Informed Consent & Pt Rights

Question 1

What principles is the paternalistic model based on?

Answer 1

Beneficience “I know what is best for you”

Question 2

What are the 2 assumptions made by the paternalistic model?

Answer 2

• Professionals assumed to be competent & to protect patient’s best interests
• Pts ignorant of their bodies and medicine

Question 3

What is the new collegial or contractual model?

Answer 3

• Pts and providers are colleagues solving a common problem

- Based on mutual trust & confidence

Question 4

What ethical principle is the collegial or contractual model based on?

Answer 4

Autonomy

Question 5

What rights do patients have when significant decisions are to be made regarding their health and life in the collegial/ contractual model?

Answer 5

• Right to make decision and have control over their life

Question 6

What is informed consent?

Answer 6

Legal and ethical doctrine that seeks to protect patient’s right to greater freedom of choice that binds the practitioner to adequate disclosure & explanation of the treatment & the various options & consequences.

Question 7

What 3 ethical principles are represented by informed consent?

Answer 7

• Autonomy
• Beneficence
• Nonmaleficence

Question 8

What 3 legal principles are addressed by informed consent?

Answer 8

• Battery (touching without consent)
• Disclosure (information about what will happen)
• Fiduciary relationship (trust that you will watch out for what is best for patients)

Question 9

What are the 3 steps in the process of informed consent?

Answer 9

1. Disclosure of necessary elements (information)
2. Consent must be voluntary
3. Competent adult (or parent/ legal guardian)

Question 10

What 2 standards can be used to evaluate how much information should be disclosed to a patient?

Answer 10

Professional standard: What a reasonable professional would disclose
Reasonable person standard: What a reasonable person would want to know

Question 11

Which standard for evaluation of consent is more paternalistic? Which is more collaborative?

Answer 11

Paternalistic: Professional

Reasonable person: Collaborative

Question 12

How is the amount of competence of the patient required for informed consent measured?

Answer 12

Based on the consequences of the act

- Different levels for different decisions

Question 13

What are the 4 “tests” by Appelbaum & Grisso used to determine competence?

Answer 13

Ability to:

1. Communicate choices
2. Understand relevant information
3. Appreciate the situation and its consequences according to one’s own values
4. Reason about treatment options

Question 14

How did Gabard define competence?

Answer 14

• Sufficiently rational or competent to understand and make health-care decisions.

Question 15

How is competence judged legally in adults?

Answer 15

Adults are assumed to be competent until a court says otherwise

Question 16

When are courts more likely to become involved in informed consent cases?

Answer 16

Life-threatening or irreversible interventions

Question 17

What are the 2 types of incompetent patients?

Answer 17

a. Never competent (infants, children, severe mental disability)
b. Once were competent (organic brain disorder, adult psychosis, brain injury)

Question 18

What are the 3 legal standards for informed consent?

Answer 18

1. Pure autonomy: Prior written or verbal
2. Substituted judgement: projecting what the patient would want
3. Best interest standard

Question 19

Are inform consent federally or state regulated?

Answer 19

Regulate on a state-by-state basis

Question 20

Who may speak for incompetent patients?

Answer 20

Parents or legal guardians

Question 21

What may cause a parent’s competence to be challenged?

Answer 21

If they refuse emergency or life-saving treatment

Question 22

Who is responsible for obtaining informed consent from patients in a PT setting?

Answer 22

Only the physical therapist.

Question 23

According to the APTA, what must the patient/ legal guardian express before interventions are administered?

Answer 23

Understanding of the intervention, and also give consent to the intervention

Question 24

According to the Declaration of Principle on Informed Consent by the WCPT, what 6 items should be provided about an intervention to a competent adult?

Answer 24

• Description of treatment
• Clear explanation of the risks
• Expected benefits
• Anticipated time frame(s)
• Anticipated costs
• Reasonable alternatives

Question 25

What 4 recommendations did Banja and Wolf provide regarding informed consent forms?

Answer 25

Yes/no answers

• Signature on blanket consent form
• Notation/ entry of what was explained by the PT in the official record
• Consent checklist signed by the patient
• Verbal explanation/ verbal consent

Question 26

What 2 things give greater acknowledgement, acceptance and endorsement of patient rights?

Answer 26

• Informed consent

- Collegial model of health care delivery

Question 27

What 4 rights do patients have in regards to medical treatment?

Answer 27

• To be informed and give consent
• To leave the hospital against the advice of their doctors, unless they are a danger to others
• To no have extraordinary measures performed to save their life
• To appoint a legal representative to make informed decisions on their behalf if they should become incompetent

Question 28

What are 3 restraints are used on patients?

Answer 28

a. Physical/ mechanical
b. Chemical
c. Environmental