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Competency to Give an Informed Consent: A Model for Making Clinical Assessments

Competency to Give an Informed Consent: A Model for Making Clinical Assessments. James Drane. The Complexity & Importance of Consent. Autonomy But, the appearance only of consent does not equal autonomy and may lead patients to ‘choose’ things that harm them.

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Competency to Give an Informed Consent: A Model for Making Clinical Assessments

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  1. Competency to Give an Informed Consent: A Model for Making Clinical Assessments James Drane

  2. The Complexity & Importance of Consent • Autonomy • But, the appearance only of consent does not equal autonomy and may lead patients to ‘choose’ things that harm them. • Standards of competency involves law, ethics, and psychiatry. • Must ensure that competent patients are prohibited from choosing and that incompetent patients aren’t allowed to make decisions.

  3. Models for Making Assessments • A variety depending on different medical conditions: • Acute vs. chronic • Critical vs. noncritical • 3 different standards or definitions of what it means to be competent

  4. Standard 1 • Least stringent – applies to medical decisions that are not dangerous and objectively are in the patient’s best interests. • Awareness • Assent (a an objectively rational course of action). • Will apply to people who will not be able to give “full consent” to other types of treatment.

  5. Standard 2 • For situations where the illness is chronic (rather than acute) • Where the treatment is more dangerous • Where there are real alternative treatments • Understanding (as opposed to awareness) of various options and their risks-benefits is required. • This doers NOT require the ability to articulate conceptual or verbal understanding. • The patient can choose to let the physician make the decision.

  6. Standard 3 • Most stringent. • Occurs when: medical action decided upon is dangerous and opposes both professional and public rationality. • The available treatment is effective and not taking it is dangerous, perhaps life threatening. • The decision appears (at least) to be irrational.

  7. Standard 3 • Appreciation is required here where person understands the medical info + the nature and consequences of their alternate decision. The person must be able intelligently and coherently describe their reasons.

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