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SDLS 2008
Medicine for the intoxicated
Subject: Bioethics Lecture Date: June 24, 2005
Topic: Free and Informed Consent Transcriber(s): ??? and ???
Lecturer: Dr. Melchor Frias No. of pages: 4
Justification:
• Autonomy
o respect for the person and his freedom
o encourage rational decision making
o in law, related with: right to privacy and law on assault and battery
• Human Dignity
• Human Rights
• Stewardship
2. Information
o disclosure
o understanding
3. Disclosure
o voluntariness
o authorization
THRESHOLD ELEMENT
Competence
• patient is able to understand information of his disease, such as diagnosis
• not only able to comprehend but also make a decision
***Decision making for minors is often done by the parents. However, an assent (verbal consent) is needed when the
patient is 7 years old and above, by this way you respect their dignity and autonomy. If the patient’s decision is in contrast
to the parent’s decision, the loyalty of the physician is to the child especially when it is a life-saving
procedure/treatment.
INFORMATION
Disclosure
• the patient is given information concerning
o the diagnosis (patient can raise questions regarding the treatment/procedures)
o the nature and purpose of the proposed treatment or procedure (what is the objective of the procedure?
What goes with it?)
o the known risks and consequences of the treatment (possible outcomes, complications, unknown risks)
o the expected benefits
o alternative treatments/procedures with their risks and benefits (treatment options for patient)
o the prognosis of the treatment and non-treatment (tell the consequences of no treatment)
o all costs
Understanding of Information
• to actually communicate and not merely to blabber out words or present facts
o turn facts to useful information that will help in decision making and compliance to treatment
2
atay
o pancreas
lapay
o spleen
pale
o gallbladder
apdo
o cervix
kwelyo
CONSENT
Voluntariness
• freedom from:
o Coercion
the doctor is unaware that he is already persuading the patient towards his preferred
treatment
The physician only concentrates on the benefit of a certain procedure when in fact the
alternative procedures will yield the same results
o Undue manipulation
physician concentrates on the moderate side effects of a certain procedure and not all
the possible side effects that the patient can get
physician does not give choices
o Persuasion
telling the patient that he/she will die if he/she will refuse treatment
Authorization
• this is obtained when the patient gives his/her free and informed consent
• if the patient asks a doctor to do anything possible…
o the patient already gave authority to the doctor
• the physician acts according to what has been communicated upon
• example:
o case of C section and appendectomy
the doctor should secure a separate permission for C section and appendectomy
Therapeutic Privilege
• the withholding of information from the patient when the physician believes that the disclosure will
have an adverse effect on the patient’s condition or health
***It is never acceptable to keep secrets from the patient. If relatives request to keep a secret from the patient, the
physician should ask them to set a deadline of until when they will keep it secret. Otherwise the physician will be the one
to tell the patient of his/her real condition.
Emergency
• treatment without informed consent is justified in emergency situations
3 Conditions:
3
1. The patient must be incompetent and no lawful surrogate is available to give consent and the wishes of the
patient are unknown.
• the proxy should be known to the patient
CASE
A 30 year old, male, elementary graduate was advised to undergo liver biopsy.
• Threshold
o competence
ability to make choices based on an understanding of the relevant consequences of that
choice on oneself and others
the ability to understand the relevant is to be judged by common sense rather than a
technical or professional standard
the competent patient is not to be judged by his educational level, nor does he have to
understand everything about the condition, treatment or procedure.
Dr. M explained the procedure to the patient in medical terms and the patient refused.
• Information
o understanding
the competent patient does have to understand the consequences of his decision to
reject or accept a procedure or treatment
the fact that the patient makes a decision contrary to that recommended by the MD, does
not prove that he is incompetent because of lack of understanding
in general, the assumption is that adults are competent unless there is clear evidence to
the contrary.
the subjective substantial disclosure rule calls for the MD to describe to the patient
everything that would be material or important to the patient as he makes the decision
Dr. M explained that the procedure has to be done or else the patient will not be admitted again in the future.
• Consent
o factors :
medical
family pressures
normal/ natural factors
the question the MD must answer is whether any of these influences substantially diminish the
patient’s freedom so that there is inadequate capacity for valid consent.
4
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