Radon 119 - Ch.4 "Patient Autonomy and Informed Consent"

who is responsible for Informed Consent

-physician is ultimately responsible for the informed consent process

-Radiation therapy/Imaging professionals may be required to witness the signing of a written informed consent form

Competence

the ability to do something successfully or efficiently

Surrogate

-a person who may be involved in the determination of competence and in the informed consent process

Possible Surrogates (3)

Parent

Individual named by the patient while competent

Person or persons appointed by the courts

Autonomy

-one human person precisely as a human person dares not have the authority and should not have power over another human person

Seven points that enable the imaging/radiation therapy professional to maintain a respect for autonomy (7)

1) Is the patient mentally capable and legally competent? Is there any evidence of incapacity that would affect the radiation therapy/imaging procedure?

2) If the radiation therapy/imaging patient is competent, has the patient expressed any preferences for the imaging procedure?

3) Does the RT/imaging patient understand the benefits and risks, and has he or she given consent?

4) If the patient is in need of a surrogate, is he or she using the appropriate standards for decision making?

5) Has the patient expressed prior preferences?

6) If the patient is unable or unwilling to cooperate with the imaging procedure, is there a specific reason?

7) Is the patient's right to choose being respected to the extent possible both ethically and legally?

Therapeutic Privilege

health care providers withhold information from a patient because they believe the information would have adverse effects on the patient's conditions or health

Emergency Exception

-situations in which informed consent may have to be abandoned to save the patient's life.

Emergency situations must meet the following criteria: (3)

1) The patient must be incapable of giving consent and no lawful surrogate is available.

2) Danger to life or risk of serious impairment to health is apparent.

3) Immediate treatment is necessary to avert these dangers

Obstacles to Autonomy and Informed Consent

Surrogates

Undue influences

Linguistic and cultural barriers

Lack of time

Lack of communication

Health care providers: may assume they know what is best for the patient

The Patient Care Partnership (document)

- document is to be given to patients whenever they are hospitalized.

-help patients understand the expectations, rights, and responsibilities regarding their health care

4 Rules to guide Provider in explaining information to patients:

1. Patient Preference rule

2. Professional custom rule

3. Prudent person rule

4. Subjective substantial disclosure rule

Patient Preference Rule

requires professionals to tell patients what they want to know

Professional Custom rule

Provides the information normally given to patients

Prudent person rule

measures the physician's disclosure to the patient based on the patient's need for information to make decisions regarding treatment.

Subjective Substantial disclosure rule

requires the physician to communicate meaningfully with the patient.

Possible outcomes of failing to obtain consent

allegations of assault, battery, false imprisonment, and negligence

intentional Tort

wrongs resulting from acts done with the intention of causing harm to another.

Unintentional tort

wrongs resulting from actions that were not intended to cause harm

Assault

deliberate act wherein one person threatens to harm another person without consent and the victim perceives that the other has the ability to carry out the threat

Battery

-touching to which the victim has not consented, even if the touching may benefit the patient.

Medical Immobilization

includes mechanisms usually and customarily applied during diagnostic and therapeutic procedures and is considered a regular and usual part of such procedures and based on standard practice.

False Imprisonment

when a person is unlawfully confined within a fixed area. The confined person must be aware of the confinement or must be harmed by the confinement

Items included on consent form (5)

1) Name of the procedure

2) Brief explanation of the procedure with benefits and risks

3) Spaces for patient's name and name of the physician

4) Signature lines for patient or surrogate, the physician explaining the procedure, and at least one witness

5) Date and time

Can a consent form be used in place of an oral explanation

NEVER

Advance Directives

A predetermined (usually written) choice made to inform others of the ways in which the patient wishes to be treated while incompetent. Also, a living will that contains written instructions for future health care.