INFORMED CONSENT

What is informed consent?

the process through which a patient is provided with enough information to make an informed, reasoned decision regarding the proposed treatment

T or F: Informed consent is a shared decision-making process

T

What are the two components to informed consent

Discussion and documentation

What underlying ethical principle is involved in informed consent?

Autonomy

What is paternalism and how is this concept related to informed consent?

Where the dentist makes the choices for the patient in an effort to honor beneficence

Paternalism has been replaced with a partnership where the dentist and patient both take responsibility for a good outcome (Informed consent lays the foundation for this partnership)

What are the benefits of informed consent?

Fosters _____ and _____ with patients

Patients are active participants in _____ decisions and thus are more _______

Helps avoid _____ ; patients know ______ and _____

It relieves dentists of the burden of ______ for the patient

rapport and partnership

treatment - compliant.

litigation - risks and benefits

decision-making

What historical movements led to the primacy of autonomous choices in health care? (3)

Consumer rights/Civil rights movement

Preventive dentistry and more choices/outcomes in dentistry.

Greater understanding and interest in ethical choices

Five Favors Needed for Informed Consent

Competence

Disclosure

Comprehensive

Voluntary

Patient Authorization/Decision

Patients must have capacity to make health care decisions

Competence

What is disclosure

Dentist must provide the information

The nature of the proposed treatment

Any reasonable alternatives to proposed treatment.

The risks, benefits, prognosis and potential complications of treatment

The patient must not only have the ability to understand but must actually understand

Comprehension

There must be no deception, coercion, or manipulation

Voluntary

Capacities needed for decision making:

Being able to _____ a choice

Understanding ______ relevant to the choice

Appreciating the ________ of the information/choice for your own future

Having the ability to foresee possible ____ ____

Having a consistent set of ____ or _____ to act on.

Being able to reason so that you can weigh the different _____ and ____

Express

information

significance

future outcomes

values or preferences

choices and consequences

A legal designation that is determined exclusively within the legal system

Competence

A clinical concept assessed within the health care system

Decision Making Capacity

What is informed refusal

Requires the practitioner to respect patient choices that are contrary to the practitioner's recommendation

T or F: You should document informed refusal in writing as you would with informed consent

T

What obligations does a practitioner have when a patient refuses treatment?

Must inform patient of the consequences of not proceeding with your recommendation

Re-educate the patient

What is surrogate decision making? When is it necessary?

Used when patients cannot make decisions for themselves (cognitively incompetent)

Brings in a third body decision maker

Guidelines used when patient is unable to make decisiosn about their medical or dental care

Substituded Judgement (Advanced directives --> living will or power of attorney)

End of life decisions in writing with no person named specifically to make decisions for a patient

Living will

The naming of a specific person to make healthcare decisions for a patient when they cannot

Power of attorney

When does power of attorney go into effect

when two physicians or a physician and psychologist agree in writing that a patient is no longer able to understand their medical choices, express their wishes or make choices

What conditions would "best interest principle" be evoked?

When substituted judgement cannot be used (no evidence as to what the patient would have wanted because they could not make decisions in the first place)

Who is the best interest principle apply to

minors and those with disabilities from birth

T or F: What is in the patient's best interest may not necessarily be what the patient would have chosen for themselves

T

Is there ever a situation where informed consent is not necessary

Yes -Emergency -> A reasonable person would grant consent for treatment to save his or her life to reduce injury

Can a health care provider override a parent's choice for their child?

ONLY in case of EXTREME emergency can health care providers act against parents wishes without court order

Warning signs of decisional incapacity:

Questionable _____

_____ questions

Unstable _____

Unexplainable _____ and ____

Being easily _____

decision

Repeated

decisions

misunderstandings and anger

overwhelmed

What is informed assent and how is it different from informed consent?

Honoring the autonomy in children

Children do not have full autonomy, but one day they will

Informed assent teaches children how to reason about the decisions they will need to make as adult

Builds their capacity so one day the child will become an autonomous decision maker

What is an emancipated minor?

Legal mechanism by which a person below the legal age of majority gains certain rights, generally identical to those of adults

Free from authority of his/her parent or other legal guardian

Does wisconsin have a stand alone emancipated minor statute?

NO