Informed consent -2013‫‬

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  • 1. HLHE- 3.1 Informed Consent Hamad Emad Thuhayr & Abdul Waris Khan
  • 2. WHAT IS “INFORMED CONSENT?” “Consent is the autonomous authorization of a medical intervention by individual patients”. Patients are entitled to make decisions about their medical care and have the right to be given all available information relevant to the refusal.
  • 3. SCENARIO A 10-year-old boy was playing near an underconstruction building of his school when he accidentally runs through a glass window and lacerates the radial artery. His teacher brings him to the emergency department. The boy is bleeding and needs both a blood transfusion and surgery to correct the defect.
  • 4. QUESTIONES I. What should the doctor do in this emergency situation if the person eligible to give consent is not reachable? II. Who can consent to medical treatment on behalf of this young child? III. Is the patient competent to make such a decision?
  • 5. Solution-1 The management in an emergency is different. In an emergency situation, when a person with parental responsibility is not available to consent, the doctor has to consider what the child’s best interests are and then act appropriately. The treatment should be limited to what is reasonably required to deal with the particular emergency. Wherever possible, it is advisable to discuss the case with a senior colleague, if available. In all cases, it is important to document fully what decisions were made and why.
  • 6. Solution-2 Only a parent or a guardian can give consent on behalf of the minor. However the guardian must be legally assigned by the court to give the consent. The teacher, the principal, the school nurse, the grandparents cannot give consent. Seeking a court order at that moment is also wrong, because it might take a lot of time and delay the treatment.
  • 7. Solution-3 It is up to the doctor to decide whether the child has the maturity and intelligence to fully understand the nature of the treatment, the options, the risks involved and the benefits. A child who has such understanding is considered Gillick competent (or Fraser competent). The parents cannot overrule the child’s consent when the child is judged to be Gillick competent. Children under 16 who are not Gillick competent and very young children cannot either give or withhold consent. Those with parental responsibility need to make the decision on their behalf.
  • 8. Conclusion 1. Situations where life saving intervention is required the doctor has to intervene under common law. 2. Child’s consent must be respected if he has fully understood the procedure. 3. Guardian can only give consent if legally assigned by the court.
  • 9. References • Children's Rights and the Developing Law By Jane Fortin 3rd edition- Chapter-1 (Children’s autonomy and parental role) • Kaplan medical ethics by Conrad Fischer, Caterina Oneto. Chapter-2 ( Competence and the capacity to make decisions). • Lecture Informed consent by Dr. Ishaaq Sarhandi