Topic 6: consent + capacity Flashcards
Why is respect for autonomy important?
- Satisfaction without choice not same as satisfaction because of choice
- Exposure to different choices = beneficial = individual knows whats truly best for them
- Persuading a particular decision not appropriate = may not align with how they live their life
What defects undermine individual autonomy?
- In an individual’s ability to control desires/actions
- In individual’s reasoning
- In information available to individual to base choice on
- In stability of own desires of individual
Define maximally autonomous decisions
- Doesn’t suffer defects
- If decision isn’t maximally autonomous = remove defects where possible
Define consent
- Autonomous actions by patients = authorizes professional to initiate medical plan
Types of consent in healthcare
1) Based on how consent is given
2) Based on patient involvement
3) Based on who gives consent
Give types of consent based on how it’s given
1) Implied = inferred through actions
- E.g. pulling sleeve up for blood draw
2) Explicit = clearly stated verbal/written
Given types of consent based on patient involvement
1) Informed = patient understands information provided
- E.g. risks + alternatives
2) Presumed = assumed unless opts out
- E.g. organ donationin some countries
3) Advance = given ahead of time for future care
- E.g. DNR
Give types of consent based on who gives it
1) Personal = given by patient
2) Proxy = given by legal representatives
What makes consent valid in healthcare?
- Voluntariness = decision made freely without coercion/pressure/influence
- Information = informed of risks + benefits + alternatives + consequences
- Understanding = understood by patient + retain = decide
- If ay of these are missing consent = invalid
How much information needs to be provided for informed consent?
- Description of procedure
- Possible risks
- Likely prognosis post procedure
- Discussionof side effects
- Alternatives
- Risks following resusal of procedure
How to make sure of the patient’s understanding?
- Teach-back method
- Have someone there involved with decision
- Interpreter/translator
- Give them time to make decision
Define capacity
- Person’s ability to understand + use info to make decisions
- Lack of capacity = mind impaired
- Adults presumed to have capacity unless evidence otherwise
- According to Mental Capacity Act = capacity is time specific
How is capacity assessed?
- Evaluate:
> Understanding
> Retention
> Use information
> Communication
Describe the capacity of young children
- Cannot make own healthcare decisions
- Guardian decides for them
- Decision only challenged if not meeting child’s best interest
Describe capacity of adolescents
- Some meet legal criteria for decision making
- Must be able to understand + retain + use information to make choice
- Assessing capacity is difficult = balancing parental authority + autonomy
Explain Gillick competence
- Child over 16 = consent to treatment without parental approval
- If refuse treatment = can be overruled by parents/court
- Gillick competent = mature enough to understand info/risk/benefits
Define advance directive
- Legal document where person outline healthcare preferences incase they lose capacity in future
- Specify what treatments they do/don’t want
Give the issues with an advance directive
- Limited foresight = cannot anticipate fully medical risks + new treatments
- Medical advances = make previous directives outdated + may have better outcomes
- Autonomy of treatment request = if advance directive requests treatment = doctors aren’t obligated to provide
- Conflict between past/present perspectives = should past decision precede current preference in distress
When is consent an exception?
- Emergency situation = necessary to save life
- Public health risk = infectious disease
- Mental health laws = pose risk to themselves or others
- Lack capacity/best interest
- Implied legal authority = safeguarding
- Therapeutic privilege = info disclosed would cause harm to well-being
