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Background reading material for Year 1 Semester 1 Biomed PPSD session on 21st September 2008 by Professor Omar Hasan Kasule Sr.
1.0 THE RIGHT OF AUTONOMY
The patient has the right of autonomy which is control of what is done to his/her body. Autonomy is a basic human right that cannot be violated except in exceptional circumstances explained below. No medical examination or 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.
2.0 CAPACITY (COMPETENCE) TO GIVE CONSENT
Informed consent is given only by a person who is capacitous (competent). The following are criteria (tests of capacity) are used to judge whether the patient is capacitous: (a) Understands what the procedure is. (b) Understands the reason for the procedure. (c) Understand the benefits and risks of the procedure. (d) Has the ability of judging and weighing the information before coming to a decision (e) Has sufficient memory to retain information given for a long enough period to enable effective decision making (f) Understands the consequences of refusing treatment
3.0 CONSENT FOR COMPETENT ADULTS
Consent can be explicit (oral, written, or non-verbal) or implied. For example a patient undressing for examination implies consent but often this is not enough we need to ask specifically for informed consent as explained below.
The patient must be free and capable of giving informed consent. Pressure on the patient by the family or the healthcare workers invalidates consent.
Informed consent requires disclosure by the physician, understanding by the patient, voluntariness of the decision, legal competence of the patient (also called capacity), disclosure of all treatment alternatives and recommendation of the physician on the best course of action, decision by the patient, and authorization by the patient to carry out the procedures. Consent should be properly documented.
The patient is free to make decisions regarding choice of physicians and choice of treatments. Consent is limited to what was explained to the patient except in an emergency.
The scope of consent is limited to what the patient agreed to and the procedures cannot exceed that except in emergencies. Consent also has a time limitation. If a long time elapses between consent and the procedure it is better to obtain new consent.
The patient is free to withdraw consent at a later time and this decision must be respected. Refusal of treatment is a human right that must be respected. Refusal to consent must be an informed refusal (patient understands what he is doing). Refusal of treatment should be documented properly. Refusal to consent by a competent adult even if irrational is conclusive and treatment can only be given by permission of the court. A patient who refuses a treatment has no automatic right to demand an alternative and may be more expensive procedure.
Doubts about whether consent was or was not given consent are resolved in favor of preserving life.
In some legal systems spouses and family members do not have an automatic right to consent and a spouse cannot overrule the patient’s choice.
Informed consent is still required for physicians in special practices such as a ship’s doctor, prison doctor, and doctors in armed forces. Police surgeons may have to carry out examinations on suspects without informed consent.
Physician assisted suicide, active euthanasia, and voluntary euthanasia are illegal even if done with the consent of the patient.