A Closer Look to Consent: For Dying Patients
What does an informed consent do? Does these benefits patient or the hospital? All the procedures, and health care that are taken in the hospital given to patient, needs to have a consent. An informed consent is a very important for the physician or nurses to do their care to these identified patient. In these paper, we are about to discuss what is informed consent and how is it deal with the patient. And also, we will elaborate about Mrs. Sparza’s case regarding her health and her legal rights in the hospital.
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An informed consent is an agreement by the client to accept a course of treatment or a procedure after being provided complete information, including the benefits and risks of treatment, alternatives to the treatment and prognosis if not treated by heath care provider. Usually the client signs the form provided by the agency. The form is a record of the informed consent, not the informed consent itself (Crow, Matheson & Steel, 2000). Basically, the informed consent is:
v To ensure that the client understands the nature of treatment including the potential complications and disfigurement.
v To indicate the client’s decision was made without pressure.
v To protect the client against unauthorized procedure.
v To protect the surgeon and hospital against legal action by a client who claims that an unauthorized procedure was performed.
There are two types of consent: Express and Implied. Express consent may be either an oral or written agreement. Usually, the more invasive a procedure and/ or the greater the potential for risk to the client, the greater the need for written permission. Implied consent exists when the individual’s non verbal behavior indicates agreement. For example, clients who position their bodies for an injection or cooperate with the taking of vital signs infer implied consent. Consent is also implied in a medical emergency when an individual cannot provide express consent because of physical condition.
Obtaining informed consent for specific medical and surgical treatment is the responsibility of the person who is going to perform the procedure. Generally it is the physician; however, it could also be a nurse practitioner, nurse-anesthetist, or nurse-midwife who is performing procedures in their advanced practices. Informed consent also applies to nurses who are not independent practitioners and are performing direct nursing care for such procedures as nasogastric tube insertion or medications administration. The nurse relies on orally expressed consent or implied for most nursing interventions. It is imperative to remember the importance of communicating with the client by explaining nursing procedures, ensuring the client understands and obtaining permission.
The law says that a “reasonable amount” of information required for the client to make an informed decision is what any other reasonable physician or practitioner would disclose under similar circumstances. These are general guidelines that an informed consent must have to and to explained by the practitioner to the patient (Dunn, 1999):
v The purpose of the treatment
v What the client can expect to feel or experience
v The intended benefits of treatment
v Possible risks or negative outcomes of the treatment
v Advantages and disadvantages of possible alternatives to the treatment
There are major elements of informed consent:
v The consent must be given voluntarily.
v The consent must be given by a client or individual with the capacity and competence to understand.
v The client or individual must be given enough information to be the ultimate decision maker.
To give informed consent voluntarily, the client must not feel coerced. Sometimes fear of disapproval by a health professional can be the motivation for giving consent; such consent is not voluntarily given. Coercion invalidates the consent. It is important, therefore, for the person obtaining the consent to invite and answer client questions. Cultural perspective also needs to be considered when clients are asked to make decisions about a procedure or treatment.
It is also important that the client understand. Technical words and language barriers can inhibit understanding. If a client cannot read, the consent form must be read to the client must state understanding before the form is signed. If the client does not speak the same language as the health professional who is providing the information, an interpreter must be present.
If given sufficient information, a competent adult ca make decisions regarding health. A competent adult is a person over 18 years of age who is conscious and oriented. A client who is confused, disoriented or sedated is not considered functionally competent. A legal guardian or representatives can provide or refuse consent for the incompetent adult.
In the case of Mrs. Sparza, there were flaws in giving the consent. The first thing is when a nurse is asking Mrs. Sparza to sign the consent without any explanations what is the operations to be taken to her. It is said that in all invasive procedure or surgical procedure to be taken in a patient, the physician or the surgeon is the one who will explain the procedure it’s advantages and disadvantages of the surgery, even the risks and complications of that surgery to the patient, so that the patient may clearly know the procedures to be taken to her. Secondly, before she was ask by the nurse to sign the consent, she was already given medications that would make her in capable to think functionally. As on of the elements of the informed consent, the patient must have capability to think properly before signing in the consent form. Third, the consent was in the English form, since the client talks and know little English words, she might not understand well the procedure. Basically, these reasons stated above makes Mrs. Sparza in capable of deciding on the procedure.
As Mrs. Sparza stated on the situation, that “if ever she went into coma, they shouldn’t do some heroic measures that prolonged the agony, she decides to terminate her life immediately.” These statement is an Advance Directives. These are the statement of the patient in advance what are their choices would be for the healthcare should when circumstances develop (Ott, 1999). Although Mrs. Sparza state that she must be terminated in case she when into coma, the family members must be informed and educate by the physician about the current condition of the patient. It is stated on the Dying Person’s Bill of Rights that “I have the right to participate in decisions concerning my care”, “I have the right to be treated as living human being until I die”.
Morphine is a type of opioid analgesics that relieve pain and improve quality of life (Barbus, 1975). In the situation above. The nurse injected an overdose morphine to Mrs. Sparza, maybe the main goal of these injecting the medication is to lessen the pain felt by the patient, but in contrast to these, the patient went died. Giving morphine in the patient is legal, but if the medication is over the doctor’s required, the medication nurse who in charge to the patient must be liable to these accounts.
Barbus, A. J. (1975). The Dying person’s Bill of Rights. American Journal of Nursing, 75 (1), 99.
Crow, K., Matheson, L., & Steel, A., (2000). Informed consent and truth telling: cultural directions for health care providers. Journal of nursing administration, 30 (3), 148 – 152
Dunn, D. (1999) Exploring the Gray areas of consent. Nursing, 29 (7), 41 – 44
Ott, B. B., (1999). Advance Directives: The emerging body of research. American Journal of critical care, 8 (1), 514 – 519