Patient Autonomy and Informed Consent

What is autonomy?

the right of self-determination

Patients are to be treated as individuals and informed about procedures to ___

facilitate appropriate decisions

A patient will not be treated without informed consent except ___

in narrowly defined emergencies

What is informed consent?

the written agreement of a patient to receive a proposed treatment

___ is essential for the patient to give truly informed consent

adequate information

Is 100% informed consent always possible?

NO

The individual giving consent must fully understand:

• the nature of the procedure

• risks involved (including side effects and complications)

• desired outcome of the procedure

• possible alternatives

The ___, established by the ___, is a guide to help ___

Patient Care Partnership; American Hospital Association; help patients understand the expectations, rights, and responsibilities regarding their health care

What is high quality hospital care?

care delivered with skill, compassion, and respect

Patients expect to be treated in a ___ and ___ environment

clean and safe

Do patients have the right to know the identity of their caregivers?

YES

What are some expectations patients have in terms of involvement in their care?

• discussing medical condition and appropriate treatment choices

• discussing treatment plans

• providing information to their caregivers

• understanding health care goals and values

• understanding who should make decisions if the patient is unable

The way that information is given depends on ___

the criteria used to inform the patient

What are the 4 (possibly conflicting) rules that may guide the care provider in explaining information to patients?

1. patient preference rule

2. professional custom rule

3. prudent person rule

4. subjective substantial disclosure rule

Explain the patient preference rule

requires health care professionals to tell patients what they want to know

(educating patient about the procedure)

Explain the professional custom rule

the health care professional should give the patient the information normally given to patients in similar situations

(even if the patient doesn’t ask questions)

Explain the prudent person rule

measures the healthcare provider’s disclosure to the patient based on the patient’s need for information to make decisions regarding treatment

(provides information patients need to know to consent or refuse treatment)

Explain the subjective substantial disclosure rule

encourages the provider/physician to disseminate all information important to the individual patient

A combination of the 4 rules that guide the care provider in explaining information to patients provides ___

provides information without overburdening patient

Explain the patient self-determination act of 1991

• helps ensure the principle of patient autonomy

• must respect the patient’s choice to refuse treatment

• must inform the patient that they have the right to refuse medical and surgical care

What are the responsibilities of the imaging professional and the physician in verifying informed consent?

imaging professional: answer patient’s questions concerning procedures

physician: specifics of informed consent such as alternatives, failure rates, risks, etc.

Whose responsibility is it to obtain informed consent?

the physician who is doing the procedure

Explain simple consent

• consent required of a patient for any procedure

• does not require knowledge of the procedure

• simply means the patient’s permission must be obtained prior to performing the procedure

The patient placing their hand on the IR for a hand x-ray is an example of ___ consent

simple

What 4 elements are required for informed consent?

1. given voluntarily

2. competent adult

3. parent of minor must sign

4. signed, witnessed, and dated

What is competence?

the ability to make choices and consider the consequences

Competence may be compromised ___ or ___

temporarily or permanently

A patient being under the influence of alcohol is an example of ___ incompetence

temporary

A patient who has suffered a traumatic brain injury is an example of ___ incompetence

permanent

What is a surrogate?

a person who substitutes for another, often in the decision making process

Is incompetence easy to prove?

NO

What are some obstacles to autonomy and/or informed consent?

• undue influences may restrict the patient’s choices

  • patient’s family or physician

  • coercion (forcing the patient to do something)

• an attitude of paternalism

  • caregiver thinking they know what is best

  • ignoring the patient’s feelings

• language/cultural barriers

• lack of time

• lack of communication

What is therapeutic privilege?

withholding information from patients due to belief that the information would have adverse effects on the patient’s condition or health

(physician must have a reason to believe patient would become unusually emotionally distraught if the information was disclosed)

Why is therapeutic privilege used less often by caregivers?

patients are becoming more aware of their rights

if patient autonomy is denied, ability to give informed consent is impaired

Explain informed consent in emergency situations

the informed consent process may be abandoned to save the patient’s life

What 3 conditions must be present in emergency situations to forego informed consent?

1. the patient is 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

What are advanced directives?

predetermined (usually written) choice made to inform others of the ways in which the patient wishes to be treated while incompetent

What is utilitarianism?

requires the greatest good to be done for the greatest number of people

What is deontology?

states that motives for an action are the most important considerations

What is virtue ethics?

relies on practical wisdom and right reason

What is a tort?

a civil wrong for which a law provides a remedy

What is a tort action?

filed to recover damages for personal injury or property damage occurring from negligent conduct or intentional misconduct

Explain intentional torts

• result when an act is done with the intent of causing harm to another

• assault, battery, false imprisonment, defamation

What is assault?

threatening to harm another without consent and the victim feels the attacker can carry out the threat

What is battery?

touching to which the victim has not consented, even if it would benefit the patient

What is false imprisonment?

unlawful confinement of a person within a fixed area (confined person must be aware of or harmed by the confinement)

Explain unintentional torts

• wrongs resulting from actions that were not intended to do harm

• most common is malpractice (negligence, failure to obtain informed consent, breach of confidentiality)

• based on the fact that duty is owed, duty was breached, and harm resulted from breach

What are 2 situations in which you do not need informed consent?

emergency situations and therapeutic privilege

Explain consent forms

• tool to help inform patient about procedure and document consent

• general form can be adapted to include specifics of particular procedure

• forms must be carefully written and are reviewed by risk management and legal counsel

• must never be used in place of an oral explanation

• should be obtained within 24 hours before the procedure

A consent form generally includes:

• name of procedure (specifics, including laterality)

• brief explanation of procedure, risks, and benefits

• space for patient’s name

• name of person doing the procedure

• signature lines for:

  • patient

  • person explaining procedure

  • witness

Written consent must always be obtained when doing ___

invasive procedures