Module 4 - Autonomy and Consent

Autonomy

“Self-governing” - freedom to make choice about own life

Paternalism

Implies well-intended actions (benevolent) for the well-being of the patient. But power-imbalance can be abused and pt interests ignored.

Informed consent

Foundations in law but also morally correct. Includes right to refuse interventions and chose alternatives.

• Helps reduce paternalism

2 Elements of Informed Consent

• Patient must understand and be fully disclosed of the essential information

• Must be voluntary (freely given)

Capacity

Having the ability to understand what you’re told.

• Requires cognitive development + awareness

• Some people lack capacity, ex. sedated

Comprehension

Person’s actual understanding of what they are being told

• Have the capacity + understand what you’re told

• Can be hindered by language, jargon

Explicit consent

• Clear statement from pt

• Written for most procedures/tx

• Ex. Surgery, colonoscopy, etc.

Implied consent

• Inferred from a pt conduct

• Consent without written or verbal means

• Ex. tetanus shot, X-ray of injured arm

What are the 3 exceptions to infomed consent?

• Emergencies - no time

• Deemed not competent

• Waivers - do not want to know prognosis/risks

Nurse Responsibilities around consent

• Pt aware of options

• Advocate for pt’s autonomy

• Explore pt + family understanding of info given

Consent for minors

Unique challenges, need to consider:

• Child’s values usually dictated by parents

• “Evolving capacity”

• “Mature minors”

• Decided on by Common Law

• Court can still intervene