Lecture 4B - Autonomy, Competence, Consent Flashcards
Which of the three approaches to disclosure do Canadian laws (Reibl v. Hughes test) reflect?
A combination of the reasonable person test and the subjective standard.
What is the ethical status of a waiver of consent?
An ignorant consent is ethically valid, if the patient is competent.
Therapeutic privilege
Withholding information on the grounds it will harm the patient.
What is a problem with the subjective standard?
It puts a huge burden on the HCP.
What are two examples of controversial exceptions to informed consent?
Therapeutic privilege and the use of placebos.
Is therapeutic privilege ethical?
It is not ethical.
Coercion
A specific type of undue influence, involving a threat that violates someone’s rights and reduces their options unacceptably.
Reibl v. Hughes test is also called the…
Modified reasonable person test
What are three approaches to disclosure?
The reasonable person test.
The professional standard.
The subjective standard.
Undue influence
Any improper effort to interfere with autonomous choice.
Waiver of consent
A voluntary request to forgo one of the elements of disclosure.
4 varieties of undue influence
- Physical restraint
- Coercion
- Manipulation
- Exploitation
How would strong paternalism deal with truth-telling for competent and incompetent patients?
Lying and withholding information are permissible sometimes for both competent and incompetent patients.
Is therapeutic privilege legal?
Status is very doubtful.
Special risks
Possible unusual risks,which in a particular case, have the potential for serious consequences if they occur (and hence would influence a decision).
Material risks
Risks that would influence a patient’s decision.
The professional standard
HCP must disclose information that a person in the patient’s circumstances would require to make an informed decision.
Guidelines for risk disclosure
- If potential for harm is great and probability is high, risk must be disclosed.
- If potential for harm is minor but probability is high, risk must be disclosed.
- If potential for harm is minor and probability is low, risk need not be disclosed.
Subjective standard
HCP must disclose information that a person in the patient’s circumstances would require to make an informed decision.
What approach to disclosure is the best?
The subjective standard.
Law regarding waivers of consent
No clear law or common law.
How would weak paternalism deal with truth-telling for competent and incompetent patients?
Never lie to competent or incompetent patients; it is permissible to without information sometimes to incompetent patients.
The reasonable person (objective test)
HCP must disclose information that a reasonable person would require to make an informed decision.
Supreme Court of Canada standard for disclosure (a.k.a. Reibl v. Hughes test)
HCP must disclose information a reasonable person in the patient’s position would need in order to make an informed decision.
BC Health Care Consent law
The health care provider must give the adult the information a reasonable person would require to understand the proposed health care.
When is it acceptable to act without informed consent?
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.
Information disclosure in BC specifically requires provision of information about:
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.
What are reasons for confidentiality in health care settings?
- Effective provision of health care.
2. Right to privacy: information given can only be used for the purpose for which it was disclosed.
