081008L - MEDICAL DECISIONS: AUTONOMY AND CONSENT

Background material by Professor Omar Hasan Kasule Sr. for Year 1 Semester 1 Med PPSD session on 08^th October 2008

DEFINE INFORMED CONSENT:

1. Describe the forms of consent (oral, written, or body language).
2. Distinguish between explicit/express consent (spoken or written) and implicit consent (taking off clothes for examination)
3. Describe the purposes of getting informed consent (autonomy rights & protect the physician).

THE PRINCIPLE OF AUTONOMY:

4. Appreciate that adults are presumed to be competent unless otherwise proved
5. Appreciate that irrational decisions by a competent person are binding.
6. Describe the scope of consent in terms of duration (if time relapses new consent should be sought) and the extent of the procedure (only what was consented to is done).
7. Appreciate that consent does not force a physician to carry out a procedure he things is inappropriate eg amputation of a healthy limb, sex change operation.
8. Describe the autonomous right of a patient to be treated by a physician of his choice.
9. Describe ethico-legal issues that arise if the physician and the patient are of opposite genders.
10. Describe compulsion for purposes of public health (quarantine, isolation, mass immunization, mass treatment during an epidemic).

THE PROCESS OF INFORMED CONSENT:

11. Understand consent as a process and not a one-off event.
12. Describe the conditions for validity of consent (understand nature and purpose of the intervention, sufficient information, believe info and be able to weigh it in balance to reach a decision, voluntary and free from pressure, be aware that can refuse).
13. Describe who should seek informed consent.
14. List and describe the type of information to be provided to the patient (diagnosis, prognosis, proposed treatment and alternatives with explanation of benefits, risks, and costs of each procedure, name of doctor who will carry out the procedure, reminding the patient that he has the right to refuse or change his mind
15. Describe situations in which it would be appropriate to withhold some information from the patient.
16. Describe what is done if the patient refuses to receive information.
17. Describe procedures for which consent must be obtained in writing (complex risky procedures, research).
18. Describe special features of consent in the following situations: surrogate motherhood (must understand the consequences), organ donation (understand risks and benefits for both donor and recipient).

CAPACITY TO CONSENT

19. Distinguish between global and specific competence (patient may be competent to make some decisions and not others).
20. Describe the tests for capacity / competence (understand the intervention and its purpose; understand the benefits, risks, and alternatives; understand the consequences of not receiving the treatment; be able to retain the information long enough to make a decision; be able to weigh the information).
21. Describe methods of enhancing capacity (non threatening venue, treatment of stressful symptoms, talk with patients when side effects of medication are minimal, break down the decision into several steps).

THE PROCESS OF INFORMED REFUSAL:

22. Explain the concept of informed refusal and its documentation.
23. Explain what is done if a patient rejects a cheap intervention in favor of a more expensive one.
24. Describe ethico-legal issues in informed refusal of admission and treatment