Week 4: Informed Consent

Question 1

Define Consent

Answer 1

permission given by a person to allow someone else to perform an act upon the person giving such permission

Question 2

Define General Consent

Answer 2

consent needed for general things (ex: bedside skills, giving meds)

Question 3

Define Specific Consent

Answer 3

consent needed for specific procedures (ex: surgery)

Question 4

Define Informed Consent

Answer 4

a person’s agreement to allow medical action to happen (ex: surgery or invasive procedure)

based on full disclosure of the possible risks/benefits of the action, alternatives to the action, & the consequences of refusal

Question 5

What are the elements of Informed Consent?

Answer 5

1. Capacity to consent
2. Information
3. Voluntariness

Question 6

Define Capacity

Answer 6

pt. MUST be capable of making an informed decision about the specific intervention suggested by understanding it all

Question 6

Define the Information of Informed Consent

Answer 6

pt. MUST be given enough info about that specific intervention to make an informed decision

• Must understand risk & benefits; talk to pt. in a way they understand (no medical jargon, interpreter PRN) -

Question 7

Define the Voluntariness of Informed Consent

Answer 7

decision MUST be voluntary & not the result of coercion, threat, or undue influence

Question 8

What information is relevant in Informed Consent?

Answer 8

-Provide a reasonable amount of info relevant to the pt.
-Patient’s condition
-Purpose of intervention or proposed treatment Identity of those performing treatment *introduce HC team members - Explanations of alternatives
-Material risks – major &/or likely (side effects); risks of delaying surgery
-Consequences of not proceeding w/ the recommended treatment - Right to refuse

Question 9

What is the nurses role in Informed Consent?

Answer 9

Nurses are often a witness. A witness confirms:
1. Signature belongs to the patient
2. Signature was voluntary – wasnt from coercion

Question 10

What must the nurse do after being a witness to informed consent?

Answer 10

-Follow-up on any questions or concerns
-Raise any concerns about the person’s understanding or voluntariness
-Report concerns to surgeon if all 3 elements of informed consent aren’t met

Question 11

Define Expressed Consent

Answer 11

*clearest form of consent
- Specific, expressed agreement to the offered intervention/procedure
- Can be verbal or in writing

Question 12

Define Implied Consent

Answer 12

*determined by pt. behaviour (pt. doesn’t specifically say they approve, but actions do)
- Agreement is implied by non-verbal behavior, actions, no resistance or protest/inaction

Question 13

Define Capacity

Answer 13

The degree to which a person can understand information relevant to a treatment decision; can vary over time and can depend on the situation

• Complex process that involves clinical judgement
• that is relevant, can they understand the consequences if they dont proceed

Question 14

When is competency and capacity questioned?

Answer 14

• Questioned when a person’s choices are risky, unusual, or appear not to be in their best interests
• Assessed more frequently and thoroughly when decisions are higher risk
  Or during life-and-death decisions or bigger interventions

Question 15

Define Competency

Answer 15

-Considers whether a person’s mental condition affects their ability to realize the consequences of making a tx decision
-In MB, competency falls under the Manitoba Mental Health Act (MMHA)

Question 16

Who determines incompetency?

Answer 16

Determination of incompetency is made by a physician & MUST be approved by a medical director of psychiatry

• Outside MB, some decisions are made by courts/judge
• Assessed when considering whether to intervene

Question 17

What information should the PT be capable of understanding?

Answer 17

• Condition for which treatment is proposed
• Nature & purpose of proposed procedure or treatment
• Consequences (risks & benefits) of undergoing the procedure or treatment
• Consequences (risks & benefits) of not undergoing the procedure or treatment.
• Any alternatives available

Question 18

How can nurses assess voluntariness?

Answer 18

-Observation of interactions & relationships
-Watch for nudging & coercion
-Careful attention to pts. body language & questions
-Speak w/ the pt. alone if needed to assess voluntariness *to be comfortable & able to express their concerns

Question 19

What information do HCP NEED to provide for Incompetent Adults?

Answer 19

-Provide info to the level of which the pt. can understand
-Respect wishes when possible
-Protect dignity & privacy
-Offer as much choice as possible *even if deemed incompetent
oStill a responsibility for nurses to ensure the pt. still has rights to choose tx
-Get consent from a substitute decision-maker

Question 20

What is a Substitute Decision Maker?

Answer 20

-A.K.A. proxy or surrogate decision-maker
-Speaks for the pt. ONLY when pt. can’t speak for themselves
-Knows the person & can represent their wishes

-Public Guardian & Trustee (PGT) can be appointed to make decisions on their behalf if:
oThere’s no family
oFamily doesn’t agree to act as the SDM

-Must follow instructions in valid Health Care Directive

Question 21

What age are children able to provide consent?

Answer 21

Children can be capable of making decisions about their health BUT usually, parents provide consent for those < 16 y/o

The older & more capable the child, the more weight is placed on their values & wishes

Question 22

Define the Mature Minor Rule

Answer 22

a minor who has the capacity to fully appreciate the nature & consequences of medical treatment & has the maturity to make their own decisions

Question 23

Define Advance Care Planning

Answer 23

A way to help one think, talk, & share thoughts & wishes about their future health care.
-Gives pts. a “voice” in decision-making
-Helps determine who would communicate for them if unable to communicate for self
-Includes conversations w/ the healthcare team

Question 24

What is a Health Care Directive?

Answer 24

-Give instructions for care in the event the pt. can’t speak for themselves
-Name a substitute decision maker or proxy (needs to be 18 years or older)
-Come into force only when pt. no longer competent
-Oblige providers to follow instructions unless they’re not consistent w/ accepted health practices

Question 25

What are the steps and rules to create a Health Care Directive in MB?

Answer 25

• Person must have capacity to make a directive
• Be 16 years or older
• HCD must be in writing, signed by the maker and dated

Question 26

What are things to consider in the best interest of the PT?

Answer 26

• Direct evidence (written
  HCD, video of pt. describing their wishes, etc.)
• Knowledge collected from conversations b/w SDM (or others) & the pt.
• The pts. previous choices (ex: lifestyle, religious convictions, values, beliefs, reactions to cases in media, etc.)
• What SDM would want if in their position
• What SDM thinks pt. needs

Question 27

What is the “Best Interest in MBs Mental Health Act”?

Answer 27

-Will the pts. condition be improved by treatment?
-Will the pts. condition deteriorate w/o treatment?
-Do the benefits of treatment outweigh the risks of harm?
-Is treatment the least restrictive & least intrusive to improve the condition?