Lecture 4A - Autonomy, Competence, Consent Flashcards
Is competence assessed for specific decisions or all decisions?
Specific decisions.
In the phrase “Competence is the ability to understand and to appreciate the consequences of treatment and non-treatment,” what does “understand” mean?
The ability to explain nature and consequences of treatment and non-treatment.
What is the legal order of substitute decision makers?
- Personal guardians
- Representatives
- Advanced directives
- Temporary substitute decision makers
What are the problems with the phrase: “Competence is the ability to understand and to appreciate the consequences of treatment and non-treatment.”
There is a concern that people won’t be taken seriously if they don’t personally really value their own choices. It’s too paternalistic. Often, people haven’t even thought about their own values. It leaves a potential for uncertainty.
In BC, competent children can accept or refuse what kind of treatments?
Treatments that have been offered to them, and that the HCP believes are in the best interest of the minor.
Competence
The capacity to make an autonomous decision.
What does BC law use to test competence?
It appears to use an understanding test, but it can be interpreted as an understanding and appreciation test.
What is the legal test to assess competence in practice?
Test if the patient can explain the information in their own words.
Are competence laws in BC the same for children and adults?
No. Laws for children are more restrictive than laws for adults.
Four elements of valid informed consent
- Competence
- Full disclosure of relevant information
- Voluntariness
- Consent
What is a “personal guardian”?
A court appointed guardian under the Patient’s Property Act.
What is the age of consent in BC that established legal competence to make medical decisions?
There is no definite “age of consent”. Competent children of any age have full adult medical decision-making powers (with some exceptions).
In BC, what is the presumption regarding competence in children?
All children are presumed competent to make medical decisions.
If a patient is incompetent, but competence can be restored in a timely way, who gets to decide?
First restore competence and let the patient decides.
How do you begin the consent process?
By identifying the decision maker.
How high should the standard for competence be?
It’s can’t be too high and it can’t be “perfectly rational.” It can’t be too demanding or the value of autonomy will be uninteresting.
If a patient is incompetent, and competence cannot be restored in a timely way, who gets to decide?
Surrogate decides based on what the patient wants.
What does “section 19” say in the Health Care and Care Facility Act?
In your best judgement, make the choice the patient would make.
In the phrase “Competence is the ability to understand and to appreciate the consequences of treatment and non-treatment,” what does “appreciate” mean?
The ability to relate a decision to one’s own values.
What does Ontario law use to test competence?
The understanding and appreciation test.
What is an alternative (to the legal) test to assess competence in practice?
Use a sliding scale of evidence of competence - as the risk associated with the decision increases, evidence of competence must increase as well.
In BC, what is the presumption regarding competence?
That all patients are competent unless found to be incompetent.
How often does incompetent status need to be reviewed?
It needs to be continually reviewed.
Is consent a single datable event, or an ongoing process?
It’s an ongoing process.
Informed consent
An autonomous decision
Is evident of competence direct or indirect.
Indirect.
Weak paternalism requires a theory of ___ and ___ to respect patients’ dignity regarding decisions around their care and treatment.
Weak paternalism requires a theory of competence and informed consent to respect patients’ dignity regarding decisions around their care and treatment.
Who decides if the patient is competent?
The patient decides.
To what extent must HCPs and substitute decision makers consult and involve incompetent patients in decision-making?
To the greatest extent possible.
What does an advance directive do?
It provides consent to or refusal of health care by the capable adult to a HCP.
