Week 6 Flashcards
Autonomy
The idea that a patient must give consent to a treatment derives directly from the notion of patient autonomy
Autonomy takes roots from humanism
-ownership of self
-a person has the right to determine their experiences
-persons should not be made to do things against their will or interests
-a person should not trespass on the person of another
Self determination, personhood, identity, integrity
Autonomy definition
The ability to define the self through one’s choices
Ability to live according to our own values and beliefs
Patients have absolute right to make their own decisions about treatment
The self determination theory
Deals with human motivation and links wellbeing, satisfaction, and performance to autonomy, competence and relatedness
The legal basis
Duty to provide enough info for the patient to make a balanced judgement
Should provide alternatives
Should inform of ‘common or serious’ consequences
What is a material risk
The test of materiality:
-whether a reasonable person in the patient’s position would attach significance to the risk or
-if the doctor knows that this particular patient would attach significance to the risk
GMC guidance on sharing info
Recognised risks of harms that you believe anyone in patient’s position would want to know
The effects of the patients individual clinical circumstances on the probability of a benefit or harm occurring
Risks of harm and potential benefits that this patient would consider significant for any reason
Any risk of serious harm, however unlikely it is to occur
Expected harms , including common side effects and what to do if they occur
Is consent always necessary
Sometimes doctor will use concept of implied consent however you should never assume patient understands what you’re about to do
Some situations you can’t get consent and cannot postpone until you can: e.g. emergency treatment of an unconscious or otherwise incapacitated patient, urgent mental health treatment under mental health act
In these situations you should act in the patients best interests
If you have info about what they would want in this situation use this
Is consent always valid
Consent can expire- over long time or if situation changes
Consent can also be invalid if certain conditions weren’t met or if it was given the wrong way
For consent to be valid:
Voluntary
Informed
Patient must be competent
Coercion undermines autonomy
If a decision is unduly influenced by someone else it is not truly that of the patient
If they’re only consenting to the treatment under duress the consent may be invalid
How does Beauchamp and Childress 1994 describe coercion.
“Coercion … occurs if and only if one person intentionally uses a credible and severe threat of harm or force to control another”
Medical coercion
This depends on whether the info is accurate and whether it can be confidently known
If its an exaggeration to persuade the patient to take doctors preferred treatment option its a form of medical coercion
Undue influence
Not a threat but persuasion
Parental consent
Those with parental responsibility can consent on behalf of children who have not yet achieved competence
Mothers have parental responsibility for any children they’ve given birth to
Fathers have parental responsibility if they’re named on birth certificate or are married to child’s mother
Fathers can also apply for parental responsibility through courts
Adoptive parents gain legal parental responsibility
Social care authorities can also have parental responsibility for children
Parental refusal
Generally only one parent needs to provide consent for a child’s medical treatment don’t need both to be present
One parent cannot veto a treatment they disagree with if other parent provides consent
Doctors discouraged from going against expressed wishes of a parent especially if there’s no clear benefit for child
If both parents refuse treatment and medical team believe treatment is in child’s best interests the team can apply to courts to provide consent
Children’s act 1989
Duty to maintain the child’s welfare as paramount
