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  • Informed consent
  • Common law (commonwealth countries) - battery and assault. Tort of battery.
  • Nuremberg code 1947 - don't do things against people's consent
  • Back in the day, consent didn't have to be informed, just comfort people, manipulate and deceive
  • Some cultures don't uphold truth and veracity
  • Chinese - some threaten to kill you if you tell the truth about the state of dying patients ?
    • Also, want to avoid litigation
  • Informed consent = 1. informed 2. voluntary 3. truthful (possible outcomes: positives and negatives, alternatives and consequences); note expectations (check expectations of patient)
  • YOU NEED DOCUMENTATION - because the doctor normally relies on usual practice - without recording everything.
  • Risk - infection, anaesthesic risk, scarring, DVT
  • Disclosure - need enough information to make informed decisions about future (extent = patient's desire for information and the urgency of the information)
    • Anxious enquiring patient versus the disinterested patient: doctor is more liable if they ask and they don't provide information
    • Some patients waive their need to know: "whatever you think, doctor".
    • Need to give your own idiosyncratic complication rate as a surgeon
  • You have an obligation to warn a patient about anything even with a 1/14000 risk. (It's the Law).
    • Material risk - one that is significant and relevant to that patient. Circumstantial, depending on the case (depends on the individual case)
  • The important of communication - don't inhibit the questions, be open and welcoming
  • Too much information - if patient is crying etc it's too much: the patient can't take in more
    • Ask patient to reword what you've told them to check understanding.
    • Need to work out how much information
    • All about the conveying of the information in the consent form to the patient (THAT is the process of informed consent - it's not good enough to get them to sign it without them understanding it).
    • The person who does the operation need to get the consent form
      • EVEN THOUGH they've signed the form, you need to get documentation of the informed consent
      • Write "I explained the risks of blah blah blah and write the probabilities".
  • If the patient has capacity, then they need to sign the documentation

Getting informed consent from person who's a bit nutty:

  1. Assess capacity (don't presume based on diagnosis e.g. dementia)
  2. Importance of communication - it's what is important to the patient, not to you
  • Watch out for Jehovah's Witnesses - need to get documentation in every case
    • Society's interest in preservation of life
    • People may refuse consent for irrational reasons (but still allowed to have that idea)
    • If you have schizophrenia but your hallucinations have nothing to do with the question at hand, then you have capacity
  • The more serious the decision, the greater the capacity.
    • Peoples' decisions do not have to be rational, they just need capacity
  1. Comprehend and retaining Rx info
  2. Believe or appreciate the information
  3. Weighing it in the balance to arrive at a choice
  • Guardianship act - this is how you get consent from people who don't have capacity
  1. Person is capacble of understanding the general nature and effect of proposed treatment
  2. Can they communicate the information back to you?

Need to know

  1. Why having the treatment
  2. Understand the nature and purpose of Rx
  3. Understand the risks and benefits of having and not having Rx
  4. Able to indicate consent
  • Depends on communication skills
  • There is a hierarchy of risk - less capacity needed for less serious stuff
  • In emergency, act in the person's best interests
    • First step - contact next of kin.
  • Contact: persons responsible
    • After that, the guardianship tribunal
  • Read the slides