatever additional information the patient requests concerning therapy.
Explain the second condition of informed consent (Voluntariness)
This is the patient’s ability to make a decision without being coerced, pressured, or deceived
Explain the first condition of informed consent that patients must be given relevant information
The HCP must provide the patient with appropriate information concerning their condition and treatment options in a manner they can understand so they can make an informed decision.
When competent individuals authorize someone to make decisions for them in the event they become incompetent to make their own decisions, who is responsible for the outcomes?
The patient
2 ways legally competency determined?
(1) Adults (18 yrs or older) are presumed legally competent until the courts declare otherwise
(2) Cognitive testing/assessment may become necessary
Explain the third condition of informed consent (Competence)
This means that the patients must be sufficiently rational or competent to understand and make health-care decisions
Why is informed consent important?
It signifies that patient isn’t being coerced into any course of action
It also enforces the ‘implicit’ rule of the relationship
What is the ‘implicit’ rule?
It signifies that the Health Care Provider:
- Will Not Harm Patient
- Will Not Be Unfaithful to Task of Helping Patient
- Will Exhibit Veracity (Truth Telling)
When is competence assessed?
Only required when the consequences of a voluntary decision are life-threatening or life-altering
(i.e. undergoing some human experimentation or sex-change operation)
What are the 3 standards for determining competency?
(1) Relies on prior written or verbal statements made by the person (pure autonomy standard)
(2) Guardians may be asked to render a substituted judgment for the patient
(3) Guardians base their decisions on what they think is in the best interest of the patient
What are the to conditions when non-compliance of guardian decision is permitted?
(1) When the care would be contrary to accepted standards
(2) When the directive conflicts with the conscience of the health-care provider
3 Degrees of competency
(1) Emerging Competency of a Child
(2) Limited Competency
(3) Intermittent Competency
What is limited competency?
An adult may be completely competent in ADLs but their decision making may be altered therefore they are considered incompetent
What is intermittent competency?
Recognizes that there times when otherwise autonomous individuals may be momentarily unable to deliberate thoughtfully and select a course of action.
i.e. when an individual is under a great deal of stress, under anesthesia, intoxicated, etc.
When does presumed consent come into play?
Patient is unable to consent or specify wishes and/or surrogate decision maker is unavailable so HCPs become surrogate decision makers (only until patient is able to make decisions or other surrogate decision maker becomes available)
What is beneficence?
The moral requirement to promote the well-being of patients
How Will Informed Consent Affect Your Student Clinical Experience?
Always tell your patients that you are a SPT
