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CONSENT Past_ Present_ Future

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CONSENT Past_ Present_ Future Powered By Docstoc
					INFORMED CONSENT

    Dr Nick Pace
   Western Infirmary
       Glasgow

       March 04
                Consent
• Principles
  – Law- external sanctions
    • remedy for redress
  – Ethics- internal
    • ought to do
Society                           Europe
                            Politics




     Ethics               E+ L             L

                                       Professional


  Individual   Religion
      CONSENT: LAW

                  LAW


Parliament &   Professional    Quasi-
   Courts        GMC          Research
  Criminal       GNC          DOH
     Civil
 Consent: Ethical Principles
– Autonomy
  • self-determination
– Beneficence
– Non-maleficence
– Justice/utility re resources
  Consent: Legal Principles
– No law of consent
  • limited defence to assault charge


– duty to obtain consent: assault
– duty to inform: negligence
             CONSENT:
• Assault
  – Allen v. Mount Sinai Hospital [1980]
  – Devi v. W.Midlands RHA [1981]
  – GMC: serious professional misconduct
              Consent: Ethics
•   Competence
•   Disclosure of relevant information
•   Understand information
•   Voluntary: free choice
•   Authorisation
   CONSENT: Competence
– Children
   • refusal
– Pre-medication
– Obstetrics
   • refusal C Section
   • birth plan
– Incompetence
   • Adults with Incapacity (Scotland) Act (2000)
                Consent
• VOLUNTARY
 – coercion
 – manipulation
   • information disclosure
 – persuasion
               Consent:
• CONFIDENTIALITY
• ORGAN DONATION
• TISSUE DONATION
  – BIO BANK
• POST MORTEM
• REFUSAL OF LIFE-SAVING
  TREATMENT
           Consent:
• DUTY TO DISCLOSE / INFORM
• Negligence
  – Duty of care
  – Breach of care
  – Causation
                  Consent:
• BREACH
• Professional Test
• Hunter v. Hanley [1955] SC 200
  – ample scope for difference of opinion
  – such failure as no doctor of ordinary skill
    would be guilty of if acting with ordinary care
           Consent: Present
• Information disclosure
      • rules of negligence
      • prudent professional standard
   – sufficient information
      • law final arbiter
   – Patient choice
               Consent: Future
•   Hospitilization
•   health care proxy
•   agreement to pay
•   surgery +/- anaesthesia
•   transfusion
•   dialysis
•   TOE
•   arterial line
•   central catheter/ PAC
           Consent: Future
• Standard of Care
    • Professional
  – Prudent/ Reasonable Patient
    • Particular Patient
            Consent: Future
• Patient based standard:
  – what would the patient want to know
  – disclose information which the doctor knows or
    ought to know this particular patient with this
    particular medical history requires in order to
    make his own decision.
         Material Disclosure
• Risk
• Alternatives
• Personal results
• Experimental procedures (new drugs or
  outside product licence)
• Trainee
• therapeutic privilege: non existent
           Consent: Present
• Chappel v. Hart [1998] HCA 55
  – Injury to vocal cords and voice loss
• would have waited for more
  experienced surgeon
       Consent: Conclusion
• Patient: right to appropriate
  explanation
• Court decide, not professional opinion
• Common Sense: put yourself in the
  patient’s position
INFORMED CONSENT

    Dr Nick Pace
   Western Infirmary
       Glasgow


  THANKYOU
                  Consent:
• Sidaway v. Bethlem Royal Hospital
  Governors [1984] 2WLR
  – practice adopted rightly and properly held
    (reasonable)
  – courts would not ‘stand idly by if the profession
    by an excess of paternalism denies their
    patients real choice.’
  – no wish to inhibit proper function of the
    medical profession
                 Consent:
• Exceptions to legal rules of disclosure
  – Emergency
  – Therapeutic privilege
                 Consent
• Therapeutic Privilege
  – further disclosure: distress and alter the
    patient’s condition, or the outcome of
    treatment, procedure or surgery.
  – Law: the welfare of the patient above
    autonomy and right to self-determination
            Consent: Present
• Bolitho v. City and Hackney HA [1997] 4
  All ER 771
  – possibility of rejecting medical opinion
  – especially weighing risks against benefits
• Courts: ultimate power in deciding
  acceptable practice
           Consent: Present
• LAW COURTS:
  – Balance:
     • Protect patients’ rights
     • Reluctance to impose impossible
       requirements on the medical profession
            Consent: Past
• Bolam v. Friern HMC [1957] 2 All ER 118
  – practice accepted as proper by a
    responsible body of medical men
                Consent
• Maynard v. W.Midlands RHA [1984] 1
  WLR 634, [1985] 1 All ER 635

• House of Lords: will not choose between 2
  bodies of competent medical opinion
           Consent: Present
• Proposed treatment
  – who will undertake procedure
• Alternatives
• Probability of success
• Risk of unfortunate consequences
    Consent: Foreign Jurisdictions
•   Australia: Rogers v. Whittaker
•   Canada: Reibl v. Hughes
•   USA: Canterbury v. Spence
•   Europe: Germany, Austria, Switzerland
•   S. Africa: Castell v. De Greef
•   New Zealand: Smith v. Auckland HB
           Consent: Future
• LAW COURTS:
  – Protect patients’ rights
     • Reluctance to impose impossible
       requirements on the medical profession
                Consent
• Personal results: if a complication has
  been encountered more frequently in
  the doctor’s own practice than the
  literature suggests is usual, then the
  doctor will be wiser to rely upon his or
  her own experience in describing the
  frequency of the complication.

				
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posted:10/11/2012
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