Week 4: Informed Consent Flashcards
Consent with a Capable Adult, Consent with a Minor, Consent with an Incapable Adult
Define Consent
permission given by a person to allow someone else to perform an act upon the person giving such permission
Define General Consent
consent needed for general things (ex: bedside skills, giving meds)
Define Specific Consent
consent needed for specific procedures (ex: surgery)
Define Informed Consent
a person’s agreement to allow medical action to happen (ex: surgery or invasive procedure)
based on full disclosure of the possible risks/benefits of the action, alternatives to the action, & the consequences of refusal
What are the elements of Informed Consent?
- Capacity to consent
- Information
- Voluntariness
Define Capacity
pt. MUST be capable of making an informed decision about the specific intervention suggested by understanding it all
Define the Information of Informed Consent
pt. MUST be given enough info about that specific intervention to make an informed decision
- Must understand risk & benefits; talk to pt. in a way they understand (no medical jargon, interpreter PRN) -
Define the Voluntariness of Informed Consent
decision MUST be voluntary & not the result of coercion, threat, or undue influence
What information is relevant in Informed Consent?
-Provide a reasonable amount of info relevant to the pt.
-Patient’s condition
-Purpose of intervention or proposed treatment Identity of those performing treatment *introduce HC team members - Explanations of alternatives
-Material risks – major &/or likely (side effects); risks of delaying surgery
-Consequences of not proceeding w/ the recommended treatment - Right to refuse
What is the nurses role in Informed Consent?
Nurses are often a witness. A witness confirms:
1. Signature belongs to the patient
2. Signature was voluntary – wasnt from coercion
What must the nurse do after being a witness to informed consent?
-Follow-up on any questions or concerns
-Raise any concerns about the person’s understanding or voluntariness
-Report concerns to surgeon if all 3 elements of informed consent aren’t met
Define Expressed Consent
*clearest form of consent
- Specific, expressed agreement to the offered intervention/procedure
- Can be verbal or in writing
Define Implied Consent
*determined by pt. behaviour (pt. doesn’t specifically say they approve, but actions do)
- Agreement is implied by non-verbal behavior, actions, no resistance or protest/inaction
Define Capacity
The degree to which a person can understand information relevant to a treatment decision; can vary over time and can depend on the situation
- Complex process that involves clinical judgement
- that is relevant, can they understand the consequences if they dont proceed
When is competency and capacity questioned?
- Questioned when a person’s choices are risky, unusual, or appear not to be in their best interests
- Assessed more frequently and thoroughly when decisions are higher risk
Or during life-and-death decisions or bigger interventions
Define Competency
-Considers whether a person’s mental condition affects their ability to realize the consequences of making a tx decision
-In MB, competency falls under the Manitoba Mental Health Act (MMHA)
Who determines incompetency?
Determination of incompetency is made by a physician & MUST be approved by a medical director of psychiatry
- Outside MB, some decisions are made by courts/judge
- Assessed when considering whether to intervene
What information should the PT be capable of understanding?
- Condition for which treatment is proposed
- Nature & purpose of proposed procedure or treatment
- Consequences (risks & benefits) of undergoing the procedure or treatment
- Consequences (risks & benefits) of not undergoing the procedure or treatment.
- Any alternatives available
How can nurses assess voluntariness?
-Observation of interactions & relationships
-Watch for nudging & coercion
-Careful attention to pts. body language & questions
-Speak w/ the pt. alone if needed to assess voluntariness *to be comfortable & able to express their concerns
What information do HCP NEED to provide for Incompetent Adults?
-Provide info to the level of which the pt. can understand
-Respect wishes when possible
-Protect dignity & privacy
-Offer as much choice as possible *even if deemed incompetent
oStill a responsibility for nurses to ensure the pt. still has rights to choose tx
-Get consent from a substitute decision-maker
What is a Substitute Decision Maker?
-A.K.A. proxy or surrogate decision-maker
-Speaks for the pt. ONLY when pt. can’t speak for themselves
-Knows the person & can represent their wishes
-Public Guardian & Trustee (PGT) can be appointed to make decisions on their behalf if:
oThere’s no family
oFamily doesn’t agree to act as the SDM
-Must follow instructions in valid Health Care Directive
What age are children able to provide consent?
Children can be capable of making decisions about their health BUT usually, parents provide consent for those < 16 y/o
The older & more capable the child, the more weight is placed on their values & wishes
Define the Mature Minor Rule
a minor who has the capacity to fully appreciate the nature & consequences of medical treatment & has the maturity to make their own decisions
Define Advance Care Planning
A way to help one think, talk, & share thoughts & wishes about their future health care.
-Gives pts. a “voice” in decision-making
-Helps determine who would communicate for them if unable to communicate for self
-Includes conversations w/ the healthcare team
