Discussion on who makes decision on behalf of those that are incapacitated

1. Role of NOK on Health decision
making in Nigeria.
Muhammed Amin Badamosi

2. Outline
What is Nok?
The misconception
Role of Nok?
Inform Consent and Autonomy
Capacity to consent
Surrogate decision
Conclusion

3. What is NOK?
Next of kin
A person's closest living blood
relative
Despite the fact that people use ‘next
of kin’ a lot, the term ‘next of
kin’ is used in different context for
different purpose.

4. The misconception
Right to inherit
Right to take over the declarant
autonomy

5. What then does nok connotes?
Next of Kin’ simply means someone who you would like
contacted in an emergency.
Being a ‘Next of Kin’ provides no legal standing whatsoever
despite widespread belief to the contrary;

6. What then is the role of NOK
Next-of-kin is merely the first contact point if anything
happens to you..
He is someone empowered to provide necessary information about
you where needed such as confirming your identity.
But
is he someone positioned to make medical decisions such as
providing consent for complex medical procedure, surgeries etc?

7. No!

8. How then would decision be taken if
one is incapacitated?

9. Inform consent
and autonomy

10. What is informed consent?
Its a 'voluntary, uncoerced decision made by a sufficiently
competent, autonomous person on the basis of adequate
information and deliberation to accept rather than to reject
some proposed course of action that will affect him or her.

11. Why is informed consent necessary?
It ensures the patient's autonomy and independence
Section 33 (1) of the Nigerian Constitution ("the
Constitution") provides that persons living in Nigeria, shall
have a right to life and no one shall be deprived
intentionally of his life unless in execution of the sentence
of a court of a criminal office of which he has been found
guilty.

12. Criteria to meet?
Consent is said to be informed when it proceeds voluntarily,
without fraud, duress, or misrepresentation, from a person
who has the capacity to understand and appreciate the nature
and consequences of the decision to be made as well as the
implications of making no decision.

13. Real life scenario
It is difficult to satisfy all the demands of an informed
consent in practice.
And it is a must according to the constitution
In Nigeria, the doctrine of informed consent has become
entrenched as a fundamental right under Section 37 and 38 of
the 1999 Constitution

14. Incapacitated conditions
mental health conditions –
dementia
severe learning disabilities
brain damage – for example, from
a stroke or other brain injuryphysical
or mental conditions that cause
confusion, drowsiness or a loss of
consciousness
intoxication

15. Who will decide?
authorized surrogate decision
maker
A durable power of an attorney for
healthcare

16. How will authorized surrogate decide?
have an obligation to follow the expressed wishes of the
patient and to act in the patient’s best interests, taking
into account the patient’s personal values, goals of care,
and wishes, to the extent known.
For power of attorney. You follow the patient written
instruction.(will)

17. What if No authorized surrogate or power of attorney?

18. What would be done…
health care practitioners usually rely on the next of kin or
even a close friend. Based on MDCN regulations.
have an obligation to follow the expressed wishes of the patient and to act in the patient’s best
interests, taking into account the patient’s personal values, goals of care, and wishes, to the
extent known. Without compromising his autonomy and right based on the constitution
If agreement on an ethically and legally sound resolution
cannot be reached, health care practitioners or their
institution may need to request court review.

19. What if No NOK?
The physicians, advisory
Council or the court of law
decides!

20. Conclusion
No specific Legal framework on consent by health act.
The legal backing are from the federal constitution and MDCN
regulations
Your autonomy is protected
You can control it if u choose an autorized surrogate or have
power of an attorney
If not you are in the hands of the court!
Well it doesn't work like this in nigeria unless Dr. Goes
extra miles for u.

21. Thanks for listening!

22. Questions.