11. CONSENT

Question 1

1. What is Consent?

Answer 1

• it is the permission to do something

Question 2

2. What is Consent in terms of Health Care?

Answer 2

• it is the voluntary agreement to treatment,
  examinations or other aspects of Health Care

Question 3

3. What is the ethical cornerstone of all Medical Interventions?

Answer 3

• Consent

Question 4

4. What is a Paternalistic approach?

Answer 4

• this was an approach that was very popular in the past
• it is a situation in which the doctor makes the sole
  decision about the patient’s treatment
• the patient then just agrees

Question 5

5. What are the benefits of a Patient-centred approach?

Answer 5

• respect of patient autonomy
• primary of consent

Question 6

6. What does the WMA Declaration on the rights of the patients state?

Answer 6

• the patient has a right to self-determination

Question 7

7. What is meant by the right to Self-determination?

Answer 7

• the patient has the right to make free decisions
  regarding themselves
• the physician must inform the patient of the
  consequences of their decisions

Question 8

8. What does a mentally competent adult have the right to do?

Answer 8

• they have the right to give or withhold consent to any
  diagnostic procedure
• the patient has the right to access all the information
  necessary to make their decision
• the patient should understand clearly what is the
  purpose of their treatment and tests
• the patient should understand clearly what the result
  of the treatment would be
• the patient should understand clearly what the
  implications of withholding consent are

Question 9

9. What does the patient have the right to refuse?

Answer 9

• the patient has the right to refuse to participate in
  research
• they have the right to refuse to be a part of the training
  of medicine

Question 10

10. What does the term: “consent” imply?

Answer 10

• it is the waiving of our rights
• it is permitting others to do things that they would
  otherwise not be allowed to do

Question 11

11. What are the aspects of informed consent in Medicine?

Answer 11

• the acceptance of treatment
• the choice amongst possible treatments
• the refusal of treatment

Question 12

12. Read through this case.
    Should the operation go ahead?

Answer 12

• NO
• the patient does not realise what she has given
  permission for
• the consent given by the patient is not valid
• the patient did not have all the necessary information
  when she gave her consent
• the patient did not understand the information given

Question 13

13. List 3 points that are necessary for consent to be valid.

Answer 13

1. The consent has to be given by a patient who has the
   capacity to make decisions about their care
2. The consent had to be voluntary
   
   • it has to be free from pressure, coercion or
     persuasion
3. The patient has to be sufficiently informed before
   they give consent

Question 14

14. What are the 3 aspects of Informed Consent?

Answer 14

1. Competence
2. Voluntariness
3. Information

Question 15

15. What does the P in PARQ stand for?

Answer 15

1. P= PROCEDURE
   
   • what is the procedure for?
   • what does the procedure entail?
   • what will the procedure feel like?
   • what is the nature and the purpose of the treatment

Question 16

16. What does the A in PARQ stand for?

Answer 16

1. A= ALTERNATIVES
   
   • no alternatives can also be included in this

Question 17

17. What does the R in PARQ stand for?

Answer 17

1. R= RISKS
   
   • these are the risks of the procedure / treatment
   • it includes the risk of doing nothing

NB:
- this will also outline the Benefits

Question 18

18. What does the Q in PARQ stand for?

Answer 18

1. Q= QUESTIONS
   
   • this includes checking the patient’s understanding

Question 19

19. According to Professional Guidance, how should a medical practitioner go about discussing the risks of the treatment with a patient?

Answer 19

• clear and accurate information should be presented to
  the patient about the risks
• present the information in a way patients can
  understand
• identify the adverse outcomes
• outline the potential outcome of taking no action

Question 20

20. List 3 forms of risks?

Answer 20

1. Side Effects
2. Complications
3. Failure of an intervention to achieve the desired aim

Question 21

21. What are the first 3 steps of the GMC Guidance when it comes to seeking consent?

Answer 21

1. THE DIAGNOSIS
   - and the prognosis
2. ANY UNCERTAINTIES ABOUT THE DIAGNOSIS OR
   PROGNOSIS
   
   • include options for further investigations
3. OPTIONS FOR TREATING OR MANAGING THE
   CONDITION
   
   • this includes the option to not treat the patient

Question 22

22. What are the next 3 steps (4-6) of the GMC Guidance when it comes to seeking consent?

Answer 22

4. THE PURPOSE OF ANY PROPOSED INVESTIGATION OR
   TREATMENT
   - outlines what it will involve
5. THE POTENTIAL BENEFITS, RISKS AND BURDENS
   
   • as well as the likelihood of success for each option
   • should be included in the information given to the
     patient
   • it should also be outlined whether the benefits and
     risks of the treatment are affected by the doctor or
     organisation providing the care
6. WHETHER A PROPOSED INVESTIGATION OR
   TREATMENT IS PART OF A RESEARCH PROGRAMME
   
   • or if there is an innovative treatment designed
     specifically for the benefit of the patient

Question 23

23. What are the next 3 steps (7-9) of the GMC Guidance when it comes to seeking consent?

Answer 23

7. THE PEOPLE WHO WILL BE MAINLY RESPONSIBLE FOR
   THE PATIENT
   - as well as the people involved in the care of the
   patient
   - what their roles are
   - to which extent medical students can be involved
8. THE PATIENTS RIGHT TO REFUSE
   
   • to take part in teaching or research
9. THE PATIENT’S RIGHT TO SEEK A SECOND OPINION

Question 24

24. What are the next 3 steps (10-12) of the GMC Guidance when it comes to seeking consent?

Answer 24

10. THE PATIENT’S BILLS
    
    • that they have to pay
11. ANY CONFLICTS OF INTEREST
    
    • that you, the organisation and the patient may have
12. ANY TREATMENTS FROM ANOTHER SOURCE THAT
    YOU BELIEVE HAVE GREATER POTENTIAL BENEFIT
    
    • for the patient
    • than what you or your organisation can offer

Question 25

25. What is one aspect that is necessary for Consent to be valid?

Answer 25

- it has to be continuous

Question 26

26. What are the 2 aspects of Continuous Consent?

Answer 26

1. THE PATIENT SHOULD BE INFORMED - that they can change their mind at any time 2. CONSENT SHOULD BE REPEATEDLY GAINED - in the course of the consultation - and in relation to specific procedures - EG: physical examinations or blood examinations

Question 27

27. What are the 2 types of Consent?

Answer 27

1. Explicit 2. Implied

Question 28

28. What is Explicit Consent?

Answer 28

- this is also known as Expressed Consent - it is consent that is given when a patient actively agrees to the use or disclosure of information - the patient expressed verbal consent - the patient expressed written consent

Question 29

29. What is Implied Consent?

Answer 29

- this is the consent that refers to circumstances in which it would be reasonable to infer that the patient agrees to the use of information - even though the patient has not directly expressed this

Question 30

30.Does consent always have to be written down?

Answer 30

- NO - but this documentation may provide evidence of the consent process

Question 31

31. Read through this case. What should have been done in this situation?

Answer 31

- the doctor needed to ask if the patient is okay with this - the doctor needed to introduce the Medical students to the patient - the doctor needed to ask if there are any limitations that the patient might have in this situation

Question 32

32. What is necessary when it comes to the consent of the patient and Medical Students?

Answer 32

- we have to seek consent from the patients to participate in the teaching or training that is essential in Clinical Education - this consent follows the same principles as seeking consent for treatment