This document discusses the issue of casual consent to treatment in Pakistan's healthcare system. It argues that while internationally the concept of informed consent is recognized, consent is still largely neglected in Pakistan. Doctors often view consent as a formality rather than properly informing patients. This fails to respect patient autonomy and leaves doctors legally vulnerable. The article calls for reforms to establish proper informed consent standards and processes in Pakistan.
This document discusses the concepts of informed consent and refusal of treatment. It outlines that patients have the right to refuse treatment as long as it is an informed refusal. For consent or refusal to be valid, the patient must be competent and the decision must be voluntary. The nurse's role is to ensure the patient understands the risks of refusing treatment through education. If refusal is documented, the record must show the teaching provided and that the patient understood risks but still refused.
Informed Refusal: you are doing it wrong Robert Cole
This document discusses informed refusal of care in emergency medical services. It emphasizes the importance of determining a patient's capacity to refuse care through a thorough cognitive assessment. A robust refusal process involves obtaining vital signs, assessing cognition using a tool like the Folstein Mini-Mental State Examination, addressing the patient's reasons for refusing care, making multiple offers of transport, and thoroughly documenting all aspects of the assessment and refusal. Proper determination of capacity and a well-executed refusal can help mitigate legal liability if the patient later experiences an adverse outcome.
Informed refusal: You are doing it wrongRobert Cole
Refusals are commonly regarded as one of the more risk and liability-laden parts of the
emergency medical services (EMS) job. A refusal, in the context of this discussion, is an
implied, implicit, or explicit decision by the patient to forgo all or part of medical care provided
by a healthcare provider, in this context, EMS providers. For the purposes of this discussion,
transport to a medical facility via EMS is also considered part of the medical care provided.
Consent must be obtained before treatment can begin. There are two types of consent - express or implied. For consent to be legally valid, several elements must be satisfied including the patient having sufficient information about the treatment, having the capacity to consent, and consent being given voluntarily without coercion. Children and incompetent adults require others to provide consent on their behalf, with the exception of those detained under the Mental Health Act. The doctrine of informed consent embodies the principle that patients have the right to determine if they undergo treatment, and requires they be given sufficient information to understand the treatment and make an informed decision.
April 28, 2017
Transparency is a relatively new concept to the world of health and health care, considering that just a few short decades ago we were still in the throes of a “doctor-knows-best” model. Today, however, transparency is found on almost every short list of solutions to a variety of health policy problems, ranging from conflicts of interest to rising drug costs to promoting efficient use of health care resources, and more. Doctors are now expected to be transparent about patient diagnoses and treatment options, hospitals are expected to be transparent about error rates, insurers about policy limitations, companies about prices, researchers about data, and policymakers about priorities and rationales for health policy intervention. But a number of important legal and ethical questions remain. For example, what exactly does transparency mean in the context of health, who has a responsibility to be transparent and to whom, what legal mechanisms are there to promote transparency, and what legal protections are needed for things like privacy, intellectual property, and the like? More specifically, when can transparency improve health and health care, and when is it likely to be nothing more than platitude?
This conference aimed to: (1) identify the various thematic roles transparency has been called on to play in American health policy, and why it has emerged in these spaces; (2) understand when, where, how, and why transparency may be a useful policy tool in relation to health and health care, what it can realistically be expected to achieve, and when it is unlikely to be successful, including limits on how patients and consumers utilize information even when we have transparency; (3) assess the legal and ethical issues raised by transparency in health and health care, including obstacles and opportunities; (4) learn from comparative examples of transparency, both in other sectors and outside the United States. In sum, we hope to reach better understandings of this health policy buzzword so that transparency can be utilized as a solution to pressing health policy issues where appropriate, while recognizing its true limitations.
Learn more on our website: http://petrieflom.law.harvard.edu/events/details/2017-annual-conference
1. Broad consent for future research on biospecimens is ethically permissible when it includes initial consent for an unspecified range of future research with some limitations, oversight of future research uses, and potential ongoing communication with donors.
2. Empirical studies show most people want some control over use of their biospecimens and risk, but broad consent reduces burdens compared to specific consent for each study.
3. Public preferences generally support broad consent with initial consent and oversight, though some may not consent to future unspecified use.
In this presentation it has been tried to give a glimpse of different type of consent, how it should be taken, how the patient to be explained, when consent is must and conditions where consent is not required, so as to guide you in your every day practice.
A presentation designed to inform health care workers about the components and importance of advance directives, with specific information for Massachusetts residents.
This document discusses the concepts of informed consent and refusal of treatment. It outlines that patients have the right to refuse treatment as long as it is an informed refusal. For consent or refusal to be valid, the patient must be competent and the decision must be voluntary. The nurse's role is to ensure the patient understands the risks of refusing treatment through education. If refusal is documented, the record must show the teaching provided and that the patient understood risks but still refused.
Informed Refusal: you are doing it wrong Robert Cole
This document discusses informed refusal of care in emergency medical services. It emphasizes the importance of determining a patient's capacity to refuse care through a thorough cognitive assessment. A robust refusal process involves obtaining vital signs, assessing cognition using a tool like the Folstein Mini-Mental State Examination, addressing the patient's reasons for refusing care, making multiple offers of transport, and thoroughly documenting all aspects of the assessment and refusal. Proper determination of capacity and a well-executed refusal can help mitigate legal liability if the patient later experiences an adverse outcome.
Informed refusal: You are doing it wrongRobert Cole
Refusals are commonly regarded as one of the more risk and liability-laden parts of the
emergency medical services (EMS) job. A refusal, in the context of this discussion, is an
implied, implicit, or explicit decision by the patient to forgo all or part of medical care provided
by a healthcare provider, in this context, EMS providers. For the purposes of this discussion,
transport to a medical facility via EMS is also considered part of the medical care provided.
Consent must be obtained before treatment can begin. There are two types of consent - express or implied. For consent to be legally valid, several elements must be satisfied including the patient having sufficient information about the treatment, having the capacity to consent, and consent being given voluntarily without coercion. Children and incompetent adults require others to provide consent on their behalf, with the exception of those detained under the Mental Health Act. The doctrine of informed consent embodies the principle that patients have the right to determine if they undergo treatment, and requires they be given sufficient information to understand the treatment and make an informed decision.
April 28, 2017
Transparency is a relatively new concept to the world of health and health care, considering that just a few short decades ago we were still in the throes of a “doctor-knows-best” model. Today, however, transparency is found on almost every short list of solutions to a variety of health policy problems, ranging from conflicts of interest to rising drug costs to promoting efficient use of health care resources, and more. Doctors are now expected to be transparent about patient diagnoses and treatment options, hospitals are expected to be transparent about error rates, insurers about policy limitations, companies about prices, researchers about data, and policymakers about priorities and rationales for health policy intervention. But a number of important legal and ethical questions remain. For example, what exactly does transparency mean in the context of health, who has a responsibility to be transparent and to whom, what legal mechanisms are there to promote transparency, and what legal protections are needed for things like privacy, intellectual property, and the like? More specifically, when can transparency improve health and health care, and when is it likely to be nothing more than platitude?
This conference aimed to: (1) identify the various thematic roles transparency has been called on to play in American health policy, and why it has emerged in these spaces; (2) understand when, where, how, and why transparency may be a useful policy tool in relation to health and health care, what it can realistically be expected to achieve, and when it is unlikely to be successful, including limits on how patients and consumers utilize information even when we have transparency; (3) assess the legal and ethical issues raised by transparency in health and health care, including obstacles and opportunities; (4) learn from comparative examples of transparency, both in other sectors and outside the United States. In sum, we hope to reach better understandings of this health policy buzzword so that transparency can be utilized as a solution to pressing health policy issues where appropriate, while recognizing its true limitations.
Learn more on our website: http://petrieflom.law.harvard.edu/events/details/2017-annual-conference
1. Broad consent for future research on biospecimens is ethically permissible when it includes initial consent for an unspecified range of future research with some limitations, oversight of future research uses, and potential ongoing communication with donors.
2. Empirical studies show most people want some control over use of their biospecimens and risk, but broad consent reduces burdens compared to specific consent for each study.
3. Public preferences generally support broad consent with initial consent and oversight, though some may not consent to future unspecified use.
In this presentation it has been tried to give a glimpse of different type of consent, how it should be taken, how the patient to be explained, when consent is must and conditions where consent is not required, so as to guide you in your every day practice.
A presentation designed to inform health care workers about the components and importance of advance directives, with specific information for Massachusetts residents.
Informed Consent in Telemedicine
How can we explain to the patient informed consent in telemedicine
Security Measures
APA & ATA Guidelines
Advantages and Disadvantages of Informed Consent in Telemedicine
The Risks of Informed Consent in Telemedicine
How useful are advance directives in directing end of life care and do people really understand or want to know the true status of their health as the end nears?
Review of the Saudi Guidelines for informed consent in Surgery as well as the international best practice guidelines for a better approach to Informed Consent in the Kingdom of Saudi Arabia.
This document discusses litigation in the field of gynaecology. It begins by noting that obstetrics and gynaecology has a reputation as a highly litigious specialty. It then discusses some of the common reasons why doctors are sued, including accountability, the need for explanation, concern over standards of care, and compensation. The document outlines the typical stages of a medical claim and summarizes several important legal cases that have influenced medico-legal rulings. It also discusses factors that commonly lead to claims in gynaecology, such as issues with consent, sterilization procedures, and laparoscopic surgeries.
A new survey of negative patient experiences finds that patients rank unpleasant waiting areas as a bigger reason for not returning to a facility than long wait times. Here’s more:
•Waiting areas: Some 30% of respondents said dirty waiting areas at urgent care and primary care facilities would keep them from returning. Some 11% said the same for waiting times at urgent care centers, while 6% said so for primary care.
•Urgent care: Patients visiting these facilities were twice as likely to report dissatisfaction if they had to see more than two health professionals during a visit.
•Primary care: Women were 2.5 times more likely than men to say they wouldn’t want to return if the doctor or nurse forgets their name. At the same time, men were five times more likely to not want to return because of waiting rooms that lack entertainment options.
Advance Directives & Advance Care Planning | VITAS HealthcareVITAS Healthcare
Learn how healthcare professionals can ensure that their patients’ voices are heard by embracing advance care planning (ACP), defined as honest conversations about how patients want to be cared for at the end of life if they are unable to communicate or make decisions. This webinar explores advance directives, the legal documents that spell out patients’ wishes for family members, caregivers and healthcare teams.
Series of lectures I gave for the PEER (Professionalism and Ethics Education for Residents) Project sponsored and organized by the Saudi Commission for Health Specialties (SCHS).
OUTLINE:
What is an informed consent to treatment?
What is the elf basis to consent?
What makes the consent an ethically valid one?
Types of Consent
When it is needed? When could it be waived?
How to take an informed consent?
What if the patient is not able to give consent?
Documentation of Consent
Special Issues about Consent
Informed consent is required for any medical procedure and involves educating the patient on the nature, risks, and benefits of the procedure. Key aspects of informed consent include voluntary agreement from the patient, disclosure of relevant medical information, and the patient's competence to consent. Exceptions may apply in emergencies or for therapeutic reasons. Standards for obtaining informed consent aim to respect patient autonomy while balancing ethical obligations of beneficence.
The document summarizes a study that assessed patient perspectives on informed consent practices for surgery. 103 postoperative patients at PIMS/SZABMU completed a questionnaire about their consent process. The results showed significant deficiencies: only 8.73% reported complications were explained, 2.91% reported anesthesia complications explained, and 65.04% reported not understanding the information. While 86.4% were satisfied, most consent was given by others and not the patient. The authors conclude significant inadequacy exists in current informed consent practices and that practices need revising to make the process more informed.
This document discusses the principle of autonomy in medical ethics. It begins by defining autonomy as self-rule or self-determination without undue external influence. The document then discusses how autonomy relates to informed consent and respecting patients' medical decisions. It also addresses challenges in applying autonomy, such as at the end of life or with patients who have impaired decision-making capacity. The document emphasizes that respecting patient autonomy involves providing full information, upholding confidentiality, and not overriding patients' preferences against their will.
Do Not Resuscitate Orders : What They Mean ?SMSRAZA
Most doctors working in Acute areas know when and how to do CPR. However, most get stuck when it comes to ' When not to do CPR' due to cultural, social, ethical and legal issues attached.
Concierge Medicine Brave New World Of Health CareJames Kane
This document summarizes concierge medicine and specialty medical services tailored for individuals. Concierge practices offer enhanced services like same-day appointments in exchange for annual fees, though they remain small. Critics argue they could worsen healthcare access, while proponents say the current system is unsustainable. The document provides tips for what to ask if your doctor transitions to concierge care. It also discusses specialty services that can provide referrals to top specialists for complex illnesses and emergency care while traveling globally through virtual consultations.
This document discusses various aspects of informed consent in anesthesia practice and medical malpractice litigation. It notes that informed consent is required to respect patient autonomy and involves explaining the risks, benefits and alternatives of a procedure to allow for substantially autonomous decision making. The key elements of competence that a patient must demonstrate to provide valid consent are described. Maintaining thorough anesthesia records and communicating well with patients can help minimize the risk of malpractice lawsuits.
It gives an overview on the concept of paternalism and autonomy and which principle prevails in the current situation. The opinion is the writer personal opinion.
The document discusses the services provided by Geriatric Care Manager Linda Recinos and her company Infinity Care Management, which offers in-home care, care coordination, medication management, and assistive technologies to help seniors live independently and safely in their own homes. Infinity Care Management utilizes assessments, care planning, care oversight, and communication with families to support the well-being, dignity, and independence of older adults. The company provides an array of services and products tailored to each client's individual needs and circumstances.
The document discusses informed consent and its importance. It defines informed consent as communication between a patient and physician that results in the patient authorizing agreement to a medical intervention. Informed consent is required by law, ethics, and regulations. It helps ensure patient safety, satisfaction, and reduces litigation risks. The clinician is responsible for obtaining informed consent, but a team approach is needed. Informed consent is required for invasive or complex procedures and includes discussing diagnosis, treatment options, risks and benefits, and alternatives. Consent can be provided by a competent patient or their healthcare representative. Improving informed consent involves simplifying language, allowing questions, and ensuring understanding.
Consent involves obtaining free and voluntary approval from a patient for medical treatment or procedures, with key requirements being that the patient understands what they are consenting to and the potential consequences. There are different types of consent including implied, expressed, and informed consent, with informed consent being the standard that requires fully explaining treatment options and risks to ensure the patient can make an informed decision. Determining a patient's decision-making capacity is also important for valid consent.
The document proposes a new "SAAIQ emergency approach" for breaking bad news in emergency situations. The approach has five components: (1) Setting the scene as soon as possible, (2) Assessing the understanding of the recipient, (3) Alerting about the bad news, (4) Informing clearly and quickly, and (5) Summarizing with information-based hope. The authors developed this approach to address challenges of breaking bad news in emergency departments, where settings are not private and time is limited. They believe this concise approach can help deliver bad news empathetically and tactfully in emergency contexts.
Chest trauma is a significant cause of morbidity and mortality, especially in young healthy adults. It accounts for 20-25% of trauma deaths and contributes to another 25% of trauma deaths. Road traffic accidents are the leading cause of chest trauma. Initial management focuses on ABCDE (airway, breathing, circulation, disability, exposure). Tube thoracostomy is often needed to treat pneumothorax and hemothorax. Other life-threatening injuries include tension pneumothorax, massive hemothorax, pericardial tamponade, and large flail segments, which require prompt treatment to stabilize the patient.
Informed Consent in Telemedicine
How can we explain to the patient informed consent in telemedicine
Security Measures
APA & ATA Guidelines
Advantages and Disadvantages of Informed Consent in Telemedicine
The Risks of Informed Consent in Telemedicine
How useful are advance directives in directing end of life care and do people really understand or want to know the true status of their health as the end nears?
Review of the Saudi Guidelines for informed consent in Surgery as well as the international best practice guidelines for a better approach to Informed Consent in the Kingdom of Saudi Arabia.
This document discusses litigation in the field of gynaecology. It begins by noting that obstetrics and gynaecology has a reputation as a highly litigious specialty. It then discusses some of the common reasons why doctors are sued, including accountability, the need for explanation, concern over standards of care, and compensation. The document outlines the typical stages of a medical claim and summarizes several important legal cases that have influenced medico-legal rulings. It also discusses factors that commonly lead to claims in gynaecology, such as issues with consent, sterilization procedures, and laparoscopic surgeries.
A new survey of negative patient experiences finds that patients rank unpleasant waiting areas as a bigger reason for not returning to a facility than long wait times. Here’s more:
•Waiting areas: Some 30% of respondents said dirty waiting areas at urgent care and primary care facilities would keep them from returning. Some 11% said the same for waiting times at urgent care centers, while 6% said so for primary care.
•Urgent care: Patients visiting these facilities were twice as likely to report dissatisfaction if they had to see more than two health professionals during a visit.
•Primary care: Women were 2.5 times more likely than men to say they wouldn’t want to return if the doctor or nurse forgets their name. At the same time, men were five times more likely to not want to return because of waiting rooms that lack entertainment options.
Advance Directives & Advance Care Planning | VITAS HealthcareVITAS Healthcare
Learn how healthcare professionals can ensure that their patients’ voices are heard by embracing advance care planning (ACP), defined as honest conversations about how patients want to be cared for at the end of life if they are unable to communicate or make decisions. This webinar explores advance directives, the legal documents that spell out patients’ wishes for family members, caregivers and healthcare teams.
Series of lectures I gave for the PEER (Professionalism and Ethics Education for Residents) Project sponsored and organized by the Saudi Commission for Health Specialties (SCHS).
OUTLINE:
What is an informed consent to treatment?
What is the elf basis to consent?
What makes the consent an ethically valid one?
Types of Consent
When it is needed? When could it be waived?
How to take an informed consent?
What if the patient is not able to give consent?
Documentation of Consent
Special Issues about Consent
Informed consent is required for any medical procedure and involves educating the patient on the nature, risks, and benefits of the procedure. Key aspects of informed consent include voluntary agreement from the patient, disclosure of relevant medical information, and the patient's competence to consent. Exceptions may apply in emergencies or for therapeutic reasons. Standards for obtaining informed consent aim to respect patient autonomy while balancing ethical obligations of beneficence.
The document summarizes a study that assessed patient perspectives on informed consent practices for surgery. 103 postoperative patients at PIMS/SZABMU completed a questionnaire about their consent process. The results showed significant deficiencies: only 8.73% reported complications were explained, 2.91% reported anesthesia complications explained, and 65.04% reported not understanding the information. While 86.4% were satisfied, most consent was given by others and not the patient. The authors conclude significant inadequacy exists in current informed consent practices and that practices need revising to make the process more informed.
This document discusses the principle of autonomy in medical ethics. It begins by defining autonomy as self-rule or self-determination without undue external influence. The document then discusses how autonomy relates to informed consent and respecting patients' medical decisions. It also addresses challenges in applying autonomy, such as at the end of life or with patients who have impaired decision-making capacity. The document emphasizes that respecting patient autonomy involves providing full information, upholding confidentiality, and not overriding patients' preferences against their will.
Do Not Resuscitate Orders : What They Mean ?SMSRAZA
Most doctors working in Acute areas know when and how to do CPR. However, most get stuck when it comes to ' When not to do CPR' due to cultural, social, ethical and legal issues attached.
Concierge Medicine Brave New World Of Health CareJames Kane
This document summarizes concierge medicine and specialty medical services tailored for individuals. Concierge practices offer enhanced services like same-day appointments in exchange for annual fees, though they remain small. Critics argue they could worsen healthcare access, while proponents say the current system is unsustainable. The document provides tips for what to ask if your doctor transitions to concierge care. It also discusses specialty services that can provide referrals to top specialists for complex illnesses and emergency care while traveling globally through virtual consultations.
This document discusses various aspects of informed consent in anesthesia practice and medical malpractice litigation. It notes that informed consent is required to respect patient autonomy and involves explaining the risks, benefits and alternatives of a procedure to allow for substantially autonomous decision making. The key elements of competence that a patient must demonstrate to provide valid consent are described. Maintaining thorough anesthesia records and communicating well with patients can help minimize the risk of malpractice lawsuits.
It gives an overview on the concept of paternalism and autonomy and which principle prevails in the current situation. The opinion is the writer personal opinion.
The document discusses the services provided by Geriatric Care Manager Linda Recinos and her company Infinity Care Management, which offers in-home care, care coordination, medication management, and assistive technologies to help seniors live independently and safely in their own homes. Infinity Care Management utilizes assessments, care planning, care oversight, and communication with families to support the well-being, dignity, and independence of older adults. The company provides an array of services and products tailored to each client's individual needs and circumstances.
The document discusses informed consent and its importance. It defines informed consent as communication between a patient and physician that results in the patient authorizing agreement to a medical intervention. Informed consent is required by law, ethics, and regulations. It helps ensure patient safety, satisfaction, and reduces litigation risks. The clinician is responsible for obtaining informed consent, but a team approach is needed. Informed consent is required for invasive or complex procedures and includes discussing diagnosis, treatment options, risks and benefits, and alternatives. Consent can be provided by a competent patient or their healthcare representative. Improving informed consent involves simplifying language, allowing questions, and ensuring understanding.
Consent involves obtaining free and voluntary approval from a patient for medical treatment or procedures, with key requirements being that the patient understands what they are consenting to and the potential consequences. There are different types of consent including implied, expressed, and informed consent, with informed consent being the standard that requires fully explaining treatment options and risks to ensure the patient can make an informed decision. Determining a patient's decision-making capacity is also important for valid consent.
The document proposes a new "SAAIQ emergency approach" for breaking bad news in emergency situations. The approach has five components: (1) Setting the scene as soon as possible, (2) Assessing the understanding of the recipient, (3) Alerting about the bad news, (4) Informing clearly and quickly, and (5) Summarizing with information-based hope. The authors developed this approach to address challenges of breaking bad news in emergency departments, where settings are not private and time is limited. They believe this concise approach can help deliver bad news empathetically and tactfully in emergency contexts.
Chest trauma is a significant cause of morbidity and mortality, especially in young healthy adults. It accounts for 20-25% of trauma deaths and contributes to another 25% of trauma deaths. Road traffic accidents are the leading cause of chest trauma. Initial management focuses on ABCDE (airway, breathing, circulation, disability, exposure). Tube thoracostomy is often needed to treat pneumothorax and hemothorax. Other life-threatening injuries include tension pneumothorax, massive hemothorax, pericardial tamponade, and large flail segments, which require prompt treatment to stabilize the patient.
This document provides guidance on writing medical papers and dissertations effectively. It discusses the typical structure of a medical paper, including the introduction, methods, results, discussion, and references sections. For each section, it provides best practices or "pearls" for writing that section successfully. It also identifies common pitfalls to avoid in each section. The document aims to help medical professionals advance their research and writing skills in order to disseminate their work, fulfill exam requirements, and advance their careers. It emphasizes the importance of revision and presenting work in a clear, concise manner.
This document discusses how to carry out an efficient and effective web-based search for medical information. It provides an overview of common medical information resources available in print and online. The document outlines a roadmap for conducting a web-based search, including using appropriate search strings, keywords, Boolean operators, and limiting options to refine results. Effective search strings are formed using keywords, truncation, parentheses, and quotation marks. Sensible handling and sharing of information is emphasized.
El documento habla sobre jugar con el teatro. Propone usar el teatro como una herramienta lúdica y didáctica para trabajar con niños y jóvenes. El teatro permite desarrollar habilidades blandas a través de representaciones creativas que divierten e involucran a los participantes.
Este documento descreve os principais elementos da oração e suas funções sintáticas, incluindo sujeito, predicado, complementos e atributos. Detalha tipos de sujeito e predicado, bem como complementos verbais e nominais. Explica termos como complemento direto, indireto e circunstancial.
Our privacy policy allows 24/7essaywriters.com to occasionally allow selected third parties to use your information about our product and services. Also we may provide your personal information to companies providing chat feature services to help us with our business activities liking shipping your order.
O Algarve em 1973 (saudades de quem conheceu)Rádio Sempre
Este documento lista locais no Algarve, Portugal, com fotos antigas disponíveis. As localidades incluem Alvor, Armação de Pêra, Carvoeiro, Faro, Lagos, Monte Gordo, Portimão, Praia da Luz, Praia do Vau, Praia da Rocha e Tavira.
This is a traditional South African song about marching in the light of God. The lyrics repeat the phrase "Siyahamba ekukhanyen' kwenkhos'" which means "We are marching in the light of God". The song encourages marching forward together in fellowship under God's guidance and protection.
A Linguagem
- O autor discute como a linguagem é fundamental para a constituição do ser humano e como ela permite a racionalidade e as emoções.
As Emoções
- As emoções são fenômenos biológicos essenciais e o amor é a emoção fundamental que permite a aceitação do outro e a convivência social.
A Ética
- As interações humanas nem sempre são sociais, somente aquelas baseadas no amor pelo outro. Instituições que negam o outro adoecem.
Uma Conspiração
-
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
As principais razões para o fracasso de pequenas e médias empresas no Ceará em 2005 incluem: 1) má avaliação do tamanho ou potencial do mercado; 2) mau acompanhamento das mudanças no mercado; 3) subestimar ou desconhecer os concorrentes.
Curl formers are a tool used to create waves or curls in hair without heat. The document provides instructions for using curl formers to achieve wavy or curly hair. Steps include applying product to damp hair, dividing it into sections, and wrapping each section around a curl former.
The document discusses informed consent in medical ethics. It defines informed consent as a process where a healthcare provider educates a patient about risks, benefits, and alternatives of a procedure so the patient can make a voluntary decision. Valid consent requires the patient be competent, informed of risks/benefits, and consent voluntarily without coercion. Exceptions exist for emergencies or incompetent patients where a surrogate may provide consent.
CHAPTER 9 CONSENTConsent is an ethical imperative of great impo.docxchristinemaritza
CHAPTER 9 CONSENT
Consent is an ethical imperative of great importance to managers and clinicians. It is clear that patients want to be more involved in medical decision making. The issues that consent raises suggest both a problem and a goal for health services providers.
The concept of consent in medical care evolved to protect patients from nonconsensual touching. Although the ethical and legal dimensions overlap, the legal requirements of consent are the minimum expected. The ethics of consent are grounded in the principle of respect for persons, specifically the element of autonomy, which reflects a view of the equality and dignity of human beings. In addition, the ethics of consent reflect the special relationship of trust and confidence between physician and patient and between organization and patient. This fiduciary relationship is supported by the principles of beneficence and nonmaleficence. The manager's virtues of trustworthiness, honesty, integrity, and candor also support the ethics of consent.
According to the law, failure to obtain consent can support a legal action for battery, an intentional tort. Beyond this, an action for negligence can be brought if the physician breaches the duty to communicate information necessary for the patient to give informed consent.
Paternalism stems from beneficence and is the ethical value that competes with patient autonomy in implementing consent. Paternalism arises naturally from the relationship between physician and patient because psychologically, technically, and emotionally, the physician is in a position of superior knowledge and is expected to help choose the best course of action for the patient. This reflects the ethics of care discussed in Chapter 1. The paternalism inherent in the physician–patient relationship was first described in the Hippocratic oath. Beneficence, nonmaleficence, and paternalism continue to be important and are implicit elements of the practice of medicine. The revisions of the Principles of Medical Ethics adopted by the American Medical Association (AMA) in 1980 moved organized medicine from paternalism toward autonomy and patient rights, themes that continued in the 2001 revision. The AMA's Council on Ethical and Judicial Affairs amplified these themes in its Fundamental Elements of the Patient–Physician Relationship statement. This document and the 2001 Principles of Medical Ethics are reproduced in Appendix B.
Specialized codes that guide biomedical research (e.g., the Declaration of Helsinki) also recognize the importance of consent. The emphasis on patients' rights or sovereignty in documents such as these are ideals toward which managers and organizations should strive.
LEGAL ASPECTS
Legally, consent must be voluntary, competent, and informed. The law presumes that persons unable to give consent in an emergency want to receive treatment. The presumption of wanting treatment can be rebutted if a competent patient declines it or if the person requiring ...
The document discusses the concept and practice of informed consent in clinical contexts. It covers informed consent from legal, ethical, and administrative perspectives. Legally, informed consent aims to protect patient autonomy and self-determination. Ethically, it seeks to make the medical decision-making process more patient-centered. Administratively, signed consent forms are used to document that a consent process occurred. The document also outlines common elements of informed consent discussions, including diagnosis, treatment options, risks/benefits, alternative treatments, and prognosis.
This document discusses informed consent and refusal of treatment issues. It begins by defining informed consent as a process where a health care provider discloses appropriate information to a competent patient so they can voluntarily accept or refuse treatment. It notes that consent was not historically required, as professionals were expected to determine treatment themselves, but it became important in the 20th century. The document then outlines the legal requirements for informed consent, including adequately informing patients and obtaining consent except in emergencies. It discusses standards for informed consent, including the professional standard of disclosing what colleagues would and the reasonable person standard of disclosing what patients need to make an informed choice. The document analyzes cases involving these standards and issues like ensuring understanding and voluntary consent.
Patient informed consent in prenatal screeningRustem Celami
This document discusses informed consent in prenatal screening. It notes that while informed consent protocols are presumed adequate in developed countries, they leave much to be desired in developing countries like Albania. The document explores whether problems with informed consent identified in Western nations also exist in Albania. Interviews with mothers and health practitioners in Albania revealed issues with informed consent similar to research findings abroad, and ways informed consent can be unintentionally undermined in clinical settings in Albania.
True professionals and doctrine of informed consent Ruby Med Plus
Abstract
The clinical practices around informed consent in healthcare settings have undergone a revolution for the better over recent decades. However the way doctor obtains informed consent still remains problematic. A number of factors have contributed to the continued dominance of the traditional dentist-patient imbalance of power, but, demands for more patient autonomy are increasing. The reasons for this ambiguity are varied. The complexity of communication in clinical encounter, the role of autonomy and the changing nature of the doctor-patient relationship, have also contributed to this uncertainty which still remains in many clinical settings. The uncertainty is partly due to the conceptual dullness of important core concepts.
This document discusses informed consent in emergency situations. It begins with an introduction to informed consent and its importance. It then discusses the historical development of the informed consent doctrine and how cases have shaped its scope. It also examines the legal issues around informed consent in emergency situations, noting exceptions allow treatment without consent if the benefit outweighs the harm. The document concludes by emphasizing the need for all parties to understand this aspect of healthcare law and ethics.
This document discusses several key topics in medical ethics including:
1. The basic concepts of medical ethics including beneficence, non-maleficence, autonomy, justice, and informed consent.
2. Historical events that shaped modern medical ethics such as the Tuskegee Syphilis Study and the Doctors' Trial at Nuremberg.
3. The role of Institutional Review Boards in ensuring ethical research and protecting human subjects.
4. Common ethical issues in healthcare like end-of-life care, advance directives, withdrawal of life-sustaining treatment, and resolving disagreements between patients/families and physicians.
This document discusses several key issues in medical ethics, including informed consent, patient capacity, disclosure, and the relationship between doctors and patients. It emphasizes that informed consent requires doctors to disclose appropriate information to patients regarding treatment procedures, risks, and alternatives so patients can make voluntary decisions. Patient capacity and surrogate decision makers are also addressed. Maintaining patient confidentiality and truth telling are presented as important principles underpinning the trust between doctors and those seeking medical care.
5 The Physician–Patient Relationship Learning Objectives After.docxalinainglis
5 The Physician–Patient Relationship
Learning Objectives
After completing this chapter, you will be able to:
· 1. Define the key terms.
· 2. Describe the rights a physician has when practicing medicine and when accepting a patient.
· 3. Discuss the nine principles of medical ethics as designated by the American Medical Association (AMA).
· 4. Summarize “A Patient’s Bill of Rights.”
· 5. Understand standard of care and how it is applied to the practice of medicine.
· 6. Discuss three patient self-determination acts.
· 7. Describe the difference between implied consent and informed consent.
Key Terms
Abandonment
Acquired immune deficiency syndrome (AIDS)
Advance directive
Against medical advice (AMA)
Agent
Consent
Do not resuscitate (DNR)
Durable power of attorney
Human immunodeficiency
virus (HIV)
Implied consent
Informed (or expressed)
consent
Incompetent patient
In loco parentis
Living will
Minor
Noncompliant patient
Parens patriae authority
Privileged communication
Prognosis
Proxy
Uniform Anatomical Gift Act
THE CASE OF DAVID Z. AND AMYOTROPHIC LATERAL SCLEROSIS (ALS)
David, who has suffered with ALS for 20 years, is now hospitalized in a private religious hospital on a respirator. He spoke with his physician before he became incapacitated and asked that he be allowed to die if the suffering became too much for him. The physician agreed that, while he would not give David any drugs to assist a suicide, he would discontinue David’s respirator if asked to do so. David has now indicated through a prearranged code of blinking eye movements that he wants the respirator discontinued. David had signed his living will before he became ill, indicating that he did not want extraordinary means keeping him alive.
The nursing staff has alerted the hospital administrator about the impending discontinuation of the respirator. The administrator tells the physician that this is against the hospital’s policy. She states that once a patient is placed on a respirator, the family must seek a court order to have him or her removed from this type of life support. In addition, it is against hospital policy to have any staff members present during such a procedure. After consulting with the family, the physician orders an ambulance to transport the patient back to his home, where the physician discontinues the life support.
· 1. What were the primary concerns of the hospital?
· 2. What was the physician’s primary concern?
· 3. When should the discussion about the patient’s future plans have taken place with the hospital administrator?
Introduction
Few topics are as important as the physician–patient relationship. This relationship impacts the entire healthcare team. All healthcare professionals who interact with the patient must understand their responsibilities to both the patient and the physician. The patient’s right to confidentiality must always be paramount.
The first physicians were “medicine men,” witch doctors, or sorcerers. The physician–pa.
The medical interview is the physician's most important diagnostic and therapeutic tool, but is difficult to master. It provides valuable patient information, yet receives little training focus. Effective communication skills like rapport building and active listening are especially important for EMTs and other pre-hospital providers to obtain information from patients. Models like partnership, shared decision making, and AIDET promote patient-centered care through open communication. Developing strong patient-doctor relationships requires commitment to caring communication skills.
Medical Research: conflicts between autonomy and beneficence/non maleficence, euthanasia, informed consent, confidentiality, criticisms of orthodox medical ethics
ETHICAL AND LEGAL ISSUES IN CARDIOVASCULAR AND THORACIC NURSING.pptxEDWINjose43
Cardiovascular and thoracic nurses often face ethical and legal dilemmas that stem from advanced medical technologies. They must apply principles like autonomy, beneficence, and informed consent. Some common issues include promoting patient well-being, preventing harm, handling errors, withdrawal of life support, and allocating resources fairly. Evidence-based practice provides the best evidence to guide complex healthcare decisions and improve patient outcomes.
M. Pharm: Research Methodology and biostatics SONALI PAWAR
This document outlines the contents of a lecture on research methodology and biostatistics delivered by Prof. Sonali R. Pawar. It covers various topics in medical ethics including: the history of medical ethics traced back to guidelines like the Hippocratic Oath; core values like autonomy, beneficence, non-maleficence; concepts like informed consent and confidentiality; criticisms of orthodox medical ethics; the importance of communication and guidelines/ethics committees; cultural concerns and conflicts of interest. It also discusses principles like double effect and end of life issues like futility.
This document discusses several important aspects of the doctor-patient relationship, including:
1) Doctors have a duty to act in their patients' best interests according to ethical principles. An effective relationship requires respect, understanding, and trust between doctors and patients.
2) Factors like mutual understanding, clear guidelines for care options, comfort during illness, and open discussion even during uncertainty are important.
3) The relationship must maintain patient confidentiality, honesty, and informed mutual decision-making while avoiding discrimination, abuse, or neglect. Terminating a relationship requires reasonable cause and respecting professional boundaries is important.
Informed consent is the process by which a physician shares information with a patient about their medical condition, treatment options, risks and benefits to allow the patient to make an informed decision. It involves a dialogue where the physician explains the diagnosis, treatment recommendations and alternatives while addressing the patient's questions and concerns. The goal is to provide the right amount of information tailored to the individual patient's needs and comprehension so they can collaborate as a partner in their care. However, studies show physicians often fail to fully practice informed consent due to challenges in communication, time constraints and patient factors like anxiety.
This document discusses the ethical aspects of anesthesia care and euthanasia. It covers topics such as informed consent, do not resuscitate orders, truth telling about medical errors, end of life decision making, physician assisted suicide, organ transplantation, medical research ethics, and euthanasia. The document outlines various ethical theories and the four pillars of medical ethics: respect for patient autonomy, beneficence, nonmaleficence, and justice. It also discusses concepts like informed consent, surrogate decision making, conscientious objection, and the ethical treatment of children and animals in medical research.
Running head IMPORTANCE OF INFORMED CONSENT .docxcowinhelen
Running head: IMPORTANCE OF INFORMED CONSENT 1
IMPORTANCE OF INFORMED CONSENT 11
The Importance of Informed Consent
Student's Name
Student's ID
University Affiliation
In the course of offering treatement, a patient might be in dire need of serious medical attention. In such a scenario, the patient needs to sign some documents, which say that before undergoing the treatement, the patient was aware of all the possible injuries or effects that could occur from this treatement. The process of getting the patient to sign these form of documents, is what is referred to as the process of acquiring an informed consent (Ruth, 1986).
By definition, informed consent refers to the process of granting permission to go through with a form of treatement, in which the patient says that he or she is aware of all the risks that come with the treatement procedure that is going to be administered. Following the granting of permission to go ahead with the medical procedure, the doctors do their best to do their work perfectly. However, in the instance that something were to go wrong, and the procedure doesn’t produce only the positive effects, the doctor is by law exempted from taking any of the blame, and the hospital is also protected by the law (Jessica, 2001).
In this case, the informed consent is important because, it acts as proof that the patient was aware of the risks, before undergoing the procedure and therefore, if something went wrong, the doctors and the hospitals are not to blame. The risk was simply part of the equation from the very beginning and therefore that it occurred is no one’s fault.
Arguably, there have been concerns among popular groups of people, concerning the method in which the doctor gets the patient to sign the various documents, constitution the informed consent documents. To some patients, especially those who were undergoing a complicated procedure, claim that they were not fully made aware of all the different problems that could arise out of the procedure.
In this case, the doctors find themselves under a spotlight since, probes will be raised over their ability to clearly inform the patients of the procedure they are undergoing, the possible risks involved with the current procedure, the alternative treatement modes, and the risks and benefits of those other methods too.
There have been concerns also, over the time that the patient is given, prior to the signing of the documents. Some researchers have reported that, the patients need to be given time to read through and understand the documents given, and then, allow him or her to deliberate on the issue, before coming to a decision. In some practices, the documents are only signed a few minutes before surgery is administered, clearly giving the patient no say in the matter as they have no other option but to sign the document.
Follo ...
Similar to Casual consent to treatment muhammad saaiq (20)
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Muhammad Saaiq received a certificate for 3 hours of CME credit for peer reviewing a manuscript for Clinical Infectious Diseases. The review was accepted and met the criteria for CME credit. IDSA thanked Muhammad for his work and hoped he would participate in peer reviewing again in the future. The certificate was included in the email and can be printed for his records.
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1. Casual Consent to Treatment: A Neglected Issue in our Health Care System Muhammad Saaiq and Khaleeq-Uz-Zaman
Medical Ethics In Debate
Casual Consent to Treatment:
A Neglected Issue in our Health
Care System
While internationally the medical community has effected a drift from the traditional concept
of simple consent to the more sophisticated notion of informed consent, consent still
continues to be a largely neglected component of our health care system. There is lack
of recognition of the significance of consent to treatment and hence the consent process is
taken as a casual formality both by our doctors as well as patients. Most of the time the
doctors are forced by local cultural factors and social customs to compromise on the
principles of consent taking. This compels them to take added responsibility and a great
professional risk. There is a dire need to rectify this trend because an informed consent not
only ensures the patient’s autonomy, self-determination and informed decision-making
but is also a reaffirmation of the doctor’s ethical and legal responsibilities towards his
patient.
This article highlights the various conceptual and methodological processes involved in the
consent with identification of the deficiency areas in our own system.
KEY WORDS : Consent to treatment, Informed consent.
Muhammad Saaiq*
Khaleeq-Uz-Zaman**
*Postgraduate Resident,
Department of Surgery,
PIMS, Islamabad.
**Professor and Head,
Department of Neurosurgery,
PIMS, Islamabad.
Address of Correspondence:
Dr. Muhammad Saaiq
Medical Officer,
Department of Surgery, PIMS,
Islamabad, Pakistan.
E-mail
muhammadsaaiq5@gmail.com
Introduction
In the last few decades the traditional paternalistic
model of patient care has been replaced by one that
emphasizes patient autonomy, empowerment and full
disclosure of facts. The entire health care delivery is
being redesigned from the patient’s perspective.1
It is
generally agreed worldwide that patient’s consent is
imperative for any medical intervention unless he is
incapable of consenting or the doctor is legally required
to intervene without the patient’s wishes.2
Even if it is a
legal requirement it is ethically more appropriate to
obtain the patient’s consent.3
The various aspects of
medical management for which consent is considered
mandatory include clinical examinations, investigations,
therapeutic interventions and participation in clinical
research etc.4,5
Whereas internationally there is growing recognition of
the significance of consent both for the doctor as well as
the patient, our doctor community still continues to be
largely informal about this very key component of
health care system.
What Constitutes a Consent?
Generally speaking consent is a mutual agreement,
compliance or understanding between the patient and
his care provider whether a person or institution.
Traditionally consent has been described as either
implied or expressed. Implied consent is the one which
is neither expressed verbally nor in writing and is
provided by the demeanour of the patient. In most of our
clinical or hospital practice it is the valid form of consent
for routine clinical assessment and treatment. e.g. a
patient visiting a clinic for the management of common
Ann. Pak. Inst. Med. Sci. 2006; 2(3):207-212 207
2. Casual Consent to Treatment: A Neglected Issue in our Health Care System Muhammad Saaiq and Khaleeq-Uz-Zaman
cold, sore throat etc. In such cases the implied consent
would be sufficient for routine clinical examination,
however more complex examination such as that of
private parts or female breast would require an explicit
consent. Expressed consent refers to the one which is
expressed either verbally or in writing. The expression
should be done in the presence of a third party
unrelated to the patient so that this evidence remains
unbiased in the event of any allegation against the
doctor . 4-6
In view of the ever-increasing new diagnostic and
therapeutic interventions and sophisticated research
protocols, the traditional concept of consent has much
changed. Now it is an era of informed consent which
adequately satisfies both ethical as well as legal aspects
of the standard medical practice of the contemporary
era. 7-9
What are the essentials of an
informed consent?
Historically there has been a move from simple to
informed consent and the basic philosophy behind this
drift is to ensure patient’s autonomy and right of self-
determination in making informed decisions about his
health. 10,11
Meaningful and fair consent essentially demands that
the patient be given sufficient and understandable
information to make a valid choice of his treatment. The
consent form is not equivalent to consent.12
The
important attributes of informed consent are information
13
, trust 14
and lack of coercion 15
. The consent
process often starts at the time of admission with implicit
rules of communication and participation being
conveyed to the patient. The signing of consent form
just prior to surgery while on the ward tends to be a re-
affirmation of the same.
Modern law emphasizes patient’s consent to treatment
not only through liability for unauthorized touching ( i.e.
criminal assault and/ or civil battery) but also through
liability for negligence. 16
New dimensions to the
traditional informed consent are being sought and there
is reconsideration of even legislative provisions
regarding public education programmes towards
consent related specific issues such as disclosure ,
advance directives, substitute decision, emerging
treatments and advocacy. 17
The generally agreed elements to be disclosed for
eliciting informed consent from a legally competent
patient include the diagnosis, the patient’s prognosis if
untreated, alternative treatment options , the success
rate of each option, the risks and benefits of the
anticipated procedure and the patient’s right to exercise
veto power over a doctor’s decision. 16,18
How much risk-information to deliver
in the consent process?
Over the last two decades particularly there has been an
explosive expansion of the understanding of how people
perceive and code risks and then use this information in
decision making. 19-21
There is growing evidence that the patients often
employ simplifying heuristics in judgment and decision
making. These heuristics may lead to bias in how
people interpret information. However much of our
understanding of risk perception is based on laboratory
studies and it is less clear whether risk perception in the
real world exhibits the same pattern and biases. 19
Legally, informed consent for therapy is a risk-
management tool that functions essentially as a release
of liability. If the patient is informed of all the expected or
potential side-effects or toxicities of a treatment, he
cannot sue the doctor or hospital because those side
effects occur. The moral doctrine of informed consent is
derived from a respect for the patient's autonomy as
well as the patient's vulnerability. The physician's goal is
not to minimize liability but to help the patient make the
best decision. These two goals are not necessarily
incompatible but they often lead to different attitudes
towards informed consent and different decisions about
what information needs to be shared with patients. If the
goal is risk-management then informed consent forms
should be encyclopaedic providing the "whole truth" to
the patient. This would however not meet the moral
goals of shared decision-making because few patients
could make sense of such data. This may elicit even
counterintuitive and probably counter-productive
response. 9
Even in the developed countries patients don’t realize
the purpose and significance of information and consent
form. In a country like the United States, less than 31%
of the people have any college education. In this context
expressing and understanding risk is a problem equally
faced by doctors and patients across the world. 22-24
Ann. Pak. Inst. Med. Sci. 2006; 2(3):207-212 208
3. Casual Consent to Treatment: A Neglected Issue in our Health Care System Muhammad Saaiq and Khaleeq-Uz-Zaman
Consent taking in developing
countries like ours!
We in our set up are faced with yet more complicated
issues. The stingy botherations are: What kind of
information to deliver ? How much risk information to
communicate? Whom to tell and Whom not to tell?
When and how to communicate? etc. Since our society
is suffering from a social divide, we in our clinical
practice encounter two extreme varieties of people. i.e.
the deprived and poor ones and the affluent and
influential ones . The former strata , owing to their
uneducated and ignorant behaviour prompt a
‘communication block’ on part of the dealing doctor
while the latter group owing to their narcissistic
behaviour cause an ‘empathy block’. As a result,
effective communication is impaired at the very outset of
doctor-patient interface.
Not infrequently we encounter problems when we are
about to break bad news to our patients. For instance a
lady with breast cancer would be all set for surgery but
the sons would insist on not disclosing any information
to their mother about the diagnosis as well as the plan
for surgery.
In Neurosurgical practice we encounter yet more
strange situations. For instance a patient with sciatica
would seek our advice and when he is advised surgery,
he would go away saying that he has heard of the risk
of paraplegia and life long disability associated with
spinal surgery. Similarly a patient with acoustic neuroma
would be ready to undergo surgery but would disappear
if the risk of facial palsy is communicated to him. These
circumstances force us not to tell the patient all the likely
risks involved in the anticipated procedure, however
who can guarantee the ‘cure without any risk of
complications’ . Still our patients would search for
someone who can offer cure with no chance of risks
whatsoever and at times end up with the so called
100% healers.
Who is competent to consent to
treatment?
Anyone who can give a legally valid consent must be
competent. There exists a fine balance between
patient’s autonomy and self-determination on one hand
and protection of the incompetent patient from potential
harm on the other hand. Competence refers to the state
in which a patient’s decision making capacities are
sufficiently intact for their decisions to be honoured. 25
This capacity to make decisions is required for anyone
to give a valid informed consent however informed
consent requires more than this capacity, for example,
trust and lack of coercion. More importantly there must
be an understanding of what is being consented to .
14,15,26
Generally the current recommendation is that in non-
emergency situations, individuals who are competent to
give informed consent to treatment should be extended
the right to refuse it as well. 27
Who are incompetent to consent?
Incompetence refers to a status of the individual as
defined by the functional deficits ( due to mental illness,
mental retardation or other mental condition) judged to
be sufficiently great that the person currently can’t meet
the demand of a specific decision making situation
weighed in light of its potential consequences. 25
Patient’s understanding of the information about
treatment is the main determinant of his capacity to
give informed consent. Incapacity is generally
considered in terms of understanding and
communication. 28-30
In England the law emphasizes a
patient’s understanding of the information about the
proposed treatment, potential risks and benefits of
treatment and the consequences of not taking the
treatment. 3
Thus any person would be considered
unable to take a decision on mental treatment in
question if he is unable to understand or retain the
information relevant to the decision, unable to make a
decision based on the information or unable to
communicate a decision. 3
Mental disorders associated
lack of insight would incapacitate the patient to consent
for treatment .
Most of the criteria for competence in current use
emphasize cognitive rather than affective dimension of
capacity to consent. Clinical experience indicates that
affective disorders may impair competence in a
detectable and identifiable way. In particular patients
with major affective disorders can retain the cognitive
capacity to understand the risks and benefits of a
medication yet fail to appreciate its benefits. 31
Ann. Pak. Inst. Med. Sci. 2006; 2(3):207-212 209
4. Casual Consent to Treatment: A Neglected Issue in our Health Care System Muhammad Saaiq and Khaleeq-Uz-Zaman
How should a doctor approach an
incompetent patient?
In cases where the patient is unable to give an informed
consent to any treatment such as when the patient is
unconscious or mentally incapable, the doctor’s duty to
preserve life remains paramount. In non-emergency
situations court approval is required for procedures such
as sterilization, abortion, organ donation or experimental
studies. 32
A patient's incapacity to give informed consent to one
medical intervention should not be assumed to imply
incapacity to give consent to all other interventions.
Legally as well as ethically if a patient is incapable of
giving consent to one intervention it does not
necessarily imply incapacity in general . For example a
patient suffering from schizophrenia may be capable of
giving informed consent to the treatment of his diabetes
but not to the treatment for his schizophrenia or vice
versa. Thus each proposed intervention would require
an independent assessment
of the patient’ s particular
capacity to give informed consent for that specific
intervention. 25
A challenging situation arises when a clinician is
required to assess a mentally ill patient’s capacity to
give informed consent to a clinical examination. The law
of the land in the form of mental health act for instance
would solve such issues by ordering or requiring the
doctor to examine the patient even without his consent.
The recent trend of encouraging patients with learning
disabilities to actively participate in decision making
about their psychological and medical treatment raises
even more complex questions regarding their ability to
consent.
How to take children’s consent to
treatment?
Children’s consent to treatment is one of the most
important issues surrounding the complex area of
consent to treatment. Conceptual and methodological
issues continue to be debated in this grey area and the
approach to the problem varies from country to country.
33-37
In general a child or young adolescent whose
competence is in doubt will be found rational if he
accepts the proposal to treatment but may be found
incompetent if he disagrees to a medially indicated
treatment. 38
Refusals of children or their parents to medically
indicated treatment result in serious legal and ethical
dilemmas putting the doctor in an embarrassing
situation. Such situations demand careful and sensitive
clinical and ethico-legal intervention and close
cooperation among professionals particularly doctors
and social workers.39
Professionals have to decide
whichever legal route is best for a given child.
In the UK , since the introduction of children act 1989
several cases have been brought on the issue of a child
or young adolescent refusing to consent to a medically
indicated treatment or assessment. 40-42
In the US,
parents usually must consent to medical procedures
involving minor children, however parental consent is
not required in areas such as emergency situations,
medical care in pregnancy, treatment of sexually
transmitted diseases , treatment of substance abuse
and experimental procedures. Moreover parents can’t
withhold medical treatment when a child’s life is
threatened by an illness or emergency. 18
We at our national level don’t have clear guidelines
regarding the knotty issue of children’s consent to
treatment and are blindly following what the Westerns
are practicing. We need to enact essential legislation to
avoid inconveniences which such issues pose to
doctors from time to time.
What is the ‘presumed consent’ to
organ procurement from cadavers?
Generally a person is considered to have a legitimate
and primary proprietary in his or her living or dead body
and thus has first right to control what happens to his or
her body before and after death. 43
The concept of presumed consent has been popular in
the transplant circles since 1968. 44
It has been given
the status of law in Singapore in 1987 , stating that all
majors are presumed to consent to organ donation if
they don’t explicitly object to it . Muslim community of
Singapore is generally considered objector unless they
opt for it. For minors and mentally incapacitated people,
consent is sought from next of kin. 45
This policy of presumed consent for organ
procurement is certainly an attempt to allow for
fulfillment of the needs of informed consent, however it
is a highly complex issue requiring further work
Ann. Pak. Inst. Med. Sci. 2006; 2(3):207-212 210
5. Casual Consent to Treatment: A Neglected Issue in our Health Care System Muhammad Saaiq and Khaleeq-Uz-Zaman
particularly in our setup by close coordination among
medical and legal professionals on one hand and
religious scholars and public leaders on the other hand.
How to tackle the consent issue in
medical education, training and
research in our setup?
We have an interesting anecdote to share with our
readers. It is rather a sort of personal experience
which someone may enjoy as a joke but it really
carries a great meaning in its depth. One of our final
year MBBS clinical batches happened to examine an
elderly male who presented with features of bladder
outflow obstruction. Following his digital rectal
examination by two students when a third one came
forward , the patient stood up and said “I know
you are all students but my anal canal is not your
‘madrassa’ “ This explicit display of the patient’s
feelings is a real reflection of what exactly is happening
in most of our teaching institutions whether
undergraduate or postgraduate. Another equally
important but ignored area is the medical research
conducted on cognitively impaired human subjects.
There is a dire need to evolve standardized approaches
to such issues, which should not only safeguard the
ethicolegal aspects from the patient’s perspective but
also ensure proper training of the medical trainees. This
need is all the greater owing to the fact that we are
faced with ignorance, lack of awareness and lack of
appropriate legal and professional guidelines
appropriate to our own indigenous population and local
circumstances.
.Conclusion
Informed consent is an indispensable component of
contemporary medical and surgical practice. It not only
ensures the patient’s autonomy, self-determination and
informed decision-making but is also a reaffirmation
of the doctor’s ethical and legal responsibilities
towards his patient. In our set up the consent is taken
for granted in the patients’ management. It is high time
that this should be taken seriously. There is an urgent
need for a properly designed study to look into the
problems relating to the consent process and come up
with clear guidelines that could be safely practiced by
doctors in our community.
21) Edwards A, Elwyn G. Understanding risk and lessons for clinical risk
communication about treatment preferences Qual Saf Health Care
2001; 10 (90001) : i9 - 13.
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