Laws and ethics Flashcards
(47 cards)
What are the applications of informed consent ?
- IC typically needs to obtained BEFORE a patient is treated
- IC is the process of providing sufficient and understandable information to a competent patient so that the patient can freely choose to authorize a procedure
- “Competency” is a pre-requisite for obtaining IC from a patient
What is competence?
- Medical decision-making capacity
- Presumed in an adult (18 years or older)
- judgement of incompetence made by a court
Competency determination involves assessment of a patient’s:
- Ability to appreciate one’s medical situation and consequences
- Rationale for the treatment decision
Explain the Dax Cowart Case
- Right to choose advocate
- Burn victim from 1973
- Competent and refused treatment
- Choice to refuse treatment was not honored by physicians
- Major shift since this time to honor patient’s autonomy
Do people with mental illness make people unable to make decisions about medical conditions?
- decision making capacity must be established as per the definition of competence
- many persons with mental illness remain competent, and informed consent must still be obtained from that person
What is a substitute decision maker?
- even if a patient is judged to lack decision making capacity, a physician doesn’t decide for the patient
- The physician must consult a substitute decision maker to obtain IC
Give the substitution makers in order
-Legal guardians or those appointed as power of attorney for healthcare
- Next-of-kin (order defined by state law)
- usual order: 1. Spouse ; 2. Adult child ; 3. Parent ; 4. Etc.
How should decision makers make decisions?
Decision makers should make decisions based on what the patient would have wanted
- known as the “substituted judgement “ standard
- Respects patient autonomy
List the components of informed consent
- Provision of information
- Comprehension
- Voluntariness
Explain provision of information as a component of informed consent
Doctor must disclose sufficient information (e.g., diagnosis, treatment choices, risks)
Standards of disclosure
- “reasonable person “ standard
- Disclosure is based on what a “reasonable person” would want to know to make a prudent decision
- Respects patient autonomy
- “Professional Practice” standard
- Disclosure is based on what a physician determines is customary practices of the medical profession
-Less ethically favored standard
Explain comprehension as a component of informed consent
Comprehension -patient understands the disclosed information
Explain voluntariness as a component of informed consent
Patient makes that decision voluntarily - free of undue inducement or coercion
What is the ethical requirements of informed consent?
IC derives from the ethical principle of “respect for patient autonomy”
What is the legal requirements of informed consent?
Without IC a physician is risking the legal charges of “battery” (unwanted touching ) and malpractice
What are the exceptions of informed consent ?
Needs to be carefully considered
- incompetence (lack of decision-making capacity)
- in some emergencies , IC can be by-passed under the doctrine of “presumed consent “
- exceptions to IC should be carefully considered
What is confidentiality?
The ethical (professional) and legal duty NOT to disclose information about a patient (except with consent from the patient)
How does confidentiality work between family members?
- A spouse (or other family member) is not entitled to patient information without consent
- In some circumstances and using clinical judgement, providers infer that a patient approves of disclosures to family/friends
- Providers should be careful about making such inferences
What is the function of confidentiality among patient-physician interactions?
Confidentiality within the physician-patient relationship helps to ensure patient disclosure
-facilitates diagnosis and treatment
-confidentiality is a stringent but not an absolute obligation
What are the exceptions to confidentiality?
There are 2 important general exceptions to confidentiality:
- due to protect a specific person
- due to public welfare
Explain protecting a specific person as a means to break confidentiality
- confidentiality may be broken. If there is a real concern for safety (serious bodily harm) of a specific person
- this determination is made using clinical judgement given the facts of the case
- judgement of dangerousness is difficult
-the breach in confidentiality is not automatic just because a threat is made
Explain physician duty to protect a person
- if a judgement of dangerousness is made, then there is typically a duty to protect the intended target:
- Actions May include notifying the police, warning the threatened individual and/or other reasonable actions (hospitalizations of the aggressor) to protect the threatened individual
- The provider’s specific actions to protect the target depends on the circumstances f the case
Explain the tarasoff case ( California)
The tarasoff case (California) is the major precedent setting legal case regarding confidentiality when a threat is made to an individual
Case: the therapist failed to warn the intended victim (tarasoff) of threats made by patient (Poddar) while in therapy; patient acted on threats and killed tarasoff
What is tarasoff 1(1974)?
“The duty to warn”
When a doctor or psychotherapist, in the exercise of his professional skill and knowledge, determines, or should determine , that a warning essential to avert danger arising from the medical or psychological condition of his patient, he incurs a legal obligation to give that warning.
- tarasoff 1 limited possible interventions by mandating confiden
- Given the importance of confidentiality to psychotherapy, an uproar about the “duty to warn” decision led the California Supreme Court to amend their decision as tarasoff II
What is Tarasoff II(1976)?
When a therapist determines or pursuant to the standard of his profession should determine, that his patient presents a serious danger of violence to another, he incurs an obligation to use reasonable care to protect the intended victim against such danger. The discharge of this duty may require the therapist to take one or more various steps depending on the nature of the case. Thus, it may call for him to warn the intended victim or others likely to apprise the intended victim of danger, to notify the police, or take whatever steps are reasonably necessary under the circumstances
- tarasoff II expanded possible interventions
- warning the victim may be part of the action taken but it is not necessarily mandated
