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Background reading material for Year 2 Semester 1 Med PPSD Session on 27th August 2008 by Professor Omar Hasan Kasule Sr.
1.0 DEFINITION OF INFORMED CONSENT
No medical procedures can be carried out without informed consent of the patient except in cases of legal incompetence. The patient has the purest intentions in decisions in the best interests of his or her life. Others may have bias their decision-making.
The patient must be free and capable of giving informed consent. Informed consent requires disclosure by the physician, understanding by the patient, voluntariness of the decision, legal competence of the patient, recommendation of the physician on the best course of action, decision by the patient, and authorization by the patient to carry out the procedures.
The patient is free to male decisions regarding choice of physicians and choice of treatments.
Consent can be by proxy in the form of the patient delegating decision making or by means of a living will.
2.0 ISSUES IN INFORMED CONSENT
Consent is limited to what was explained to the patient except in an emergency.
Refusal to consent must be an informed refusal (patient understands what he is doing). Refusal to consent by a competent adult even if irrational is conclusive and treatment can only be given by permission of the court.
Doubts about consent are resolved in favor of preserving life.
Spouses and family members do not have an automatic right to consent. A spouse cannot overrule the patient’s choice.
Advance directives, proxy informed consent by the family are made for the unconscious terminal patient on withholding or withdrawal of treatment.
Physician assisted suicide, active euthanasia, and voluntary euthanasia are illegal even if carried out with patient consent.
3.0 ADVANCE DIRECTIVES/LIVING WILL
The living will has the following advantages: (a) reassuring the patient that terminal care will be carried out as he or she desires (b) providing guidance and legal protection and thus relieving the physicians of the burden of decision making and legal liabilities (c) relieving the family of the mental stress involved in making decisions about terminal care.
The disadvantage of a living will is that it may not anticipate all developments of the future thus limiting the options available to the physicians and the family.
4.0 PROXY DECISION
The device of the power of attorney can be used instead of the living will or advance directive.
Decision by a proxy can work in two ways: (a) decide what the patient would have decided if able (b) decide in the best interests of the patient.
5.0 CONSENT OF CHILDREN
Competent children can consent to treatment but cannot refuse treatment. The consent of one parent is sufficient if the 2 disagree. Parental choice takes precedence over the child’s choice. Courts can overrule parents. Life-saving treatment of minors is given even if parents refuse. Parental choice is final in therapeutic or non-therapeutic research on children.
6.0 CONSENT FOR MENTAL PATIENTS
Mental patients cannot consent to treatment, research, or sterilization because of their intellectual incompetence. They are admitted, detained, and treated voluntarily or involuntarily for their own benefit, in emergencies, for purposes of assessment, if they are a danger to themselves, or on a court order.
7.0 CONSENT IN OBSTETRICS
Labor and delivery are emergencies that require immediate decisions but the woman may not be competent and proxies are used. Forced medical intervention and cesarean section may be ordered by a court in the fetal interest. Birth plans can be treated as an advance directive.