Informed Consent in

Home Care
 Why Value Informed Consent?
 “No medical/nursing intervention done for any
purpose—whether diagnostic, investigational,
cosmetic, palliative, or therapeutic—should take
place unless the patient has consented to it.”
(Doing Good, 84)

– Later qualified: “in the case of an incompetent patient,

someone else who is authorized to do so has agreed to
do it.” (84)
– Emergencies
 Why is informed consent
important?
 Deontology

– Respect for persons

 Consequentialism

– Promoting good outcomes

 Principilism

– Autonomy, Beneficence, Non-maleficence, Justice

 Why Value Informed Consent?
 Justification #1

– via The Principle of Autonomy (self-rule)

 Controltypically requires consent

 Very deontological
Why Value Informed Consent?
 Justification #2

– via The Principles of Beneficence and Non-

maleficence

 We're generally thought to be the best judges of our

own best interest
 As such, obtaining consent is an effective way of
doing good and avoiding harm
 Doing Right misses this
 Potential for Conflict
 Notice the potential for conflict between the two
justifications

– What if we don’t think you know your best interest in a

particular case?

– Some might say this means you’re incompetent but best

interest
 Elements of Informed Consent*
 I Information Elements

1. Disclosure of Information
2. Comprehension of Information

 II Consent Elements

3. Voluntary Consent
4. Competence to Consent

* follows Beauchamp & Childress, Principles of Biomedical

Ethics
 Competence
 No competence, no consent

– We often talk about parents or guardians

consenting for you, but we need to remember
this is really a very different thing.

 Competence is not all or nothing

– Perhaps I am competent to drive a car, but not

to make complicated medical decisions about
myself
 What is Competence?
 Being rational?

– i.e., using reason to pursue your own goals?

 Having the right goals?

– A competent person reaches reasonable

conclusions based on reasonable goals?
– There’s a danger of paternalism here
 What if the Patient Isn’t
Competent?

 Substituted Judgment - Someone else can

decide for the patient.

– Who?  Parents? Doctors? Courts

 Voluntariness

 Consentmust be free of corercion or

undue influence from others

 Simple in theory although often

trickier in practice
– Pressure from family
– Health care providers
 Disclosure & Comprehension
 Disclosure: How much information must
be given?

– Remember that how information is presented

is crucial
– An overload of information can actually
hamper informed consent

 Comprehension: What must you do to

ensure the patient has consented?
 Disclosure & Comprehension
 Disclosure must:

– Be specific to the intervention

– Explain alternatives
– Explain prognosis with and without treatment
– Explain risks and benefits of treatment and
alternatives
– Involve an opportunity for questions form
patient
 What is adequate disclosure?
3 Standards:

1. Nurse/Medical Community: What a

typical nurse/physician/researcher
would disclose
2. Subjective: What the patient wanted
to know
3. Objective:  What a reasonable person
would want to know
 Moral vs. Legal Consent
 Moral informed consent
– patient actually having made an informed voluntary
decision with an appropriate level of disclosure

 Legal informed consent

– having gone through appropriate steps so that consent
will be considered legally valid

– Use informed consent form