Lecture 4B - Autonomy, Competence, Consent

Question 1

Which of the three approaches to disclosure do Canadian laws (Reibl v. Hughes test) reflect?

Answer 1

A combination of the reasonable person test and the subjective standard.

Question 2

What is the ethical status of a waiver of consent?

Answer 2

An ignorant consent is ethically valid, if the patient is competent.

Question 3

Therapeutic privilege

Answer 3

Withholding information on the grounds it will harm the patient.

Question 4

What is a problem with the subjective standard?

Answer 4

It puts a huge burden on the HCP.

Question 5

What are two examples of controversial exceptions to informed consent?

Answer 5

Therapeutic privilege and the use of placebos.

Question 6

Is therapeutic privilege ethical?

Answer 6

It is not ethical.

Question 7

Coercion

Answer 7

A specific type of undue influence, involving a threat that violates someone’s rights and reduces their options unacceptably.

Question 8

Reibl v. Hughes test is also called the…

Answer 8

Modified reasonable person test

Question 9

What are three approaches to disclosure?

Answer 9

The reasonable person test.
The professional standard.
The subjective standard.

Question 10

Undue influence

Answer 10

Any improper effort to interfere with autonomous choice.

Question 11

Waiver of consent

Answer 11

A voluntary request to forgo one of the elements of disclosure.

Question 12

4 varieties of undue influence

Answer 12

1. Physical restraint
2. Coercion
3. Manipulation
4. Exploitation

Question 13

How would strong paternalism deal with truth-telling for competent and incompetent patients?

Answer 13

Lying and withholding information are permissible sometimes for both competent and incompetent patients.

Question 14

Is therapeutic privilege legal?

Answer 14

Status is very doubtful.

Question 15

Special risks

Answer 15

Possible unusual risks,which in a particular case, have the potential for serious consequences if they occur (and hence would influence a decision).

Question 16

Material risks

Answer 16

Risks that would influence a patient’s decision.

Question 17

The professional standard

Answer 17

HCP must disclose information that a person in the patient’s circumstances would require to make an informed decision.

Question 18

Guidelines for risk disclosure

Answer 18

1. If potential for harm is great and probability is high, risk must be disclosed.
2. If potential for harm is minor but probability is high, risk must be disclosed.
3. If potential for harm is minor and probability is low, risk need not be disclosed.

Question 19

Subjective standard

Answer 19

HCP must disclose information that a person in the patient’s circumstances would require to make an informed decision.

Question 20

What approach to disclosure is the best?

Answer 20

The subjective standard.

Question 21

Law regarding waivers of consent

Answer 21

No clear law or common law.

Question 22

How would weak paternalism deal with truth-telling for competent and incompetent patients?

Answer 22

Never lie to competent or incompetent patients; it is permissible to without information sometimes to incompetent patients.

Question 23

The reasonable person (objective test)

Answer 23

HCP must disclose information that a reasonable person would require to make an informed decision.

Question 24

Supreme Court of Canada standard for disclosure (a.k.a. Reibl v. Hughes test)

Answer 24

HCP must disclose information a reasonable person in the patient’s position would need in order to make an informed decision.

Question 25

BC Health Care Consent law

Answer 25

The health care provider must give the adult the information a reasonable person would require to understand the proposed health care.

Question 26

When is it acceptable to act without informed consent?

Answer 26

In some emergencies. If the patient is in a life-threatening emergency that requires immediate treatment. If the patient cannot take part in meaningful consent procedures. If there is no time to seek substituted consent.

Question 27

Information disclosure in BC specifically requires provision of information about:

Answer 27

The condition for which the health care is proposed. The nature of the proposed health care. The risks and benefits of the proposed health care that a reasonable person would expect to be told about. And permits the adult the opportunity to ask questions and receive answers about the proposed health care.

Question 28

What are reasons for confidentiality in health care settings?

Answer 28

1. Effective provision of health care.

2. Right to privacy: information given can only be used for the purpose for which it was disclosed.