Chapter 12 Patient Consent

Informed consent: is both process and procedure. (Page 404)

(Its a legal concept that provides that a patient has a right to know the potential risks,
benefits, and alternatives of a proposed procedure.)
The right to control the integrity of ones own body spawned the doctrine of informed
consent.
I. It is not a matter of simply reading and signing a document.
II. It is about understanding and comprehending. It is as important that the
information provider (the medical provider) be clear and make sure that the
information receiver (the patient) understand what can be done and what other
options exist.
III. Informed consent does not take place in the moment only. It is a continuing
discussion. It is not just about being taught or told what to do. This is because
we have autonomy.
IV. We must know potential risks, benefits, and alternatives.
V. An informed consent is designed to bind medical facility, medical provider, and
patient.
VI. Informed consent should equally protect both patient and provider.

Determining incapacity (Page 406)
Do not start from the assumption that it is automatic. It is not a function of age.
It depends upon each person.

Types of consent
Oral consent if proved is as binding as written consent. (Page 408)

Written consent is more ideal. (Page 408)
I. In general it should include the following elements:
The nature of the patients illness or injury
The name of the proposed procedure or treatment
The purpose of the proposed treatment
The risks and probable consequences of the proposed treatment
The probability that the proposed treatment will be successful
Any alternative methods of treatment along with their associated risks and
benefits
The risks and prognosis if no treatment is rendered
An indication that the patient understands the nature of any proposed
treatment, the alternatives, the risk involved, and the probable
consequences of the proposed treatment
The signatures of the patient, physician, and witnesses
The date the consent is signed

Emergency consent is much closer to implied consent. (Page 409)

Implied consent determined by some act or silence. (Page 413)

Consent for minors - Parental consent not needed if minor married or otherwise
emancipated. (Page 413)

Chapter Review (Page 420)
1. Patients have the right to make decisions regarding their own health care.
2. Consent is voluntary agreement by a person to allow something proposed by another to
be performed on ones body. A person can consent to something only if he or she
sufficient mental capacity to make an intelligent choice.
3. The legal concept that protects a patients right to know the potential risk, benefits, and
alternatives of a proposed procedure is referred to as informed consent. Most often, the
duty to inform the patient and to decide what information the patient should be given falls
to the treating physician.
4. If an individual is found incompetent to give consent and if there are no relatives or other
parties from whom to obtain consent, an application should be made for a court order that
would allow the procedure.
5. Implied consent is generally presumed when immediate action is required to prevent
death or permanent impairment of a patients health. In such cases, documentation
justifying the need to treat before obtaining consent should be maintained.
6. Over the past few decades, case law has developed in such a way that any person,
regardless of religious beliefs, has the right to refuse any medical treatment.
7. Hospitals have a legitimate interest in receiving official guidance when resolving the
ethical dilemmas they face: whether to practice medicine by trying to save a patients life
despite that patients refusal to consent to treatment or to practice medicine in accordance
with the patients wishes and likely watch the patient die, knowing nonetheless that they
had the power to save that patients life.

Chapter 10 Physicians' Ethical and Legal Issues

Code of Medical Ethics (p. 356)
I. A physician shall be dedicated to providing competent medical care, with compassion
and respect for human dignity and rights.
II. A physician shall uphold the standards of professionalism, be honest in all professional
interactions, and strive to report physicians deficient in character or competence, or
engaging in fraud (no) or deception, to appropriate entities.
III. A physician shall respect the law and also recognize a responsibility to seek changes in
those requirements that are contrary to the best interest of the patient. (Dr. Corvorkein)
IV. A physician shall respect (law) the right of patients, colleagues, and other health
professionals, and shall safeguard patient confidences and privacy within the constraints
of the law. (willing to make a change)
V. A physician shall continue to study, apply, and advance scientific knowledge; maintain a
commitment to medical education; make relevant information available to patients,
colleagues, and the public; obtain consultation; and use the talents of other health
professionals when indicated. (Protecting Privacy)
VI. A physician shall, in the provision of appropriate patient care, except in emergencies, be
free to choose whom to serve, with whom to associate, and the environment in which to
provide medical care.
VII. A physician shall recognize a responsibility to participate in activities contributing to the
improvement of the community and the betterment of public health.
VIII. A physician shall, while caring for a patient, regard responsibility to the patient as
paramount.
IX. A physician shall support access to medical care for all people.

Credentialing professions (p. 358)
Credentialing is a process for validating the background of health care professionals and
assessing their qualification to provide health care services in an organization.
A physicians right to practice medicine is subject to the licensing laws contained in the
statutes of the state in which the physician resides. The right to practice medicine is not a
vested right but is a condition of a right subordinate to the police power of the state to
protect and preserve public health.
Regulation must be reasonably related to the public health and welfare and must not
amount to arbitrary or unreasonable inference with the right to practice ones profession.

Chapter Review (p. 375- 376)
1. The medical profession has long subscribed to a body of ethical statements developed
primarily for the benefit of the patient. As a member of this profession, a physician must
recognize responsibility to patients first and foremost, as well as to society, to other
health professionals, and to self.
2. Credentialing is a process for validating the background and assessing the qualifications
of health care professionals to provide health care services in an organization.
3. Physicians have a legal, ethical, and moral duty to respect patient autonomy and to
provide only authorized medical treatment. It is inappropriate for physicians to pursue a
treatment alternative other than the one to which their patient has given consent.
4. The American Medical Associations Council on Ethical and Judicial Affairs mandates
that once having undertaken a case, the physician should not neglect the patient. The
relationship between a physician and a patient, once established, continues until it is
ended by the mutual consent of the parties, the patients dismissal of the physician, the
physicians withdrawal from the case, or the fact that the physicians services are no
longer required.
5. A physicians efforts do not constitute negligence simply because they were unsuccessful
in a particular case. A physician cannot be required to guarantee the results of his or her
treatment.
6. Respect for the privacy of medical information is a central feature of the physician
patient relationship.
7. A deliberate falsification by a physician of his or her patients medical record to protect
his or her own interests at the expense of his patients is regarded as gross malpractice
endangering the health or life of his or her patient.
8. Physicians can be held liable for failure to order diagnostic test, read nurses notes, seek
consultation, obtain a second opinion, abstain an adequate family history, perform an
adequate physical examination, and provide an accurate diagnosis.