Medical ethics is a set of moral principles, beliefs and values that guide decisions about patient care. It is an integral part of good medical practice. The health care professional uses knowledge, experience, and judgment and considers the ethical principles to make decisions on management recommendations.

1. Ethical Issues
in
Obtaining
Informed Consent

2. Lecture Outline
 What is Medical Ethics?
 Family Medicine & Medical Ethics
 Principles of Medical Ethics
 What is Autonomy?
 What is The Informed Consent?
 Why Informed Consent?
 When to Request a Consent?
 Who is a competent patient to give consent?
 How to Obtain Informed Consent?

3. What is Ethics?
 Ethics is a system of moral principles
and a branch of philosophy that guides
in determining what is right or wrong
for individuals and society.
 Ethics has probably been a concern of
human beings since the dawn of
history.
 The first known evidence of ethical
concerns in the Practice of Medicine in
Western cultures is the Hippocratic
corpus (about 2,500 years ago).

4. Medical Ethics
 Medical ethics is a set of moral
principles, beliefs and values that guide
decisions about patient care.
 It is an integral part of good medical
practice.
 The health care professional uses
knowledge, experience, and judgment
and considers the ethical principles to
make decisions on management
recommendations.

5. Ethical dilemmas
Ethical dilemmas in medical practice have
increased in frequency and complexity as
both the potential benefit and harm of new
medical technologies and treatments have
increased.
The frequency and content of the ethical
dilemmas are determined by several factors:
including patients’ knowledge of medical
advances, their desire for participation in
decision-making, the law, and public policy.

6. Family Medicine & Medical Ethics
Family physicians provide
comprehensive continuing primary
health care for their patients.
They make many decisions every
working day, ranging from how to care
for people with common, self-limiting
minor illnesses to major life-and-death
decisions.
Family physicians have a duty to
consider the various aspects of the
health care decision: medical, legal,
economic, and ethical.

7. Principles of Medical Ethics
 Medical ethics is based on a series of ethical
principles that are particularly relevant to
medical practice and patient care.
 Beauchamp and Childress introduced four
fundamental principles of medical ethics.
 Thomas L Beauchamp (1939—present) and
James F Childress (1940—present) are
American philosophers, best known for their
work in medical ethics. Their book Principles
of Biomedical Ethics was first published in
1985, where it quickly became a must read
for medical students, researchers, and
academics.
James Childress Thomas Beauchamp

8. The 4 Principles of Medical Ethics
It emphasizes the moral importance of benefiting patients. It entails acting in the best
interest of the patient. This suggests that the physician must, through his actions and
reactions, seek to promote good for his patient
It states that the physician must avoid harming his patients. By using his skill and
knowledge, the physician should strive to never inflict harm, to prevent harm if able, and
to remove or reduce opportunities for harm.
The Principle of Non-Maleficence
2
It means that all people should have access to equal health care. It also requires a fair
allocation of health care resources among community members.
The Principle of Justice
3
The Principle of Beneficence
1
The Principle of Respect of Autonomy
4

9. What is Autonomy?
‘Autonomy’ is defined as the capacity for self-
determination or the capacity to make one’s
own decisions and to act freely and
independently on the basis of these
decisions.
Respect for Patient Autonomy is the core
legal and ethical principle that underlies all
human interactions in health care.
Every adult human being of sound mind has a
right to determine what shall be done with his
own body and he has the right and
responsibility to make health care decisions.

10.  Offer a way to approach ethical
dilemmas that arise in the course of
practicing medicine.
 Help in making difficult health care
decisions.
 Provide a way to organize our thinking
about ethical issues in patient care.
 Help in interacting with patients and
their families.
 Remind us that medicine is, ultimately,
an ethical enterprise.
Contributions of the
Principles of Medical Ethics

11. The obligation to Obtain Informed Consent is
an implication of respecting patients’
autonomy.
The Informed Consent
It is the process of communication between a
physician and a patient that results in the
patient’s authorization or agreement to undergo
a specific medical intervention.
Central to modern medical ethics is a respect
for patient autonomy and the fundamental
principle of informed consent.

12. Why Informed Consent?
Obtaining informed consent is an ethical, legal
and professional duty:
• Ethically, it ensures that a patient’s autonomy
is respected.
• Legally, any medical intervention without
consent can be interpreted as assault, battery,
or both, even if there were no hostile intentions
or harm caused.
• Professionally, it engages the patient in
decision making.
Battery = touching in a harmful or offensive manner without
consent or lawful justification.

13. When to Request a Consent?
 Consent is needed on every occasion a
physician wishes to initiate a medical
intervention, except in emergencies or where
the law dictates otherwise.
 Written consent is advisable, even if not
mandated by country law, as it may decrease
the liability from miscommunication.
 However, it is usually not required for more
common and generally less risky treatments,
tests, and medications and request for verbal
approval may be adequate.

14. CREDITS: This presentation template was created by
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infographics & images by Freepik
Informed Consent as a Process
 The main issue is not simply that consent to a medical
intervention is obtained, but more importantly, how it is
obtained.
 Informed consent is a process, not a form; a patient’s
signing a consent form should not preclude a thorough
discussion.
 Informed consent is a two-part process that involves
providing the patient with relevant information regarding
intervention that is the subject of the consent and the
patient’s subsequent decision to consent or to refuse the
intervention.

15. Before Obtaining Consent
Before performing any intervention involving
a patient, the physician must ensure that:
 An adult patient has the mental capacity
to give consent.
 His decision is free from coercion.
 He has been given sufficient information
to make an educated decision.
 The setting is also be of importance.

16. General Consideration in
Obtaining Consent
 Only a competent adult (18 years or older) can give consent.
 For patients under the age of majority or adults with diminished
mental capacity, informed consent should be obtained from the
appropriate substitute decision maker (e.g. a parent or Legally
appointed guardian).
 Competent adult patients are entitled to refuse treatment even
when doing so may result in permanent physical injury or death.
 Those whose decision-making capacity is questionable should still
be provided with information they can understand and be allowed to
make age- and capacity-appropriate decisions.
 Thus, a physician needs to evaluate the individual patient’s capacity
to make medical decisions.

17. Who is a competent patient?
A patient is competent if he can:
 Understand his medical problem.
 Understand what the intervention is.
 Understand why the intervention is being proposed.
 Understand the alternatives to the intervention.
 Understand the benefits and risks of the intervention
and of its alternatives.
 Understand the consequences of the intervention and
of its alternatives.
 Retain the information for long enough to weigh it in
the balance and reach a reasoned decision.

18. The information required
to make decisions
 What the intervention is.
 Why the intervention is being
proposed.
 How the intervention is to be
performed.
 Alternatives to the intervention,
including no intervention.
 The principal benefits and risks of
the intervention and of its
alternatives.
 The consequences of the
intervention and of its alternatives.

19. A Guideline to Obtain Informed Consent
Provide the information needed to make decisions.
Offer an opportunity for the patient to ask
questions and express concerns.
Elicit the patient's ideas, concerns, and
expectations, and tailor the explanations
accordingly.
Ask the patient to summarize the above
information, and be certain that the patient is
competent to give consent.
Remind the patient that he does not have to make
an immediate decision and that he can change his
decision at any time.
Allow the patient to make a voluntary decision.
Explore reasons for refusing to consent.

20. • The physician and the patient should actively
participate in the informative process in order to
execute informed consent.
• The provided information should be in a way, which
does not increase anxiety or decrease confidence.
• The information should be clear and simple,
avoiding medical terminology and technical
expressions.
• Patients should be encouraged to ask questions
and their understanding should be checked.
• The presentation and explanation of the information
should be adjusted to suit the patient’s language,
level of maturity and competence.
Important Notes

21. Briefly..
Pillars of a valid consent:
Must be informed.
Must be voluntary.
Patient must be competent.

22. Further details about Medical Ethics & Informed Consent
have been discussed in the second edition of my book
"Essentials of Practicing Family Medicine", Chapter 6.