WEEK 8 Flashcards
Who should decisions be made by?
Those whose life the decision impacts most
What is the foundation of consent?
Decision making
What are the three basic phases of decision making?
1) Gathering information
2) Recalling and pooling that information
3) Weighing things up
How may the quality of your decision making be adversely affected?
1) You aren’t competent to make it
2) You were coerced, or put under pressure to make the decision
3) You were deceived, or had information concealed from you
What are the fundamentals to patients’ decision making?
They must decide whether or not to go ahead with all stages of the medical process and it should be viewed as a joint enterprise between Pt and Dr
Where is consent derived from?
Patient autonomy as it is the ability to live according to our own beliefs/values
What is self-determination theory?
A theory dealing with human motivation, linking well-being, satisfaction and performance to autonomy, competence and relatedness
What is the role of the doctor in patients’ decision making?
To aid the patient to make the best choice possible
Define ‘benevolent concealment’
Where medical paternalism was more prominent, even to the point of lying or deceiving patients
What has been the shift in decision making with relation to autonomy and beneficence?
Advent of humanism resulted in the shift away from ‘benevolent concealment’ to autonomy
Define humanism
The belief that each individual creates their own set of ethics
Summarise the GMC’s definition on the 7 key principles of consent
1) Patients have right to be involved and supported in decisions
2) Decision making is an ongoing process focused on meaningful dialogue
3) Patients have right to be listened to and given relevant information for decisions, along with time and support
4) Doctors must try to find out what matters to patients so information given is more specific
5) Doctors must start from presumption that all adult patients have capacity to make decisions
6) Choice of treatment/care for those without capacity must be of overall benefit to them
7) Patient whose right to consent is affected by law should be involved in decision-making process
What is the shift in the Dr-Pt decision-making process?
Dr=Active, Pt=Passive to Dr=Facilitator, Pt=Active/Participant
What did the Sidway vs Bethlem Royal Hospital Governers 1985 case highlight?
The duty to provide enough information for patients to make a balanced decision (eg. alternative treatments and ‘common or serious’ consequences)
What dictates how much information is given to patients?
What it is you’re proposing to do and how much information they want
Give two cases where the need to provide enough information to patients was highlighted
Sidway vs Bethlem Royal Hospital Governers 1985 (risk of paralysis not explained before trapped nerve operation)
Montgomery vs Lanarkshire 2015 (risk of shoulder dystocia not explained, baby with cerebral palsy)
What is the test of risk 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 this risk
What is the GMC guidance about giving patients information?
Must give clear, accurate and up-to-date information based on the best and most recent evidence about: benefits/risks for each option and option to take no action
What is a principle of consent?
That it is dynamic
When is consent not valid?
When it expires (consent is dynamic)
If certain conditions aren’t met or it was given in the wrong way
What 3 decision-making rules must apply for consent to be valid?
1) Voluntary (not coerced)
2) Informed (adequate information)
3) Patient must be competent to make it
In which situations is gaining consent not necessary?
1) Emergency treatment or unconscious/otherwise incapacitated patient
2) Urgent MH treatment under the MH act
What is the ‘therapeutic exception’ to consent?
Where it’s conceivable that obtaining informed consent would cause ‘significant psychological harm’ (not in patient’s best interests)
How would you act when gaining consent cannot be achieved due to the patient being unconscious/otherwise incapacitated patient?
Act in the patient’s best interest or what they would want (eg. advanced directive)
What is capacity?
How able someone is to consent to treatment/care
What is capacity a pre-requisite of?
Autonomy