INFORMED CONSENT

ADVANTAGESFEATURESSTYLES

ADVANTAGES OF INFORMED CONSENT• CREATES A BOND OF MUTUAL TRUST BETWEEN PATIENT AND

PHYSICIAN BY OPENING IMPORTANT PATHWAYS OF COMMUNICATION

• HELPS PATIENTS TAKE A GREATER MEASURE OF RESPONSIBILITY IN THE COURSE OF THEIR TREATMENT BY HAVING MORE EXTENSIVE KNOWLEDGE OF THEIR CONDITION AND ITS IMPACT ON THEIR PERSONAL LIFESTYLE

• ALLOWS THE PHYSICIAN TO CARE FOR PATIENTS MORE EFFECTIVELY BY HAVING MORE COMPLETE INFORMATION ABOUT PATIENTS INCLUDING THE VALUE BASIS FOR GRANTING OR WITHHOLDING CONSENT

• REDUCES THE LIABILITY EXPOSURE OF PHYSICIANS BY MAINTAINING AVENUES OF COMMUNICATION WHEREBY CONFLICTS CAN BE RESOLVED WITHIN THE RELATIONSHIP WITHOUT THE NECESSITY OF HAVING RECOURSE TO THE COURTS

GENERAL COMPONENTS OF INFORMED CONSENT• CONDITION

– DIAGNOSIS– PROGNOSIS– AVAILABLE TREATMENTS

• PROPOSED TREATMENT– NATURE– PURPOSE– RISKS– BENEFITS– REASONABLE ALTERNATIVES– COST???

INFORMED CONSENTPRESIDENT’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

• PRESUMPTION OF CAPACITY TO MAKE DECISIONS

• CAPCITY IS SPECIFIC TO EACH DECISION

• CONSULTATION IN CASES OF INCAPACITY– INFORMATIVE BUT NOT DETERMINATIVE

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”

• PROCESSING– PATIENT HAS INTEGRATED FACTS INTO HIS/HER

VALUE CONTEXT

EXCHANGE OF POWER

• INFORMATION EMPOWERS THE PATIENT

• CONSENT EMPOWERS THE PHYSICIAN

• DYNAMICS OF NEGOTIATION ARE ESSENTIAL TO RELATIONSHIPS OF POWER

MODELS OF IMPLEMENTING INFORMED CONSENTEVENT MODEL

• DISCRETE ACT• MINIMAL LEGAL REQUIREMENT• CONSENT FORM AS A SYMBOL• HOW MUCH DO PATIENTS TRULY

UNDERSTAND?

MODELS OF IMPLEMENTING INFORMED CONSENTPROCESS MODEL• ACTIVE PATIENT PARTICIPATION IN DECISION

MAKING• ROLE EXPECTATIONS OF PHYSICIANS AND

PATIENTS• IMPORTANCE OF PATIENT’S PERSONAL AND

VALUE HISTORY• PATIENT RESPONSIBILITY• MUTUAL MONITORING• CONTINUAL DIALOGUE• CONTINUAL RUMINATION AND REORDERING

OF KNOWLEDGE IN LIGHT OF NEW INFORMATION AND EXPERIENCE

STRATEGIES FOR PROCESS MODEL• ESTABLISH RESPONSIBILITY• DEFINE PROBLEM• SET GOALS FOR TREATMENT• SELECT APPROACH TO TREATMENT• FOLLOW-UP IN EXTENDED TREATMENT• SOLICIT PATIENT REFLECTIONS• ACKNOWLEDGE PERSONAL AUTONOMY AS

NORMAL PART OF PROCESS OF GETTING WELL OR MANAGING A DISEASE PROCESS

COMMUNICATION AND INFORMED CONSENT• GIVING ACCURATE INFORMATION• GIVING INFORMATION IN AN

UNDERSTANDABLE WAY• PROCESSING INFORMATION IN

PATIENT’S VALUES AND GOALS• EXPLORING FEELINGS• SHARING RESPONSIBILITY• AVOIDING EUPHEMISMS AND DOUBLE

MESSAGES• SUPPORTING PATIENT IN THE DECISION