Informed Consent - Ethical and Legal Perspectives Flashcards

1
Q

name the 4 types of medical battery

A

4 types

  1. no consent to any procedure
  2. consent to a different procedure
  3. same procedure, different body part
  4. same procedure, same part, different doctor
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2
Q

define medical battery

A
  • intentional violation of patient’s right to direct their own medical treatments
  • main point of dispute: whether patient agreed to the treatment
  • no need to prove injury or negligence, but that medical personnel engaged in unauthorized touching, contact or handling of the victim
  • different from medical malpractice: negligence
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3
Q

describe the core complaint of informed consent

A
  • core complaint: physician failed to disclose information
  • legally actionable only if the physician had a duty to disclose that information
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4
Q

list the 5 elements of informed consent

A
  1. voluntarism
  2. capacity
  3. disclosure
  4. understanding
  5. authorization
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5
Q

describe how to explain informed consent to a patient

A
  • alternatives (one of which is doing nothing)
  • inherent risks associated with each alternative
    • probability
    • severity
  • who will be providing treatment and their roles
  • physician experience
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6
Q

the key to informed consent is to find a _____

A

the key to informed consent is to find a disclosure balance

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7
Q

define a reasonable patient

A
  • duty measured by what a hypothetical reasonable patient would deem material and significant in making a treatment decision
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8
Q

describe a reasonable physician

A
  • aka “professional standard” or “malpractice standard”
  • professional custom
  • if the custom is to not disclose –> no duty
  • what would a reasonable physician have disclosed under the same circumstances?
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9
Q

define the 3 related terms for capacity

A
  • competence: legal determination by a court that applies to all decisions
  • insanity: legal determination by a court in relation to criminal responsibility
  • capacity: clinical determination that is decision specific
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10
Q

define capacity

A
  • ability to understand, make a decision and communicate that decision
  • can fluctuate over time
  • is decision-specific
    • understanding the treatment regimen for a laceration (disinfect, stitches) vs. treatment regimen for testicular cancer
  • a clinical decision with legal consequences
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11
Q

if patient’s decision is not impaired by cognitive or volitional defect, physician must ______

A

if patient’s decision is not impaired by cognitive or volitional defect, physician must respect decision

  • otherwise, not honoring choice = paternalism
    • violation of patient autonomy
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12
Q

describe when a patient would lack capacity

A
  • all patient are presumed to have capacity until the presumption is rebutted
  • why would a patient lack capacity?
    • had at one point but lost (i.e. dementia)
    • not yet acquired (i.e. minors)
    • never had capacity (i.e. mental disability)
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13
Q

describe what happens during lack of capacity

A
  • if a patient cannot make decisions, a Substitute Decision Maker (SDM) is needed
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14
Q

describe the 3 options for SDM

A
  1. patient selects his/her SDM via advance directive (agent or durable power of attorney for health care - DPAHC)
    • someone they trust
    • knows their preference
    • cares about their welfare
  2. if no pre-specified agent or DPAHC, default priority list (surrogate, proxy)
    • sequence: agent/DPAHC > spouse > adult child > parent > adult sibling > adult grandchild/next closest relative
  3. if no pre-specified agent of DPAHC and no adult family member as court to appoint an SDM
    • “guardian”
    • “conservator”
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15
Q

describe the hierarchy in substitute decision making

A
  1. subjective
    • follow previous patient instructions addressing the situation, if available
  2. substituted judgement
    • do what the patient would decide to do
    • must know the patient well
  3. best interests
    • used if substituted judgement will not work because the SDM does not know the patient’s values and preferences
    • burden of treatment vs. benefits assessment
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16
Q

describe subsitute decisions for minors

A
  • SDM for minors are parents
    • consent of just one parent is sufficient
  • parent must act in the child’s best interest
  • parent cannot refuse life-saving treatment unless low chance of effectiveness and heavy burdens
17
Q

when are minors competent to consent?

A
  • emancipated minors:
    • must be > 13 years old
    • married or economic self-sufficiency
    • military service (from age 17) with no parental support
18
Q

which types of treatment are minor competent to consent?

A
  • contraception
  • STDs
  • pregnancy
  • mental health
  • alcohol and substance abuse
  • emergency/trauma
  • public health policy reason to allow consent
    • e.g. reportable communicable diseases
19
Q

describe detaining patients

A
  • physician can detain patients:
    • up to 48 hours
    • pending a court hearing
    • danger to self or others
  • detained patients only lose the right to leave: all other rights intact (e.g. consent/refuse treatment)
20
Q

name 2 scenarios for detaining a patient

A
  • infectious diseases of great peril (i.e. ebola, tuberculosis, measles)
  • mental health issues (i.e. danger to self or others)
21
Q

____ minors can consent in some states

A

“mature” minors can consent in some states

  • any treatment, including life sustaining treatment
  • minimum age for accepting a minor’s consent to treatment depends on the region
    • in NC, there is no age limit established in the law–the decision to accept a minor’s consent is based on physican’s conclusion about minor’s decisional capacity