Ethics in Health Care - Consent
- when is consent needed?
- who 'gets' consent?
- who 'gives' consent?
- who are substitute decision makers?
- what is required for consent?
- what is informed consent?
- what risks must be disclosed?
When is Consent Needed?
Consent is needed whenever touch occurs, intentional or otherwise. This needs to be done on a treatment-by-treatment basis.
Written consent is preferable, but not necessary. Conversely, a signature at the end of a paper is not enough. Thorough discussion (documented in the chart) is necessary.
Exceptions include:
implied consent
- ie, when someone sticks their arm out to have blood drawn
emergency siutations
- when consent or refusal cannot be obtained from patient or substitute decision maker
- when consent would likely be given
- when situation calls for immediate action to save life/limb
safety of others (security or criminal aspects prevail)
Who 'Gets' Consent?
legal respoisibility rests with the person administering the test or treatment, but can delegate to others.
Who Gives Consent?
- competent adult patient
- this needs to be assessed on a treatment-by-treatment basis
- 'mature minor'
- surrogate decision maker
Who are Substitute Decision Makers?
- next-of-kin, guardian, proxy, Public Trustee, court
- SDMs need to make as big an effort as they can to put themselves in the patient's shoes to act as the patient would as best they can
- it can be tough to pick the 'next-of-kin' - don't rush in to a hasty choice
- can be difficult to find if patient is incompetent due to psychiatric conditions
- adult protection is needed if adults have medical or mental conditions and need someone to consent on their behalf
What is Required for Consent?
- voluntary participants - free of undue pressures
- competency - mental capacity to understand and appreciate consequences of decisions
- informed participants - necessary information has been given and understood so that decision can be made
What is Informed Consent?
Information disclosed needs to be:
- diagnosis
- which specific symptoms the treatment(s) will address
- treatment options, including no treatment
- what treatment(s) are expected to do
- prognoses with various treatments
- potential harms/benefits/side ffects of treatment(s)
What Risks are Required to Disclose?
Ensure you tell them what they are going to tell them:
- any serious harmful consequence, regardless of probability
- common risks, ie infection and bleeding - don't assume the patient knows anything
- risks particular patient (smoker, diebetic, etc)
- risks more important to this patient (ie a chef would not want to lose his sense of taste)
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