Legal & Ethical Concerns Flashcards
What is the health care consent act?
- Promoted individual authority and autonomy
- facilitates communication between health practitioners and clients
- ensure role for family members if client is incapable of giving consent
- ensures HCP’s have no authority to make treatment decisions on client’s behalf (outside of emergencies)
When are nurses accountable for obtaining consent from patients?
- admission
- treatment
- personal support services
Who can give consent?
- capable patient
- substitute decision maker of a patient not capable
- in emergency when no SDM available, no consent required
What are forms of consent?
Verbal, written, implied
Is there a age limit for consent?
No age limit, do not need to be 16 years old
Can consent be withdrawn?
Yes, at any time
When should nurses not proceed?
If there is any doubt about whether the client understands and is capable of consenting
What information does a patient need to make an informed decision?
- nature of treatment
- expected benefits and risks
- expected side effects
- alternative courses of action
- likely consequences of not having the treatment
What do SDM’s do?
Make decisions for patient relevant to their wishes. If their wishes are not known, SDM makes decisions in the best interest of the patient
Hierarchy of SDM
- guardian of person
- Someone who has been named as an attorney for personal care
- Some appointed as a representative by the CCB
- Spouse or partner, child if 16 or older, custodial parent, relative, brother or sister
- PGT
What is autonomy?
Personal freedom to direct one’s own life as long as it does not infringe on rights of others
What is competency?
- Ability to manage one’s affair overall, in a responsible matter
- ability to make decisions
- adults (18+) are presumed to be competent
What does the judge do if someone is deemed incompetent?
Assigns either partial or full guardianship to a designated person
What does capacity mean?
Ability to understand, make, and be responsible for the consequences of health care decisions
Who determines one’s capacity?
Health care providers
What does decision making capacity require?
- ability to understand consequences of refusing or consenting
- ability to understand info relevant to make a decision about an admission, treatment, or personal assistance services
Is capacity based on age or diagnosis?
No, assessed situationally
What is advanced care planning?
Legal documents that allow individuals to outline preferences for medical care if they become unable to communicate decisions and will often choose a SDM
Is advanced care plan consent? Are wishes decisions?
No, not consent or decisions.
Therefore patients cannot provide future consent for treatments
How does ACP work?
Select SDM or appoint a power of attorney
Patient should then communicate their wishes for future care to SDM or HCP’s
Benefits of ACP?
- improve quality of end of life care
- supports substitute decision makers in a difficult time
- may reduce health care costs with reduced unwanted treatment
Barriers of ACP?
- patient not informed, encouraged, supported to start conversation
- patient fear of talking about death, fear of family conflict, low health literacy
- HCP lack of education and patience; rushing client to make decisions
How do nurses support older adults with ACP?
- Think
- Learn
- Decide
- Communicate
- Documentation
What is advanced directives?
Legal documents that allow competent older adults to document medical care they would or would not want to receive
What is advanced directives? What are the things it contains?
Legal documents that allow competent older adults to document medical care they would or would not want to receive
- DNR
- Preferences
- power of attorney/SDM
- living will
what is a DNR order?
Specific type of advance directive that compels health care providers to refrain from CPR if there is no heartbeat or breathing
What is client does not have document for DNR upon admission or with a changing health status?
Client will be asked to provide consent or refuse consent in an event CPR is needed
What are living wills?
Also type of advance directive. Outlines person’s preferences for refusing or receiving a broad range of health treatments in the future, should they become incapacitated, unconscious, terminal illness, or end of life
Can living wills be changed?
Yes, and can be revoked at any time
What are Physician Orders for Life Sustaining Treatment directives? POLST
Medical directives that a health care provider fills out for an individual and signs. It’s used for emergency situations and has clear instructions for health care provides to follow without interpretation
What is the Bill of Rights for residents in LTC?
Outlines rights and protections for individuals living in LTC’s
