Informed Consent and Respect for Autonomy

Question 1

What are the two aspects of autonomy?

Answer 1

1) Moral Autonomy

2) Psychological Autonomy

Question 2

What is Moral Autonomy?

Answer 2

The moral authority or right to make one’s own decisions

Question 3

What is Psychological Autonomy?

Answer 3

The competency to make one’s own decisions and the ability to reason and act rationally
*Presupposed when one exercises one’s moral autonomy

Question 4

What type of people lack Psychological Autonomy?

Answer 4

Infants and people with advanced Alzheimer’s disease

Question 5

What is medical paternalism?

Answer 5

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

Question 6

What 3 things must be avoided in order to respect the autonomy of the patient?

Answer 6

(1) Coercion
(2) Deceiving the Patient
(3) Pressuring a Patient

Question 7

What does coercion mean?

Answer 7

To restrain or dominate by force

Question 8

What does deceiving the patient mean?

Answer 8

To cause to accept as true or valid what is false or invalid

Question 9

What does pressuring the patient mean?

Answer 9

The burden of physical or mental distress

Question 10

What is an important thought to keep in mind regarding autonomy?

Answer 10

“Treat persons as autonomous rational beings who have their own purposes and never as a mere means to reaching your own purposes.”

Question 11

What is the first and most important implication of respect for autonomy in health care?

Answer 11

The duty to obtain Informed Consent

Question 12

What is informed consent?

Answer 12

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

Question 13

Is informed consent an ongoing process?

Answer 13

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

Question 14

What are the 3 conditions that must be met for patients to give informed consent?

Answer 14

(1) Information
(2) Voluntariness
(3) Competence

Question 15

8 Things one must provide to patients seeking informed consent

Answer 15

(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

Question 16

What are some examples of relevant information?

Answer 16

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.

Question 17

Explain the second condition of informed consent (Voluntariness)

Answer 17

This is the patient’s ability to make a decision without being coerced, pressured, or deceived

Question 18

Explain the first condition of informed consent that patients must be given relevant information

Answer 18

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.

Question 19

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?

Answer 19

The patient

Question 20

2 ways legally competency determined?

Answer 20

(1) Adults (18 yrs or older) are presumed legally competent until the courts declare otherwise
(2) Cognitive testing/assessment may become necessary

Question 21

Explain the third condition of informed consent (Competence)

Answer 21

This means that the patients must be sufficiently rational or competent to understand and make health-care decisions

Question 22

Why is informed consent important?

Answer 22

It signifies that patient isn’t being coerced into any course of action
It also enforces the ‘implicit’ rule of the relationship

Question 23

What is the ‘implicit’ rule?

Answer 23

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)

Question 24

When is competence assessed?

Answer 24

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)

Question 25

What are the 3 standards for determining competency?

Answer 25

(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

Question 26

What are the to conditions when non-compliance of guardian decision is permitted?

Answer 26

(1) When the care would be contrary to accepted standards

(2) When the directive conflicts with the conscience of the health-care provider

Question 27

3 Degrees of competency

Answer 27

(1) Emerging Competency of a Child
(2) Limited Competency
(3) Intermittent Competency

Question 28

What is limited competency?

Answer 28

An adult may be completely competent in ADLs but their decision making may be altered therefore they are considered incompetent

Question 29

What is intermittent competency?

Answer 29

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.

Question 30

When does presumed consent come into play?

Answer 30

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)

Question 31

What is beneficence?

Answer 31

The moral requirement to promote the well-being of patients

Question 32

How Will Informed Consent Affect Your Student Clinical Experience?

Answer 32

Always tell your patients that you are a SPT