Transcript informed consent

INFORMED CONSENT
PATIENT PARTICIPATION IN
HEALTH CARE
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ADVANTAGES OF
INFORMED CONSENT I
BOND OF MUTUAL TRUST BETWEEN
PATIENT AND PHYSICIAN.
OPENING IMPORTANT PATHWAYS
OF COMMUNICATION.
PATIENTS TAKE A GREATER MEASURE
OF RESPONSIBILITY.
MORE EXTENSIVE KNOWLEDGE OF
THEIR CONDITION.
IMPACT ON PERSONAL LIFESTYLE.
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ADVANTAGES OF
INFORMED CONSENT II
MORE EFFECTIVE CARING FOR
PATIENTS.
INFORMATION ABOUT PATIENTS.
VALUE BASIS FOR GRANTING OR
WITHHOLDING CONSENT.
REDUCES LIABILITY EXPOSURE.
MAINTAIN AVENUES OF
COMMUNICATION WHEREBY
CONFLICTS CAN BE RESOLVED
WITHIN THE RELATIONSHIP
WITHOUT THE COURTS.
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GENERAL COMPONENTS
OF INFORMED CONSENT I
CONDITION.
DIAGNOSIS.
PROGNOSIS.
AVAILABLE TREATMENTS.
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GENERAL COMPONENTS
OF INFORMED CONSENT II
PROPOSED TREATMENT.
NATURE.
PURPOSE.
RISKS.
BENEFITS.
REASONABLE ALTERNATIVES.
COST???
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INFORMED CONSENT
CONSIDERATIONS I:
President’s Commission (1982)
INTEGRAL PART OF A PLURALISTIC
SOCIETY WITH MULTIPLE VIEWS OF
THE “GOOD LIFE.”
BASIC VALUES UNDERLYING
INFORMED CONSENT.
PERSONAL WELL-BEING.
SELF-DETERMINATION.
SHARED DECISION MAKING --MUTUAL RESPECT.
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INFORMED CONSENT
CONSIDERATIONS II:
President’s Commission (1982)
PRESUMPTION OF CAPACITY TO MAKE
DECISIONS.
CAPCITY IS SPECIFIC TO EACH
DECISION.
CONSULTATION IN CASES OF
INCAPACITY.
INFORMATIVE BUT NOT
DETERMINATIVE.
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LEVELS OF RECEIVING
INFORMATION
FACTS.
PATIENT IS MERELY ACQUAINTED
WITH A BODY OF FACTUAL
KNOWLEDGE WHICH MAY BE FAIRLY
DISCRETE AND UNRELATED.
UNDERSTANDING.
PATIENT HAS MASTERED THE
FACTS AND IS ABLE TO SEE THE
RELATIONS BETWEEN THEM “AT A
DISTANCE.”
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LEVELS OF RECEIVING
INFORMATION
PROCESSING.
PATIENT HAS INTEGRATED FACTS
INTO HIS/HER VALUE CONTEXT.
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EXCHANGE OF POWER
INFORMATION EMPOWERS THE
PATIENT.
CONSENT EMPOWERS THE
PHYSICIAN.
DYNAMICS OF NEGOTIATION ARE
ESSENTIAL TO RELATIONSHIPS OF
POWER.
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SURROGATE STANDARDS:
SUBSTITUTED JUDGMENT I
DECISION THAT THE INCAPACITATED
PERSON WOULD MAKE IF HE/SHE
WERE ABLE TO MAKE A CHOICE.
DECISION THROUGH THE “VALUE
EYES” OF THE INCAPACITATED
PERSON.
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SURROGATE STANDARDS:
SUBSTITUTED JUDGMENT II
BASED UPON:
DIRECT STATEMENTS BY PATIENT.
INFERENCES FROM VALUE CHOICES
OF PATIENT.
GROUNDED IN THE PRINCIPLE OF
AUTONOMY.
SUBSTITUTED JUDGMENT STANDARD
IS PREFERABLE BUT BEST INTEREST
STANDARD IS PERMITTED AND OFTEN
NECESSARY.
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SURROGATE STANDARDS:
BEST INTEREST I
“OBJECTIVE STANDPOINT.”
PROMOTE PATIENT’S GOOD.
REFERENCE TO THE INCAPACITATED
PATIENT’S ACTUAL OR SUPPOSED
PREFERENCES.
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SURROGATE STANDARDS:
BEST INTEREST II
WEIGHING BENEFITS AND BURDENS.
“REASONABLE” PERSON LOOKING AT
CLINICAL OUTCOMES.
SELF-REFLECTIVE.
RELATIVELY UNBIASED.
ATTEMPTING FACT-BASED
OBJECTIVITY.
SETTING ASIDE SELF-INTEREST.
GROUNDED IN THE PRINCIPLE OF
BENEFICENCE.
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MODELS OF IMPLEMENTING
INFORMED CONSENT:
EVENT MODEL
DISCRETE ACT.
MINIMAL LEGAL REQUIREMENT.
CONSENT FORM AS A SYMBOL.
HOW MUCH DO PATIENTS TRULY
UNDERSTAND?
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MODELS OF IMPLEMENTING
INFORMED CONSENT:
PROCESS MODEL I
ACTIVE PATIENT PARTICIPATION IN
DECISION MAKING.
ROLE EXPECTATIONS OF PHYSICIANS
AND PATIENTS.
IMPORTANCE OF PATIENT’S
PERSONAL AND VALUE HISTORY.
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MODELS OF IMPLEMENTING
INFORMED CONSENT:
PROCESS MODEL II
PATIENT RESPONSIBILITY.
MUTUAL MONITORING.
CONTINUAL DIALOGUE.
CONTINUAL RUMINATION AND
REORDERING OF KNOWLEDGE IN
LIGHT OF NEW INFORMATION AND
EXPERIENCE.
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STRATEGIES FOR
PROCESS MODEL I
DEFINE PROBLEM.
ESTABLISH RESPONSIBILITY.
PERSONAL AUTONOMY.
NORMAL PART.
GETTING WELL.
MANAGING A DISEASE.
SET GOALS FOR TREATMENT.
SELECT APPROACH TO TREATMENT.
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STRATEGIES FOR
PROCESS MODEL II
SET GOALS FOR TREATMENT.
SELECT APPROACH TO TREATMENT.
FOLLOW-UP IN EXTENDED
TREATMENT.
SOLICIT PATIENT REFLECTIONS.
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COMMUNICATION AND
INFORMED CONSENT I
ACCURATE INFORMATION.
INFORMATION IN AN
UNDERSTANDABLE WAY.
PROCESSING INFORMATION WITHIN
PATIENT’S VALUES AND GOALS.
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COMMUNICATION AND
INFORMED CONSENT II
EXPLORING FEELINGS.
SHARING RESPONSIBILITY.
AVOIDING EUPHEMISMS AND DOUBLE
MESSAGES.
SUPPORTING PATIENT IN THE
DECISION.
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PROBLEMS IN
INFORMED CONSENT I
COMMUNICATION.
TIME.
EFFICIENCY.
LANGUAGE.
UNCERTAINTIES.
PROBABILITIES.
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PROBLEMS IN
INFORMED CONSENT II
TRUST.
IN PHYSICIAN.
IN PATIENT.
PATIENT’S VALUE CONTEXT.
WHAT PATIENT CONSIDERS
BENEFICIAL.
PATIENT’S TOLERANCE LEVEL FOR
RISKS --- MORBIDITY, MORTALITY.
PATIENT’S FEAR LEVEL.
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PROBLEMS IN
INFORMED CONSENT III
INEQUALITY OF PATIENT AND
CAREGIVER.
KNOWLEDGE BASE.
VARIABILITY OF VALUES.
EXPERIENCE.
VULNERABILITY.
PRESUMING TOO MUCH KNOWLEDGE
FROM PATIENT.
SPECIFICITY IN CONSENT FORM.
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PROBLEMS IN
INFORMED CONSENT IV
TESTING UNDERSTANDING.
REPEATING WORDS.
SIGNIFICANCE FOR LIFESTYLE.
ROLE OF SURROGATES.
DECISIONAL CAPACITY.
VARYING WISHES OF PATIENTS AND
SURROGATES.
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PROBLEMS IN
INFORMED CONSENT V
ROLE OF CAREGIVERS.
PROVIDE INFORMATION.
PROCESS INFORMATION.
RESOURCE ISSUES.
STANDARDS.
REASONABLE PHYSICIAN.
REASONABLE PATIENT.
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