Informed Consent Limitations, Loopholes and Benefits
INFORMED CONSENT • What it is: • Based on the legal premise of Patient Autonomy, patients have the right to make decisions about their own health and medical treatment. • The physician must disclose: • The patient’s diagnosis, if known • Nature and purpose of the proposed treatment • Risks and benefits of a treatment or procedure • Alternatives to certain treatments regardless of cost • Risks and benefits of alternate treatments • Risks and benefits of not receiving a treatment or undergoing a procedure.
History: • First introduction of the idea of informed consent was in the court case Mohr vs. Williams (1905). • A physician obtained Anna Mohr’s consent to an operation on her right ear, but during surgery, the surgeon decided that her left ear needed surgery instead and operated on it. • The judge determined that the physician should have obtained the patient’s consent to surgery on the left ear and therefore: a physician needed to advise a patient of all the information related to a particular procedure, including all risks and benefits.
Legislature: • Canterbury vs. Spence: • Informed consent emerged as a legal right with full redress equivalent to battery if the informed consent was not given. • Patient Self-Determination Act (PSDA) • Passed in 1990, gave the public the right to be fully informed and fully self-determining in end-of-life decisions. We should be completely protected and informed in our decisions…
Benefits • Patients have legal protection for medical decisions as well as the right to information about all available procedures. • Patient’s religious and social views can be preserved and all sorts of treatments can be explored. • The patient can form a relationship with the physician through the process of informed consent. • “But the documents are at best props in the theater of informed consent. It’s the process itself that is really important.” ~Dr. Eric D. Kodish, senior author of the study and a professor of pediatrics and chairman of bioethics at the Cleveland Clinic. http://www.nytimes.com/2009/07/30/health/30chen.html
Limitations: • The PSDA protects patient’s rights to decisions about treatments and procedures, but how do we know what we are being told is true? Or even the whole truth? • When does manipulation and coercion come into play? http://www.proprofs.com/polls/upload/yuiupload/1148429670.jpg
Issues: • Doctors are not supposed to coerce patients into suggested treatment, according to informed consent. • But how do we detect a little blurring of the facts, some half-truths, and missing information? • Are we really qualified to make decisions about medical treatment? We aren’t doctors.
Informed consent: problems? • When does informed consent get in the way of treatment? http://www.priv.gc.ca/information/ar/images/cartoon2.jpg
Do you really want to know? • If told that possible risks included death or permanent incapacitation, what risks are worth it? http://drnewportbeach.com/images/Informed%20Consent.jpg
How far is too far? • Doctors allowed to forcibly operate on woman with phobia of hospitals • Court rules 55-year-old woman with learning difficulties can be coercively sedated in order to have life-saving cancer surgery • Dr. Sarada Mylavarapu, an anesthesiologist at Fountain Valley, recalls watching helplessly as a 48-year-old mother of two died during open-heart surgery several years ago. • "It was gut-wrenching to watch - she was bleeding to death," Mylavarapu said of the woman, a Witness."Just blood - that was all she needed." But it is a crime for doctorsto give blood to an adult patient who refuses it. http://www.guardian.co.uk/law/2010/may/26/doctors-operate-woman-phobia-hospitals http://www.mombu.com/gardening/gardening/t-transfusion-free-surgery-a-religious-belief-of-jehovahs-witnesses-may-also-be-good-medicine-for-everyone-medicine-have-silver-walking-large-2941901.html
OPPOSITE ENDS OF THE SPECTRUM • Forcing treatment on a patient despite their personal wishes and views. • Reasoning: the patient’s life is a higher priority than their stated wishes • Hidden reasoning: the patient cannot, does not understand the situation • Refusing to administer treatment and risking death by respecting a patient’s desires. • Reasoning: the patient’s pre-stated conditions are of higher priority. • Hidden reasoning: Legal repercussions
WHAT IT ALL COMES DOWN TO • What do people value more, their pride or their life? Morals and ethics or life? http://synergydevelopmenttraining.co.uk/images/morals.gif http://www.mediabistro.com/fishbowlDC/original/tombstone-clipart.gif
PERSONAL VIEW • If treatment determines life or death, life is more valuable than pride; under certain circumstances. • For example: life support. The choice cannot be made by the patient on life support, so the patient’s consent does not apply because the patient will have a designated decision-maker.
WORKS CITED http://www.deathreference.com/Ho-Ka/Informed-Consent.html http://www.emedicinehealth.com/informed_consent/article_em.htm http://www.guardian.co.uk/law/2010/may/26/doctors-operate-woman-phobia-hospitals http://www.mombu.com/gardening/gardening/t-transfusion-free-surgery-a-religious-belief-of-jehovahs-witnesses-may-also-be-good-medicine-for-everyone-medicine-have-silver-walking-large-2941901.html http://www.nytimes.com/2009/07/30/health/30chen.html