week 3: consent Flashcards
“treatment” - Health Care Consent Act
anything that is done fora therapeutic, preventative palliative, diagnostic, cosmetic or health related purpose and includes a course of treatment, plan of treatment or community treatment plan
no treatment without:
CONSENT
- prior to their initiation all treatment interventions require consent
- includes all healthcare professionals (doctor, nurse, PT)
- exceptions for emergencies
4 elements of consent:
- consent must relate to the treatment
- consent must be informed
- consent must be given voluntarily (cant be coerced or influenced by family)
- consent must not be obtained through misrepresentations or fraud
do parents have parental right?
when making a decision they have parental RESPONSIBILITIES
- have to make decisions in the best interest
what is informed consent
- The patient must receive all relevant information about their treatment.
- standard for this is based on what a reasonable person in the same circumstances would require to make an informed decision
- interactive process
6 elements of what makes consent informed:
- nature of the treatment
- expected benefits of treatment
- material risks
- material side effects of treatment
- alternative courses of action
- likely consequence of not having treatment
what treatment changes do not require re-consent
- Variations or adjustments in the treatment if the
nature, benefits, material risks, and material side effects of change are not significantly
different than those described - Continuation of treatment in a different setting as long as there is no expected change in benefits, risks, and/or side effects
what is capacity
capacity is FLUID, time and treatment specific
- being able to understand the information that is relevant to making a decision
- able to appreciate the reasonably foreseeable consequences of decisions or lack of it
a person should be presumed to be capable of treatment decisions unless:
there are reasonable grounds to believe the person is incapable
what does capacity evaluation entail:
- Talking to patient about condition
- About risks, benefits
- Asking them to repeat information
- Asking them to talk about the treatment that was proposed
- Conversations with family members
what is used to measure capability
clinical judgements
- just because someone is making a bad decision or something we dont agree with it doesn’t make them incapable
substitute decision making (SDM)
if a person is incapable with respect to a treatment, consent may be given or refused on his or her behalf by a person described in the laws
- patients must be incapable for there to be a SDM
a person described in subjection (1) may give or refuse consent only if he or she:
a. is capable with respect to the treatment
b. is at least 16 years old unless he or she is the incapables persons parent
c. is not prohibited by court order or seperation agreement
d. is available
e. willing to assume responsibility of giving or refusing consent
how must an SDM make decisions?
- prior expressed capable wishes (values, beliefs)
- best interests
what is the age of medical consent
NO AGE
- a person can give consent if they are capable with respect to the treatment at the particular time
- if incapable: SDM does
withdrawal - provider
the removal of a treatment intervention that has been started
- the intervention may or not be effective for supporting the patient
- REQUIRES consent
withdrawal - patient
consent may be withdrawn by a patient at any time if they are capable to do so
withholding treatment
is the decision to not start a treatment intervention for a patient
emergency treatment (define emergency)
a person is experiencing severe suffering or is at risk, if the treatment is not administered promptly, of sustaining serious bodily harm
when can a healthcare practitioner administer treatment in an emergency
of an incapable person, if in the opinion of the health care practitioner:
- there is an emergency
- delay required to obtain consent or refusal on person behalf will prolong suffering or put person at risk for dying
Case Summary: Wawrzyniak v. Livingstone
Mr. DeGuerre’s family had consented to full code status, expecting CPR and ICU admission if needed, but Dr. Livingstone unilaterally changed it to DNR without informing them, believing resuscitation would cause harm. When Mr. DeGuerre went into respiratory distress, CPR was not provided despite the family’s requests, and he passed away, leading to legal and ethical concerns over informed consent and standard of care
final: courts argued in favour of physician
- argued family should have communicated better
- dont need consent to change a DNA order
