2. Informed Consent

Who are emancipated minors

defined via state statute; court ordered except certain situations without court order: a) Marriage, b)Parentage, c) Self-Supporting, d) Armed Forces

2 types of informed consent

expressed and implied

2 types of consent

informed and uninformed

What are Good Samaritan laws for

protect providers who act in good faith without gross negligence or malice

2 types of expressed informed consent

verbal, written

Reasonable patient standard for consent

"Material risks" must be disclosed; A risk is material if the physician believes a reasonable person in the patient's position would likely attach significance to the risk

What is the rule with emergency situations with informed consent

- Physicians do not need to receive informed consent from a patient when stopping to obtain consent would cause serious harm; Potential loss of life/limb, bodily function, use of body parts, severe pain, permanent disability

Steps to follow with informed refusal

1. Ask them to sign an AMA form 2. Always remember, "if it isn't charted, it didn't happen."

3 ways to get informed consent (2 unethical)

1. Coercion: Always unethical/ Credible Threat 2. Manipulation: Always unethical/ Non-Truthful 3. Persuasion: Ethical (and legal) / Presentation of rational argument

What should be documented with consent

1. Diagnosis, Examination and Evaluation 2. Recommended Intervention 3. Risks, Benefits and Prognosis 4. Ask for Questions and Gave Answers 5. Consequences to Inaction

4 nuances to minors

1. Emergency Situations 2. Mature Minors 3. Emancipated Minors 4. Specific Decisions

4 exceptions to informed consent

1. Emergency Situations 2. Waivers 3. Incapacity 4. Minors

When obtaining consent, what are 4 things you want to do

1. Make sure the patient has capacity 2. Get consent that is given freely 3. Provide sufficient information 4. Time to ask questions

5 generally accepted requirements in obtaining consent

1. Nature 2. Risks 3. Alternatives 4. Benefits (Expected) 5. Consequences to Non-Action (cervical cancer case)

When making disclosures, what are 3 things you should do

1. Plain English 2. Use an interpreter if necessary 3. Encourage questions and answer to patient's satisfaction

general rules to follow for obtaining consent

1. The greater the risk, the greater the duty to inform 2. The more elective the procedure, the more detailed the description 3. Provide information that is pertinent to the patient's decision making 4. Remember the purpose of informed consent

2 main things you need to tell patients when getting consent

1. Things that are most common: Drowsiness, weight gain, nausea, vomiting 2. Things that are most severe: Paralysis, loss of vision, loss of hearing, death

General Rule of Informed Consent

All primary health care providers have a legal and ethical duty to provide their patients with sufficient information about examination and intervention to allow them to make a knowing, intelligent, and unequivocal decision regarding treatment

Who are "mature minors"

An individual who possesses sufficient understanding and appreciation of the nature and consequences of treatment despite their chronic age Factors: Age, cognitive ability, moral development, current functionality, etc.

Why is no consent necessary to treat a minor in need of immediate care

Assumption is that parents would have consented to treatment had they been present

What is the general rule for treating minors

Minors are presumed to be incompetent to make their own decisions in all arenas, including health care, due to cognitive limitations and immaturity; Best Interest Standard

How are waivers an exception to informed consent

Patients may voluntarily and deliberately decline the right to provide informed consent

Reasonable Physician Standard for consent

Physicians provide information that a "reasonably prudent practitioner in the same situation would"

What is implied informed consent

Present in situations where a patient voluntarily submits to a procedure or examination with apparent knowledge of the procedure; Procedure presents slight or no apparent risk Examples: Rolled sleeve for blood test, rolling sleeve for taking pulse, and opening mouth to take temp.

How do you figure out incapacity in informed consent

Starting point: Always assume patient has capacity Decision Specific: Understand, Weigh Pros and Con, Communicate the Decision

Who is the person that should obtain consent?

The person performing the procedure

Michigan Definition of emancipated minors

The termination of the rights of the parents to the custody, control, services, and earnings of a minor

Informed consent

The voluntary affirmation by the patient to allow touching, examination and treatment

Uninformed consent

When a patient gives permission but does not understand or comprehend what he/she has consented to

What is the key when using forms for consent

Whether they were given the information necessary to make a decision

Why do you need informed consent

a lot of pitfalls if you have someone else do it for you (like a resident)

4 examples of specific decisions with consent in minors where you don't need the parents' permission

a) Mental Health b) Treatment for STI's c) Substance Abuse d) Contraception