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Medical ethics > Week 4 > Flashcards

Week 4 Flashcards

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USMLE® Step 1 flashcards
1
Q

What is consent?

A
  • CONSENT IS THE PERMISSION TO DO SOMETHING
  • ‘patient’s voluntary agreement to treatment,
    examination or other aspects of health care’.
  • Consent is the ethical cornerstone of all medical
    interventions
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2
Q

What does a doctor-patient relationship contain?

A
  • Respect of patient autonomy
  • Primacy of consent
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3
Q

The main ideas of WMA DECLARATION ON THE RIGHTS OF THE PATIENTS

A

Right to self-determination
Consent and patient rights

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4
Q

What is informed consent?

A
  • the term ‘consent’ implies waiving our rights and permitting
    others to do things that they would otherwise not be
    allowed to do
  • The concept of informed consent in medicine applies
    equally to
  • acceptance of treatment,
  • choice among possible treatments
  • refusal of treatment
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5
Q

What is informed/ valid consent?

A

For consent to be valid it should be
* Given by a patient who has capacity to make decisions about his
or her care
* Voluntary, that is free from pressure, coercion or persuasion
* Sufficiently informed
*Additional component: For consent to be valid it should also be
Continuous
1) the patient should be informed that they can change their
mind at any time
2) should be repeatedly gained in the course of the
consultation in relation to specific procedures, i.e. physical
examination or blood examinations

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6
Q

What are the three requirements for informed/ valid consent?

A
  1. Competence
  2. Voluntariness
  3. Information
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7
Q

What is the information the patient needs before making a decision?

A
  • Procedure (what it is for, what it entails, what it will feel like,
    nature and purpose)
  • Alternatives (including nothing)
  • Risks (of the procedure/treatment, including risks of doing
    nothing) and Benefits
  • Questions (including checking patient’s understanding)
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8
Q

What does professional guidance include?

A
  • Clear, accurate information about the RISKS
  • presented in a way patients can understand.
  • identify the adverse outcomes
  • potential outcome of taking no action.
  • Risks can take a number of forms, but usually:
  • a side effects
  • b complications
  • c failure of an intervention to
    achieve the desired aim
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9
Q

What is the information needed by the patient according to GMC Guidance?

A

a) the diagnosis and prognosis
b) any uncertainties about the diagnosis or prognosis, including
options for further investigations
c) options for treating or managing the condition, including the
option not to treat
d) the purpose of any proposed investigation or treatment and
what it will involve
e) the potential benefits, risks and burdens, and the likelihood of
success, for each option; this should include information, if
available, about whether the benefits or risks are affected by
which organisation or doctor is chosen to provide care
f) whether a proposed investigation or treatment is part of a
research programme or is an innovative treatment designed
specifically for their benefitg) the people who will be mainly responsible for and
involved in their care, what their roles are, and to what
extent students may be involved
h) their right to refuse to take part in teaching or research
i) their right to seek a second opinion
j) any bills they will have to pay
k) any conflicts of interest that you, or your organisation,
may have
l) any treatments that you believe have greater potential
benefit for the patient than those you or your organisation
can offer

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10
Q

What are the types of consent?

A
  • Consent may be explicit or implied.
  • Explicit (also known as express) consent is given when a patient
    actively agrees to the use or disclosure of information
  • Expressed verbal consent
  • Written consent
  • Implied consent refers to circumstances in which it would be
    reasonable to infer that the patient agrees to the use of the
    information, even though this has not been directly expressed.
    ➢Consent need not be written but documentation may provide
    evidence of the consent process
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11
Q

What legal frameworks of human rights should be considered?

A
  • UN Declaration of Human Rights
  • National Legislation
  • UK - The Human Rights Act 1998
    Including the rights to
  • life
  • be free from inhuman or degrading treatment
  • (respect for) privacy and family life
  • freedom of expression
  • be free from discriminatory practice
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12
Q

What is neglecting to take consent?

A
  • breach of rights,
  • Disrespect of Autonomy
  • Non treating patient with Dignity
  • Anti-professional behavior; Not following legal and
    professional guidance
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13
Q

How can you respect patient’s autonomy?

A
  1. PRECONDITIONS
    * Competence/ability to understand and decide
    * Voluntariness in deciding
  2. INFORMATION
    * Disclosure of information
    * Recommendation of a plan
    * Understanding of information and plan
  3. CONSENT
    * Decision (in favor of a plan)
    * Authorization (of the chosen plan)
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14
Q

What are the benefits of consent?

A
  • Consent has therapeutic power and critical impact on care
  • manifestation of ethical care in which people are recognised as
    individuals with own priorities, anxieties, perspectives
  • more control over their care
  • more realistic expectations
  • more cooperative
  • establish a relationship of trust
  • respect and recognition of the value of the human person, etc
  • Consent and the ways in which people approach it may vary
  • the constant remains the commitment on the part of
    professional and patient
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15
Q

Exceptions to the requirement for informed consent?

A
  1. Situations where patients voluntarily give over their
    decision-making authority to the physician or to a third
    party.
    This may be because of
    * the complexity of the matter
    * or because the patient has complete confidence in
    the physician’s judgement
    * or on the basis of cultural ideologies.
  2. Instances where the disclosure of information would cause
    harm to the patient
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16
Q

What is therapeutic privilege?

A
  • Allows physicians to withhold medical information if disclosure
    would be likely to result in serious physical, psychological or
    emotional harm to the patient,
  • for example, if the patient would be likely to commit suicide if the
    diagnosis indicates a terminal illness.
  • physicians should make use this privilege only in extreme
    circumstances.
17
Q

Why would you withhold information?

A
  • You should not withhold information necessary for making
    decisions for any other reason, including when a relative,
    partner, friend or carer asks you to, unless you believe that
    giving it would cause the patient serious harm.
  • If you withhold information from the patient you must record
    your reason for doing so in the patient’s medical records, and
    you must be prepared to explain and justify your decision.
18
Q

When is consent not necessary?

A
  • in a medical emergency
  • ‘Doctrine of necessity’ used
19
Q

What is capacity?

A
  • Capacity is a legal concept not a medical concept
  • THE ABILITY TO GIVE PERMISSION TO HAVE TREATMENT
  • OR TO WITHHOLD PERMISSION AND REFUSE TREATMENT
  • All choices and decision-making in a clinical context flow from
    assessment of capacity
  • Forms part of consent (competence)
20
Q

What does the WMA Declaration of Patient Rights say about consent?

A
  • If the patient is unconscious or otherwise unable to express his/her will,
    informed consent must be obtained, whenever possible, from a legally
    entitled representative.
  • If a legally entitled representative is not available, but a medical
    intervention is urgently needed, consent of the patient may be presumed
  • unless patient’s previous firm expression or conviction that he/she would
    refuse consent
21
Q

What are the principles of the UK Law regarding capacity?

A

❑Every adult has the right to make his/her own decisions and to
be assumed to have capacity unless proven otherwise
❑ Everyone should be encouraged and enabled to make decisions
or participate in decision-making
❑ This includes people’s right to make apparently eccentric or
unwise decisions
❑ Proxy decisions should be made in the patient’s best interests
❑ Proxy decisions should be “the least restrictive of basic rights
and freedoms”

22
Q

What does the Mental Capacity Act say the patient withy capacity should be able to do?

A
  • Understand (the information relevant to the decision)
  • Retain (the information)
  • Use or weigh (the information as part of decision-making process)
  • Communicate (his/her devision whether orally, in written, using sign language or other form)
23
Q

Why is capacity a dynamic concept?

A

➢An individual’s capacity to make particular decisions may be
temporarily affected by factors such as pain, fear, confusion or
the effects of medication.
➢Assessment of capacity must be time and decision-specific.

24
Q

What should a patient with capacity be able to do?

A

❑ understand in simple language what the medical treatment is, its
nature and purpose and why it is being proposed;
❑ understand its principal, benefits, risks and alternatives;
❑ understand in broad terms the consequences of not receiving the
proposed treatment;
❑ retain the information for long enough to make an effective
decision;
❑ make a free choice

25
Q

What are special considerations for capacity?

A
  • Patients with mental illness
  • Elderly patients
  • Young people
26
Q

What is the link between capacity and children?

A
  • In many countries people need to 18 to consent to treatment
  • In some countries people can consent at an earlier age
  • Decisions on behalf of children are usually made by their parents or
    legally appointed person
27
Q

What should you do when an adult is not capacious?

A
  • Proxy decisions makers – legal representative
    -People can appoint someone to act as a proxy decision-maker
    for them in case they lose capacity
  • Advance decisions (living wills)
    -statements made by people at a time they have capacity, about
    how they want to be treated in the future if they were to lose
    the capacity
28
Q

How do you determine the patient’s best interest?

A

The concept involves taking into consideration
* Patient’s diagnosis and prognosis; medical benefit
ALSO exploring what’s best in terms of patient perspective
* patients’ past and present wishes and feelings (including any
written statements)
* information received from those who are significant in the
patient’s life and who could help in determining his or her best
interests;
* other factors, such as beliefs and values, aspects of the patient’s
culture and religion, that would influence a treatment decision.

Medical ethics (13 decks)

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