When is enough enough?What else could have the physician done to avoid the lawsuit?Do you agree with the verdict? Explain.
Informed consent: permission to perform invasive procedure (shots)story: hysterosalpingooophorectomy = explain and understoodMinors: emancipated minor/mature minorIncapacity/incompetentLanguage barrier (interpreter)Separate consent to relapse information (HIV, mental health, substance abuse)
Cultural impact:Oscar Ramirez, a 55-year old patient of Mexican descent, presented with a large growth in his throat. He was told that the growth was cancerous. Mr. Ramirez was also told that he would need to have the tumor removed and start an aggressive round of chemotherapy. Mr. Ramirez agreed to the proposed treatment. However, Ramirez’s wife and children told the oncologist that complete truthfulness would devastate him and that it was their duty to protect him. They supported this claim by saying that their background required that “la familia” take this protective role. They added that their culture does not place the same value on the individual’s control of his own life that most American’s do. Thus, when the tumor could not be completely removed, Mr. Ramirez was merely told that his recovery would be lengthy and that much treatment would be needed to keep the cancer from recurring. Because of great skill in deception and an tightly orchestrated effort to conceal the truth, Oscar Ramirez died without ever being told of his terminal illness.
Minors: emancipated minor/mature minor differencesIncapacity/incompetentLanguage barrier (interpreter)Separate consent to release information (HIV, mental health, substance abuse)Order of priority (person authorized) in absence of self1. Appointed guardian2. Person given durable power of attorney for health care3. Spouse, 4. adult children, 5. parent, 6. adult siblingsImplementation of consent: staff responsible for preparing formsWitness signature means person is who they say they areThorough documentation if patient refused treatment
Objectives Explain the consent process from start to finish Understand the definitions of: consent, doctrine of informed consent, implementation of consent Problems in the consent process (mature minors, emancipated minors, etc.)
Vignette: When is enough enough? A client comes in for her annual gynecological examination. Her physician recommends she have a Pap smear, but she refuses. The physician stresses its importance and documents why it is important in the chart. The following year when the client returns for her annual examination, the physician again stresses why she needs the pap smear. The client again refuses. Six months later the client is diagnosed with cervical cancer. Soon she files a lawsuit against the physician. Outcome: the jury found the physician liable under the doctrine of informed consent for not stressing more that the client needed a pap smear.
Informed & uninformed consent Informed consent Patient understands an voluntarily affirms to allow touching, examination, or treatment Uninformed consent Patient gives permission but does not understand or comprehend what has been consented to.
Doctrine of Informed Consent What the procedure is and how it is to be performed The possible risks involved and the expected results Any alternative procedures or treatments and their risks Results if no treatment is given
Problems with Consent MinorsMature minors, emancipated minors Language Competency Authorization Implementation of consent Refusal