Chapter 13: Patient Consent

Adequacy of Consent

-A physician must reveal to his or her patient such information as a skilled practitioner of good standing would provide under similar circumstances. -A physician must disclose to the patient the potential death, serious harm, and other complications associated with the procedure.

Right to Refuse Treatment

-Adult patients who are conscious and mentally competent have the right to refuse medical care to the extent permitted by law. *Hospital should inform patient of risk

Exculpatory Agreement

-An agreement that relieves an individual from liability when he or she has acted in good faith. *Exculpatory agreements generally invalid in health care setting.

Competent Patients

-Every human being of adult years has a right to determine what shall be done with his or her own body and cannot be subjected to medical treatment without his or her consent.

Types of Consent

-Express consent can take the form of *verbal agreement *written document authorizing medical care. -Implied consent is determined by some act or silence, which raises a presumption consent has been authorized (e.g., patient in accident & in comatose state).

Incompetent Patients

-If a physician doubts a patient's capacity to consent, the consent of the legal guardian or next of kin should be obtained. *A person who is mentally incompetent cannot consent to treatment. *Consent of legal guardian required. *If no legal guardian, court must be petitioned to permit treatment.

Patient Consent

-If the patient's choice is not consistent with the physicians recommendation, the physician has the option of withdrawing from the case.

Guardianship

-Individual who by law is vested with the power and charged with the duty of taking care of a patient by protecting their rights and managing the patient's estate. -Necessary when a patient is incapable of managing or administering their private affairs b/c of physical or mental disabilities or they are a minor.

Informed Consent

-Legal doctrine where a patient has right to know potential risks, benefits, & alternatives of a proposed procedure. -Patient has absolute right to know about & select from available treatment options.

Subjective test

-Must determine if the "individual patient" would have chosen the procedure if fully informed.

Objective test

-Must show that a "reasonable person" would not have undergone a procedure if properly informed.

Release form

-Patient's refusal to consent to treatment, for any reason, religious or otherwise, should be noted in the medical record, and a release form should be executed. Completed release provides documented evidence of a patient's refusal to consent to a recommended treatment.

Special Forms of Consent

-Temporary Consent *Allows teacher etc. to act on parent's behalf and seek emergency treatment when necessary while attempts to contact parent are being made -Implied Consent - will be presumed when immediate action is required to prevent death or permanent impairment of a patient's health. *car accident, patient unconscious

Consent Topics

-Verbal Consent *Verbal Consent to Surgery Sufficient -Written Consent - Should be executed when a proposed treatment may involve some unusual risk to the patient. - A list of procedure and treatment requiring written consent should be maintained.

Consent

Voluntary agreement by a person who possesses sufficient mental capacity to make an intelligent choice to a medical procedure and/treatment.

Judicial Consent

_May be necessary where there is a concern as to the absence or legality of consent *When alternatives exhausted *2nd opinions by consulting physicians helpful *On-call legal advice should be sought

Statutory Consent

_When a patient is clinically unable to give consent to a lifesaving emergency treatment, the law implies consent on the presumption that a reasonable person would consent to the lifesaving medical intervention -Consent generally assumed *Ambulance Care -Good Samaritan Statutes *Emergency Departments -When patient clinically unable to give consent the law implies consent on the presumption that a reasonable person would consent to lifesaving medical intervention.