Counseling patients with dementia Maine Pharmacy Association


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  • We have managed, in Pharmacy, to avoid this terminology for the last decade. However, from both legal and ethical standards, treatment with a prescription medication or device is a MEDICAL TREATMENT. Thus it requires the same professional care given in any CONSENT TO MEDICAL TREATMENT situation. The first 2 items on this slide are generally easy for us, as we only need to confirm that the person being treated is aware of them. The third item lands squarely in the pharmacist’s area of professional responsibility.
  • • The nature of the patient’s medical condition and prognosis. • The nature and purpose of the proposed intervention. • The risks, benefits, and side-effects of the proposed intervention and any alternative interventions or nonintervention. • Informed surrogate permission involves all the “informational” elements of informed consent. • When a person has incomplete decisional capacity, both informed surrogate permission and patient assent must be sought. • When a person lacks decisional capacity and has not previously expressed his preferences, surrogates may give or refuse permission to initiate or terminate a healthcare intervention. • If failure to provide a healthcare intervention would constitute a significant burden or risk to a patient’s health or welfare, and if permission is withheld by the surrogate, providers may seek authorization from appropriate state agencies or the legal system. When coupled with patient assent, informed surrogate permission approximates informed consent.
  • The Belmont principle of respect for persons states --make special provisions for individuals who have diminished capacity for making decisions in their own best interests.
  • Counseling patients with dementia Maine Pharmacy Association

    1. 1. Counseling patients with dementia Maine Pharmacy Association 16 May 2010 Anne Teichman, Pharm. D. Associate Professor of Pharmacy Practice Husson University
    2. 2. Learning objectives <ul><li>Know the pharmacists legal obligations to an adult patient with dementia </li></ul><ul><li>Be able to access the guidelines available to advise the pharmacist counseling patients with dementia </li></ul><ul><li>Be able to discuss the blending of legal requirements and best practices to advance medication use for this population </li></ul>
    3. 3. Overarching issue <ul><li>Informed consent </li></ul><ul><li>• The nature of the patient’s medical condition and prognosis. </li></ul><ul><li>• The nature and purpose of the proposed intervention. </li></ul><ul><li>• The risks, benefits, and side-effects of the proposed intervention (and any alternative interventions) or nonintervention. </li></ul>
    4. 4. Legal obligations <ul><li>Most states statutes </li></ul><ul><ul><li>Informed consent to medical treatment varies widely </li></ul></ul><ul><ul><li>must offer counseling to every adult </li></ul></ul><ul><li>Maine State statutes </li></ul><ul><ul><li>Informed Consent - Maine Rev. Stats. Ann., Title 24-2905 adopts the “professional community standard.” </li></ul></ul><ul><ul><li>Pharmacy statutes – defers to OBRA 1990 guideline </li></ul></ul><ul><ul><li>Silver alert [] </li></ul></ul>
    5. 5. NIH: Ethical Guideline <ul><li>Individuals should be treated as autonomous agents : “An individual capable of deliberation about personal goals and of acting under the direction of such deliberation.” </li></ul><ul><li>Persons with diminished autonomy are entitled to additional protections </li></ul><ul><ul><li>Fetus </li></ul></ul><ul><ul><li>Child </li></ul></ul><ul><ul><li>Dementia? </li></ul></ul>
    6. 6. NIH: Ethical Guideline <ul><li>Because children cannot provide informed consent, children provide assent to participate, to the extent that they are able, and parents/guardians give permission for a child to participate. </li></ul><ul><li>Assent varies relative to the age and health condition of the child. </li></ul><ul><li>Key concept – can the person understand consequences of the decision? </li></ul>
    7. 7. guidelines <ul><li>Elderly – American Society of Consultant Pharmacists </li></ul><ul><li>Mentally retarded - Task Force on Healthcare for Adults with Developmental Disabilities </li></ul><ul><li>Children – American Academy of Pediatric Dentistry clinical guideline “Periodicity of Examination, Preventive Dental Services, Anticipatory Guidance, and Oral Treatment for Children” </li></ul>
    8. 8. Practical Barriers <ul><li>Patient is not present </li></ul><ul><ul><li>How is the offer to counsel extended? </li></ul></ul><ul><li>Pharmacist discomfort with uncertainty </li></ul><ul><ul><li>Doubt consultation abilities/pharmaceutical knowledge </li></ul></ul><ul><ul><li>Cultural embarrassment </li></ul></ul><ul><li>“ Unfunded mandate” </li></ul><ul><li>“ Time,” “noise,” “space” </li></ul><ul><ul><li>largely not accepted </li></ul></ul>
    9. 9. Cases <ul><li>Practice blending these concepts presented to achieve best health results </li></ul>
    10. 10. Thank you. <ul><li>Please offer constructive comments and ask questions for any part of this topic. </li></ul>